Risk Factors for Antepartum Haemorrhage in Women With Placenta Praevia

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.

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

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.

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.

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.