Association Between First-Trimester Bleeding and Retained Placenta Requiring Dilatation and Curettage

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Medicine

Background:

• Subchorionic hemorrhage in early pregnancy can disrupt the placental-uterine interface.
• This disruption may lead to placental adherence to the endometrium, increasing the risk of retained placenta after delivery.

Purpose of the Study:

• To evaluate the association between first-trimester bleeding and the need for postpartum dilatation and curettage (D&C).
• To assess the impact of early pregnancy bleeding on retained placenta complications.

Main Methods:

• A case-control study was conducted between 2012 and 2016.
• Cases were patients requiring D&C for retained placenta post-vaginal delivery; controls were matched patients who did not.
• Conditional logistic regression adjusted for maternal age and prior uterine surgery.

Main Results:

• First-trimester bleeding occurred in 11.8% of cases versus 0.6% of controls (OR 25.3, P < 0.001).
• Retained placenta requiring D&C was associated with postpartum hemorrhage, blood transfusion, and manual placenta removal.

Conclusions:

• First-trimester bleeding is a significant risk factor for postpartum D&C due to retained placenta.
• Early pregnancy bleeding should be recognized as a predictor of severe postpartum hemorrhage.