INTRODUCTION
One of the most important causes of antepartum haemorrhage (APH) is Placenta praevia (PP), which is characterised by abnormal placentation in close proximity to the internal cervical os, with a reported prevalence of 5 per 1000 pregnancies worldwide.1 The Royal College of Obstetricians and Gynaecologists (RCOG)2 defines APH as bleeding from or in to the genital tract beyond 24 weeks of pregnancy and acknowledges that there is no consistent definition for describing its severity. However, APH is globally regarded as a leading cause of perinatal and maternal mortality, complicating 3–5% of pregnancies.3
Compared to non-placenta praevia women, those with placenta praevia have approximately a four- to ten-fold increased risk of APH.4,5 In 2017, a systematic review of 29 studies by Fan et al.6 reported that among women with PP the overall prevalence of APH was 51.6%, ranging from 20% to 90%.7,8 Women with PP who experience increasing episodes of APH have been associated with greater risks of requiring blood transfusion, preterm caesarean section, and emergency hysterectomy.9
Previously, RCOG has recommended that women with PP and previous bleeding events require admission at or after 34 weeks. However, the most recent RCOG (2018) guidelines2 recommend that women with recurrent bleeding be given tailored antenatal care based on recommendations from a Cochrane systematic review10that showed no clear disadvantage to a policy of home versus hospital care. Likewise, women with PP without APH can be managed in the outpatient setting with similar outcomes compared to hospitalisation.11
Although APH is common in women with PP, it has not been extensively evaluated in the literature, with previous studies recruiting small populations of less than 250 cases.12–14 The aim of this large scale retrospective study was to examine a range of obstetric outcomes for women with placenta praevia complicated by any bleeding episodes compared to those without.