Healthy Evidence

Bleeding before labour- What does it mean to my baby?

The next #BlueJC: Bleeding before labour- What does it mean to my baby?

We will discuss "Maternal and perinatal consequences of antepartum haemorrhage of unknown origin" by Bhandari and co-workers from 26 February 2014. The paper will be made free-to-view for four weeks from 17 February 2014.

Start date: 26 February 2014 (discussion open for 7 days)

First hosted discussion session(s): starts at Central European Time at 1730

(UK time 1630; Eastern Time Zone 1130; AEDT 0400)

Host: @robertdeleeuw

Platforms: Twitter and via our Facebook page

The discussion points are attached below (quoted from the published manuscript)


A patient, G3 P1+1, presented with an episode of antepartum haemorrhage at 26 week of her otherwise uncomplicated pregnancy. On examination, her genital tract was normal. Ultrasound showed a normal intrauterine pregnancy with no placenta praevia or abruption. She asked, “should I worry?”.

Description of this study


All primigravidae delivering between 1976 and 2010 in Aberdeen Maternity Hospital (UK)


Antepartum haemorrhage (APH) of unknown origin


Primigravidae with no antepartum haemorrhage


Preeclampsia, induced labour, mode of delivery, preterm delivery, postpartum haemorrhage, admission to neonatal unit, perinatal death

Study design:

Cohort study (retrospective data extraction using a prospectively collected database)

Discussion points

How did the authors define antepartum haemorrhage (APH) of unknown origin? Are there any other ways to define it?

What are the potential biases in a historical cohort study?

What is the odds ratio (OR)? What is the difference between OR and adjusted OR?

How could you determine whether the different adverse outcomes associated with APH of unknown origin might be causal?

Can you briefly summarise the results of this study? How would you advise the patient in the clinical scenario?

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