Influence of antepartum hemorrhage on placenta previa: A multi-center, retrospective cohort study

Abstract BACKGROUND Placenta previa can be a serious, life-threatening obstetric complication that causes painless but potentially catastrophic bleeding. It is unclear as to whether the frequency of antepartum hemorrhage (APH) relative to the specific gestational week in placenta previa will lead to negative perinatal outcomes. The purpose of the present study was to determine the relationship between APH and gestational week number, and to ascertain the different perinatal outcomes in women with placenta previa. METHODS This was a multi-center, retrospective study in which we enrolled all women with placenta previa between October of 2015 and September of 2018. Patients with placenta previa were divided into two groups: women with APH and women without APH. RESULTS A total of 247 patients were included in this study: 121 women with APH and 126 women without. The incidence of APH was 49.0% (121/247). The mean bleeding frequency was 2.2 ± 1.3 (mean ± SD), with the majority having experienced a one-time bleeding episode (36.4%, 44/121), followed by 26.4% with 2 episodes (32/121), and 23.1% with 3 (28/121). The APH was distinct in every gestational-week category, with bleeding occurring at 31.4 ± 3.3 weeks, ranging from 24 to 37 gestational weeks. The incidence of bleeding varied from 2.6–14.6%, with the highest incidence at 32 gestational weeks. Patients categorized as having complete placental coverage included a greater number of women experiencing bleeding than women who did not bleed (72.9% vs 47.4%, P < 0.001), indicating that a complete placenta was an independent risk factor for APH (odds rations [OR], 4.17; 95% confidence interval [CI], 1.805–9.634). In addition, although APH did not augment the rates of hysterectomy (6.6% vs 7.1%, P = 0.869), it was associated with critical neonatal outcomes that included lower weight, lower Apgar score at 1 minute, preterm age, and more frequent neonatal intensive care unit admissions (P < 0.05). CONCLUSIONS The gestational week and frequency of each APH varied in patients with placenta previa and might result in an increase in adverse maternal and neonatal outcomes. The 32nd gestational week appeared to be the most precarious time—exhibiting the highest incidence of bleeding—and we consider complete placenta previa to be an independent risk factor for APH.