F., Hammadeh, M., Expectant versus surgical management of first-trimester miscarriage: A randomised controlled study, Archives of gynecology and obstetrics, 289, 1011–1015, 2014 H., Antenatal testing to predict outcome in pregnancies with unexplained antepartum haemorrhage, British Journal of Obstetrics and Gynaecology, 99, 122–125, 1992 Ĭomparison outside of interest: all women with unexplained vaginal bleeding received Doppler ultrasound scan and the results were compared across different resistance index of uterine artery flow.Īl-Ma’ani, W., Solomayer, E. See appendix L for more details.Īhmadi, F., Akhbari, F., Indication of first trimester sonongraphy, International Journal of Fertility and Sterility, 1), 139, 2013Īhmadi, F., Javam, M., First trimester complications & emergencies: Differential diagnosis by transvaginal ultrasound, Journal of Obstetrics and Gynaecology Research, 1), 97, 2015Ījayio, R. Given the lack of evidence on the benefits and harms of managing unexplained vaginal bleeding via hospitalisation, the committee agreed that a research recommendation on this topic was merited, particularly in the population of women where the clinical benefit of hospitalisation may be uncertain (in other words those with relatively mild bleeding). These would be logistical/practical considerations that consider how quickly she’s able to rush to the hospital in case she is not admitted and she starts bleeding more or otherwise there’s an emergency, for example her proximity to the hospital, if she has a phone, car, a partner to bring her, childcare issues. The committee made a recommendation to consider whether or not to hospitalise women with unexplained vaginal bleeding taking into account their risk of placental abruption, preterm delivery, the extent of the bleeding and their ability to attend secondary care in the case of emergency. The committee agreed that hospitalisation for pregnant women at risk may be warranted as it enables maternal and fetal monitoring, administration of corticosteroids, and ensures proximity to the neonatal unit if needed. Given the limited and low quality evidence from a relatively old study with a small sample size, the committee based the recommendations on their knowledge and experience. The study reported that there were no fetal deaths in either the women who were hospitalised or women who were discharged on the day of presentation. In relation to whether or not women with unexplained vaginal bleeding should be admitted to inpatient care, only 1 retrospective cohort study was identified which was relevant for this review but only reported on one relevant outcome. The committee agreed via informal consensus that women who present in primary care with unexplained vaginal bleeding after 13 weeks should be referred to secondary care for review. There was no evidence identified for the interventions: departmental or formal ultrasound scan, non-prophylactic anti-D immunoglobulin or steroids. No evidence was identified for the following outcomes: bleeding/haemorrhage after treatment, birth within a week of receiving intervention, infant death of up to 1-year, admission to intensive care unit for the treatment of unexplained vaginal bleeding, duration of hospitalisation for the treatment of unexplained vaginal bleeding, women’s experience or satisfaction of care, or small for gestational age. This was mainly due to a serious risk of bias as there was no adjustment for confounding factors and a significant amount of missing data (~20%) imprecision around the estimate of effect and issues around indirectness, as the study did not specify whether the women were in the second or third trimester, as specified in the protocol. The quality of the evidence was very low. There was 1 retrospective cohort study identified for the review on the effectiveness of hospitalisation amongst pregnant women with unexplained vaginal bleeding.
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