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 has been made free-to-view for four weeks from 17 February 2014. 

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

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

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

Host: @robertdeleeuw

Platforms: Twitter and via our Facebook page

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time.

All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (data S1).

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

Scenario 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 research

Participants All primigravidae delivering between 1976 and 2010 in Aberdeen Maternity Hospital (UK)
Events Antepartum haemorrhage (APH) of unknown origin
Comparison No antepartum haemorrhage
Outcomes 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)
  • 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? (data S1)

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

9 thoughts on “Bleeding before labour- What does it mean to my baby?

  1. Odds ratio is the ratio of odds of event happening in a exposed population compared to non exposed. Adjusted odds ratio is mentioned I guess for confounders

  2. Case control model is alright to identify demographic associations and their significance . To prove causality of obstetric and perinatal outcomes group comparison with placenta previa abruption may also be suggested but problem lies in defining which can be done prospectively after ruling out others

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