Late Αntepartum Ηemorrhage and Neonatal Outcome: A Retrospective Study

Panagiotis Tsikouras, Zacharoula Koukouli, Anastasios Liberis, Bachar Manav, Constantinos Bouschanetzis, Panagiotis Naoumis, Marina Dimitraki, Georgios Galazios
2016 Open Journal of Obstetrics and Gynecology  
Objective: To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Methods: We retrospectively identified all eligible patients at a single institution from January 1990 to December 2012. A thorough research was made through patients' medical and obstetrical records. The various causes of late APH were compared to each other regarding the
more » ... r regarding the parameters of the neonatal outcome. Multiple regression models were applied for gestational age (GA) at birth, birth weight, Apgar score at first and fifth minute and selection of modus of delivery. Results: 480 patients were included in the study, in a total of 7221 pregnancies. The causes of APH were: cervical dilatation (n = 54, 11.3%), central placental abruption (n = 57, 11.9%), peripheral placental abruption (n = 59, 12.3%), placenta previa (n = 140, 29.2%), others non-related to pregnancy (n = 42, 8.8%), uterine rupture (n = 2, 0.4%) and unknown etiology (n = 126, 26.3%). Overall, 253 neonates (52.7%) were born prematurely at gestational age below 37th week. 37 pregnancies (7.7%) resulted in giving birth prior to 32 weeks of gestation. In multivariable analysis, the cause of hemorrhage was found to be an important independent predictive factor for gestational age (GA) at birth, birth weight, Apgar scores at first and fifth minute and modus of delivery. Preeclampsia, diabetes, thyroid disorder and smoking were associated with decrease of GA at birth. Birth weight below 1500 gr and GA at birth was found to be significant independent factors for Apgar score at first and fifth minute respectively. Modus of delivery did not significantly alter Apgar score. Conclusions: Late APH required immediate evaluation of the general condition of the pregnant woman and the fetus. The cause of APH was important in the prognosis of the neonatal outcome. As long as maternal and fetal status were ensured, expectant management, instead of emergency CS, seemed to be more beneficial even for late preterm neonates.
doi:10.4236/ojog.2016.62013 fatcat:qzsmh3jirras5brs5sq4jgpqym