Üçüncü Trimesterde Vajinal Kanama Şikâyetiyle Acil Servise Başvuran Gebelerde Klinik Sonuçların 10 Yıllık Retrospektif Analizi

Abstract

Amaç: Bu çalışma, üçüncü trimesterde vajinal kanama şikâyetiyle acil servise başvuran gebelerin klinik özelliklerini ve sonuçlarını değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif, gözlemsel çalışmaya, Ocak 2013–Aralık 2023 tarihleri arasında ≥28. gebelik haftasında olup vajinal kanama nedeniyle acil servise başvuran gebeler dahil edildi. Demografik veriler, parite, gebelik haftası, başvuru zamanı, kanama şiddeti, vital bulgular, laboratuvar sonuçları ve klinik sonuçlar (doğum, yatış, taburculuk, düşük riski) analiz edildi. Bulgular: Çalışmaya toplam 1263 gebe dahil edildi. En sık başvuru nedeni %49,9 ile lekelenme tarzı kanama, ikinci sırada ise %46,8 ile aktif vajinal kanama yer aldı. Tüm hastaların %33,7’si hastaneye yatırıldı, %12,9’u doğum yaptı, %15,1’i düşük riski olarak değerlendirildi. Kanama şiddeti arttıkça doğum ve düşük riski oranları anlamlı şekilde yükseldi (p<0,001). Gece saatlerinde (00:00–05:59) doğum oranları daha yüksek bulunurken, akşam başvurularında (18:00–23:59) düşük riski en fazla görüldü. Parite ile sonuçlar arasında anlamlı ilişki saptandı; multipar hastalarda doğum oranı daha yüksekken (%10,7 vs. %5,8), primipar hastalarda düşük riski daha yüksekti (%59,3 vs. %44,0; OR=1,89, %95 GA: 1,45–2,47, p<0,001). Sonuç: Üçüncü trimester vajinal kanamaları, kanama şiddeti, başvuru zamanı ve pariteye göre değişken klinik sonuçlar doğurabilen önemli obstetrik acillerdir. Acil tıp ve kadın doğum hekimlerinin bu risk desenlerini tanıması ve multidisipliner iş birliği içinde hareket etmesi gerekmektedir. Kanıta dayalı protokollerin geliştirilmesi, bu yüksek riskli grupta maternal ve fetal sonuçları iyileştirebilir.

Keywords

• Üçüncü trimester kanamaları
• Acil servis
• Vajinal kanama
• Obstetrik acil
• Maternal sonuçlar

Clinical Outcomes of Third Trimester Pregnant Women Presenting to the Emergency Department with Vaginal Bleeding: A 10-Year Retrospective Analysis

Abstract

Aim: This study aimed to evaluate the clinical characteristics and outcomes pregnant women in the third trimester presenting to the emergency department with vaginal bleeding. Material and Methods: This retrospective, observational study included pregnant women at ≥28 weeks of gestation who presented to the ED with vaginal bleeding between January 2013 and December 2023. Demographic characteristics, parity, gestational age, timing of admission, bleeding severity, initial vital signs, laboratory results, and clinical outcomes (delivery, admission, discharge, miscarriage risk) were analyzed. Results: A total of 1263 pregnant women were included. The most frequent complaints were spotting (49.9%) and active vaginal bleeding (46.8%), accounting for over 96% of all visits. Of all patients, 33.7% were hospitalized, 12.9% delivered, and 15.1% were categorized as miscarriage risk. Heavier bleeding was significantly associated with both delivery and miscarriage risk (p<0.001). Deliveries occurred more frequently at night (00:00–05:59), while miscarriage risk peaked during evening admissions (18:00–23:59). Parity was significantly associated with outcomes: multiparous women were more likely to deliver (10.7% vs. 5.8%), whereas primiparous women had higher miscarriage risk (59.3% vs. 44.0%; OR=1.89, 95% CI: 1.45–2.47, p<0.001). Conclusion: Third-trimester vaginal bleeding is a complex emergency with variable outcomes depending on bleeding severity, timing of presentation, and parity. Emergency physicians and obstetricians should recognize these risk patterns and collaborate closely in managing such cases. Development of evidence-based protocols may improve maternal and fetal outcomes in this high-risk population.

Keywords

• Third trimester bleeding
• Emergency department
• Vaginal bleeding
• Obstetric emergencies
• Maternal outcomes

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