Maternal and neonatal outcomes of repeated antepartum bleeding in 493 placenta previa cases: a retrospective study

Abstract Background Placenta previa (PP) is a serious complication of late pregnancy. Exploring the effect of antepartum bleeding caused by PP on pregnancy outcomes is very important.Methods We retrospectively analyzed 493 women complicated with PP. Patients were divided into antepartum repeated bleeding and non-bleeding groups. Maternal characteristics and pregnancy outcomes were compared.Results The risk of antepartum hemorrhage was 2.038 times higher when gravidity was 5 (95% CI 1.104 ~ 3.760, P = 0.023). Pregnant women with a history of more than three intrauterine procedures had a 1.968 times higher risk of antepartum hemorrhage (95% CI 1.135 ~ 3,412, P = 0.016) compared to pregnant women without any intrauterine procedures. The risk of antepartum bleeding was found to be decreasing with the pregnancy advancing; When the placenta edge was noted to be over cervival os, the risk of antepartum bleeding was 4.385-fold than the low-lying plcaenta cases (95%CI2.454ཞ8.372,P = 0.000). In the respect of maternal outcomes, the repeated bleeding group, the risk of emergency surgery was 7.213 times higher than elective surgery (95% CI 4.402ཞ11.817, P = 0.000). As for the neonatal outcomes, the risk of asphyxia was 2.970 times and the risk of NICU admission was 2.542-fold higher in repeated bleeding group compared to non-bleeding group, respectively.Conclusions Obstetricians should be aware of the increased risk of antepartum bleeding especially for ≤ 34 weeks and placenta edge over cervical os PP patients, they have a higher risk of antepartum bleeding. These women have higher possibility of emergency c-section and need preterm newborn resuscitation.