Neonatal uterine bleeding

Neonatal uterine bleeding (NUB) also known as neonatal menstrual-like bleeding,[1] neonatal menstruation[2] and false menses[3] is vaginal bleeding[4] that occurs in some female neonates shortly after birth as a result of withdrawal from maternal hormones.[5][2] Overt neonatal uterine bleeding can be seen in neonates with the prevalence of 3–10%, but bleeding that is not visible (called occult neonatal uterine bleeding) can also be revealed by laboratory tests, with the incidence of 25–60% in the reported literature.[6] Neonatal uterine bleeding is thought to be a normal physiological reaction that does not need any treatment.[4]

Neonatal uterine bleeding usually occurs in the first 10 days after birth.[7] Laboratory evaluation is performed if bleeding is prolonged or excessive.[7] Vaginal bleeding that happens in the later periods after birth is not neonatal uterine bleeding, and it is considered pathological; the differential diagnosis in such cases assumes many different possible causes, including infections.[7]

Neonatal uterine bleeding has probably been seen by mothers from ancient times, but practitioners of those times didn't notice it, possibly because there weren't any other accompanying symptoms, considering it clinically insignificant.[2] As a distinct type of vaginal bleeding, it was acknowledged only in the 19th century.[2] In the 20th century, the cause of neonatal uterine bleeding was revealed, and it was considered a normal physiological reaction.[2]

Characteristics

Neonatal uterine bleeding occurs shortly after birth, between 3 and 5 days of infancy. Female infants may experience bleeding for up to 10 days.[3]

It is caused by an exposure of the fetus to the mother's high level hormones like estrogen and progesterone. After birth the abrupt decrease and withdrawal of these hormones leads to a drop in the baby's hormone levels which affect the developing fetal endometrium, triggering the shedding of the uterus which can cause small vaginal bleeding.[8] However, it is theorized that a mucus plug in the neonate's cervix can contribute to a "retrograde flux" of endometrial cells into the pelvic cavity, which may contribute to NUB.[9]

Occurrence

Neonatal uterine bleeding varies considerably. In a study carried out by Judith Dekker, "the prevalence of visible bleeding ranged from 3.3 to 53.8% and the prevalence of occult bleeding from 25.4 to 96.7%". NUB occurrence is highest between the 3rd and 7th day of postpartum.[10][6]

According to studies, NUB occurs in approximately 5% of female newborns. While it is rare, biochemical proofs of vaginal bleeding can be found in 25–61% of neonates.[11]

Effects

Studies suggest that the presence of endometrial mesenchymal stem cells (eMSCs) in neonatal uterine blood could lead to early development of endometriosis hypothesizing a link between NUB and accelerated maturation of endometriosis.[12][6] The retrograde flow of endometrial cells during NUB may lead to ectopic endometrial implants in the pelvic cavity that can become active later in life, especially after menarche begins.[13][9]

See also

References

  1. ↑ Brosens I, Benagiano G (1 January 2016). "Clinical significance of neonatal menstruation". European Journal of Obstetrics & Gynecology and Reproductive Biology. 196: 57–59. doi:10.1016/j.ejogrb.2015.11.022. ISSN 0301-2115. PMID 26685798.
  2. 1 2 3 4 5 Benagiano G, Habiba M, Lippi D, Brosens IA (10 December 2021). "A History of Neonatal Uterine Bleeding and Its Significance". Reproductive Medicine. 2 (4): 171–184. doi:10.3390/reprodmed2040018. ISSN 2673-3897.
  3. 1 2 "Vaginal Bleeding in newborns". Seattle Children's Hospital. Retrieved 15 October 2025.
  4. 1 2 Wróblewska-Seniuk K, Jarząbek-Bielecka G, Kędzia W (4 March 2021). "Gynecological Problems in Newborns and Infants". Journal of Clinical Medicine. 10 (5): 1071. doi:10.3390/jcm10051071. ISSN 2077-0383. PMC 7961508. PMID 33806632.
  5. ↑ Sourial S, Tempest N, Hapangama DK (2014). "Theories on the Pathogenesis of Endometriosis". International Journal of Reproductive Medicine. 2014 (1) 179515. doi:10.1155/2014/179515. ISSN 2314-5757. PMC 4334056. PMID 25763392.
  6. 1 2 3 Ogawa K, Khan KN, Kuroboshi H, Koshiba A, Shimura K, Tajiri T, et al. (February 2024). "Neonatal uterine bleeding: Risk factors and its association with endometriosis-related symptoms later in life". European Journal of Obstetrics & Gynecology and Reproductive Biology. 293: 146–155. doi:10.1016/j.ejogrb.2023.12.033. PMID 38199071.
  7. 1 2 3 Pejavar RK, Thakre R (31 May 2021). Textbook of Clinical Neonatology. Jaypee Brothers Medical Publishers. p. 172. ISBN 978-93-90595-13-6.
  8. ↑ Kesavan S (June 2024). "Vaginal bleeding in children". Lerner College of Medicine of Case Western Reserve University.
  9. 1 2 A Brosens I, J Brosens J, Benagiano G (17 September 2013). "Neonatal uterine bleeding as antecedent of pelvic endometriosis". Human Reproduction. 28 (11): 2893–2897. doi:10.1093/humrep/det359. PMID 24048011.
  10. ↑ Dekker J, Hooijer I, Ket JC, Vejnović A, Benagiano G, Brosens I, et al. (18 January 2021). "Neonatal Uterine Bleedings: An ignored sign but a possible cause of early-onset endometriosis − a systematic review". Biomed Hub. 6 (1): 6–16. doi:10.1159/000512663. PMC 7991472. PMID 33791312.
  11. ↑ Puttemans P, Benagiano G, Gargett C, Romero R, Wei Guo S, Brosens I (18 August 2016). "Neonatal Uterine Bleeding as a biomaker for reproductive disorders during adolescence: a worldwide call for systematic registration by nurse midwife". J Matern Fetal Neonatal Med. 30 (12): 1434–1436. doi:10.1080/14767058.2016.1216540. PMC 5505234. PMID 27454348.
  12. ↑ Ogawa K, Khan KN, Kuroboshi H, Koshiba A, Shimura K, Tajiri T, et al. (19 June 2023). "Is neonatal uterine bleeding responsible for early-onset endometriosis?". Reproductive Biology and Endocrinology. 21 56. doi:10.1186/s12958-023-01099-1. PMC 10278367. PMID 37337237.
  13. ↑ Marwan H, Sun WG, Benagiano G (26 July 2023). "In Memory of Ivo Brosens: Reflections on the Pathophysiology of Neonatal Uterine Bleeding". Gynecol Obstet Invest. 88 (5): 257–266. doi:10.1159/000533123. PMID 37494891.
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