Risk Factors for Antepartum Haemorrhage in Women With Placenta Praevia.

Abstract

Background: Placenta praevia (PP) is a significant obstetric complication associated with antepartum haemorrhage (APH) and adverse maternal and fetal outcomes. Identifying risk factors for APH in women with PP is important for guiding management decisions.

Aims: This study aimed to identify risk factors associated with APH amongst women admitted to a single tertiary hospital with PP.

Materials and methods: A retrospective cohort study was undertaken, utilising data from the hospital's maternity dataset (2007-2021) and included publicly funded women with PP after 24 weeks gestation. Exclusions comprised multiple pregnancies, fetal abnormalities, intra-uterine fetal death and deliveries at other hospitals. Baseline characteristics, outcomes and potential risk factors for APH were analysed through bivariate and stepwise logistic regression.

Results: Of the 430 cases with PP, 112 (26%) were admitted with APH. Of these, 45 had two or more admissions with APH, constituting 40% of the APH cohort. Those requiring admission were more likely to deliver at an early gestation, and their baby required nursery admission. Factors independently associated with APH included a higher number of previous caesarean sections, parity, Caucasian ethnicity and major PP.

Conclusions: Most women with PP will not require an admission with APH. In considering inpatient versus outpatient management, multiparous Caucasian women with a major PP appear more likely to be at risk of APH admission and premature delivery. These findings underscore the importance of tailoring clinical decision-making.