Vaginal bleeding in early pregnancy at a regional-level emergency department in KwaZulu-Natal

Abstract

Background: Vaginal bleeding in early pregnancy (VBIEP) affects between 15% and 25% of all pregnancies worldwide and it portends life-threatening gynaecological emergencies. One of the core functions of an emergency medicine physician is to recognise critical illness and institute high-quality emergency care. This study aimed to describe the demographics, clinical presentation, management and outcomes of patients with VBIEP presenting to the emergency department (ED).

Methods: Retrospective descriptive data were collected on all patients presenting to the ED of General Justice Gizenga Mpanza Regional Hospital (GJGMRH) with VBIEP between 01 January 2022 and 30 April 2022.

Results: The most affected group comprised multiparous women, in the first trimester of pregnancy between the ages of 25 and 29 year. Among HIV-positive participants majority (40.9%) were aged 35–39 years of age. Majority (87%) of patients had received no prior antenatal care. Incomplete miscarriage was the most (46.1%) common diagnosis made in the ED. Most (61.7%) patients from the ED required admission to the hospital for further care.

Conclusion: This study showed that multiparous women in their first trimester of pregnancy are at highest risk of VBIEP. It also highlighted early antenatal care and early use of point-of-care ultrasound may prevent and improve outcomes with VBIEP. Incomplete miscarriage was the commonest cause. A standardised management protocol for these patients should be developed, however larger studies must be conducted to validate this.

Contribution: This study contributes to the limited literature on VBIEP in low to middle-income countries and the findings may influence the department of health’s allocation of resources to this condition.