Predictors and Patterns of Antepartum Bleeding among Patients with Placenta Previa

Antepartum bleeding is a common complication of placenta previa and contributes to maternal and neonatal morbidity; however, limited data describe bleeding patterns and their clinical course. We sought to identify predictors of antepartum bleeding and to characterize bleeding patterns among patients with placenta previa.

Retrospective cohort study of patients with ultrasound-confirmed persistent placenta previa delivering at a tertiary academic center (June 2013-March 2025). The primary outcome was antepartum bleeding, defined as any bleeding episode preceding delivery prompting hospital evaluation. Demographic and clinical characteristics were compared between patients with and without bleeding using bivariate tests and multivariable logistic regression. Among patients who experienced bleeding, secondary analyses evaluated bleeding recurrence, gestational age at first bleeding episode, number of bleeding episodes, and latency from bleeding to delivery.

Among 247 patients with placenta previa, 139 (56.3%) experienced antepartum bleeding. Advanced maternal age (50/139 vs. 61/108, p = 0.001) and obesity (36/139 vs. 45/108, p = 0.009) were less common among patients with bleeding. In multivariable analysis, advanced maternal age (odds ratio: 0.42, 95% confidence interval: 0.25-0.71) and obesity (odds ratio: 0.50, 95% confidence interval: 0.28-0.89) were independently associated with decreased odds of antepartum bleeding. Among those with bleeding, recurrent bleeding occurred in 85/139 (61.2%) patients and was associated with an earlier gestational age at first bleed (median 28.0 vs. 31.6 weeks, p < 0.001). Descriptive trends demonstrated shorter latency to delivery and a greater proportion of bleeding episodes prompting delivery as the number of bleeding episodes increased.

Antepartum bleeding occurred in more than half of pregnancies complicated by placenta previa and frequently recurred. Bleeding timing and recurrence may have clinical relevance for counseling and anticipatory management, warranting further prospective study.

· Antepartum bleeding is a common complication of placenta previa, but limited data describe bleeding patterns, recurrence, and timing in affected pregnancies.. · Antepartum bleeding occurred in 56.3% of patients with placenta previa and recurred in 61.2% of those who experienced bleeding.. · Earlier gestational age at first bleeding episode was associated with recurrent bleeding, and increasing numbers of bleeding episodes were associated with shorter latency to delivery.. · This study characterizes bleeding patterns in placenta previa and suggests that earlier bleeding onset and recurrent episodes may reflect a more severe clinical course..