Maternal Outcome in women with placenta previa who had antepartum
haemorrhage compared to those without haemorrhage: Retrospective Cohort
Study
Abstract
Objective: To compare maternal outcomes for placenta praevia (PP)
between those who experience antepartum haemorrhage (APH) and those
without APH. Design: Retrospective cohort study. Setting: Royal Brisbane
& Women’s Hospital, Australia. Population: Over ten years, a total of
368 women with placenta praevia (PP) were recruited and divided into APH
(n=230) and No APH (n=138). Methods: Data retrieved from
institution-based obstetric database were analysed using logistic
regressions for binary outcomes and Poisson or negative binomial
regressions for counts. Main Outcome Measures: Type of PP, timing and
mode of delivery, intra-operative and postpartum complications, volume
of blood loss and number of blood transfusions. Results: Compared to
women without APH, women who experienced APH had a greater proportion of
major PP (OR=2.88,p<0.001), emergency lower uterine segment
(OR=6.24,p<0.001) and classical (OR=14.9,p<0.001)
sections, use of general anaesthesia (OR=3.14,p<0.001),
preterm delivery (median 35.4 vs 38.0 weeks, p<0.001). There
was no significant differences intra-operatively (number of uterotonics
used or additional surgical techniques), greater volume of bloods loss
(IRR=1.20,p=0.006), increased frequency of blood transfusion
(IRR=3.36,p<0.001), and longer post-operative hospital stay
(IRR=1.27,p=0.001). There was a total of four hysterectomies and no
intensive care unit admissions or maternal deaths. Conclusions: Women
with PP who experienced APH had a tendency for preterm delivery,
emergency caesarean section, greater blood loss requiring more blood
transfusion and longer hospital admissions. However, a lack of serious
maternal morbidity among these women provides support for an
individualised approach towards management of bleeding in PP. Funding:
No funding body. Keywords: Antepartum Haemorrhage, Placenta Praevia,
maternal outcomes.