# Epistaxis during the third trimester of pregnancy is associated with blood transfusion a retrospective case–control study

## TL;DR

Nosebleeds in late pregnancy are linked to a higher chance of needing blood transfusions, suggesting they may signal underlying vascular issues.

## Contribution

This study identifies third-trimester epistaxis as an independent predictor of blood transfusion requirements during pregnancy.

## Key findings

- Epistaxis in the third trimester is independently associated with a nearly fivefold increase in blood transfusion odds.
- Women with epistaxis had higher rates of third-trimester vaginal bleeding and preterm labor in univariate analysis.
- Most epistaxis episodes were mild and resolved on their own.

## Abstract

Epistaxis is common during pregnancy due to physiological changes, yet its clinical significance regarding obstetric outcomes is poorly understood. This study investigated the associations between epistaxis during pregnancy and maternal and neonatal outcomes.

We conducted a retrospective case–control study (2013–2022) at a single tertiary medical center. The study group included 104 pregnant women presenting with epistaxis, matched with 1924 controls based on age, ethnicity, and preexisting comorbidities. Multivariable logistic regression was used to identify independent predictors of adverse outcomes, including blood transfusion and preterm labor.

Women with epistaxis experienced significantly higher rates of third-trimester vaginal bleeding (7.7% vs. 1.1%; p < 0.001), preterm labor (15.4% vs. 8.7%; p = 0.022), and blood transfusion requirements (4.8% vs. 1.6%; p = 0.014). In a multivariable model, third-trimester epistaxis emerged as an independent predictor for blood transfusion (OR 4.96, 95% CI 1.47- 14.38; p = 0.005), even after adjusting for delivery mode and initial hemoglobin levels. While univariate analysis associated epistaxis with preterm labor, this relationship did not remain significant in the multivariable model (p = 0.254). Most epistaxis episodes (81.7%) were mild and resolved spontaneously.

Epistaxis during pregnancy, particularly in the third trimester, is independently associated with a nearly fivefold increase in the odds of requiring a blood transfusion. While typically considered benign, epistaxis may serve as a clinical marker for systemic vascular susceptibility. These findings suggest that pregnant women presenting with epistaxis may benefit from enhanced clinical surveillance and interdisciplinary coordination to manage potential peripartum hemorrhagic complications.

The online version contains supplementary material available at 10.1007/s00404-026-08334-1.