TITLE:
Late Αntepartum Ηemorrhage and Neonatal Outcome: A Retrospective Study
AUTHORS:
Panagiotis Tsikouras, Zacharoula Koukouli, Anastasios Liberis, Bachar Manav, Constantinos Bouschanetzis, Panagiotis Naoumis, Marina Dimitraki, Georgios Galazios
KEYWORDS:
APH, Vaginal Bleeding, Neonatal Outcome, Prognostic Factors
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.6 No.2,
February
17,
2016
ABSTRACT: 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 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.