Colposcopy - A Valuable Diagnostic Tool for Pregnant Women With Unexplained Vaginal Bleeding

Objectives: We aimed to examine the diagnostic value of colposcopy in a large cohort of pregnant women with unexplained vaginal bleeding during the second or third trimester. Materials and Methods: This retrospective study included women who underwent colposcopy due to vaginal bleeding in the second and third trimesters during 2012-2022 at a tertiary care hospital. Demographics, obstetric data, bleeding characteristics, colposcopy results, cervical cytology testing, a sonogram directed at the placenta, and birth details were collected. Results: In total, 364 women were included. The mean maternal age was 29.7 years and the mean gestational age at examination was 30.7 weeks. Vaginal bleeding was mild in 80.8%, moderate in 14.6%, and severe in 4.7%. Only 3.3% had been vaccinated against human papilloma virus and 25.5% underwent a Pap smear study before pregnancy. Colposcopy diagnosed the bleeding source in 83 women (22.8%). The colposcopic examination revealed vaginal bleeding due to contact bleeding from ectropion in 46 (12.6%), a decidual/cervical polyp in 37 (10.2%), acetowhite epithelium in 12 (3.3%), herpes genetalis in 2 (0.5%), and bleeding from vaginal varices in 2 (0.5%). Of those who were recommended a follow-up examination after the postpartum period, only 49.1% completed such. Among women with compared to without postcoital bleeding (N = 72), the risk of abnormal colposcopic findings was higher (24 [33.3%] vs 54 [19.7%], p =.017) and the rate of abnormal Pap smear was higher (7 [13.2%] vs 7 [3.2%], p =.008). Conclusions: Colposcopy can be a valuable diagnostic tool for women with unexplained vaginal bleeding in the second or third trimester.