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Maternal Outcome in women with placenta previa who had antepartum haemorrhage compared to those without haemorrhage: Retrospective Cohort Study
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  • Philip Chung,
  • Kenny Cheer,
  • Eva Malacova,
  • Satomi Okan,
  • Thangeswaran Rudra
Philip Chung
Royal Brisbane and Women's Hospital
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Kenny Cheer
Royal Brisbane and Women's Hospital
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Eva Malacova
QIMR Berghofer
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Satomi Okan
QIMR Berghofer
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Thangeswaran Rudra
Royal Brisbane and Women's Hospital
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Abstract

Objective: To compare maternal outcomes for placenta praevia (PP) between those who experience antepartum haemorrhage (APH) and those without APH. Design: Retrospective cohort study. Setting: Royal Brisbane & Women’s Hospital, Australia. Population: Over ten years, a total of 368 women with placenta praevia (PP) were recruited and divided into APH (n=230) and No APH (n=138). Methods: Data retrieved from institution-based obstetric database were analysed using logistic regressions for binary outcomes and Poisson or negative binomial regressions for counts. Main Outcome Measures: Type of PP, timing and mode of delivery, intra-operative and postpartum complications, volume of blood loss and number of blood transfusions. Results: Compared to women without APH, women who experienced APH had a greater proportion of major PP (OR=2.88,p<0.001), emergency lower uterine segment (OR=6.24,p<0.001) and classical (OR=14.9,p<0.001) sections, use of general anaesthesia (OR=3.14,p<0.001), preterm delivery (median 35.4 vs 38.0 weeks, p<0.001). There was no significant differences intra-operatively (number of uterotonics used or additional surgical techniques), greater volume of bloods loss (IRR=1.20,p=0.006), increased frequency of blood transfusion (IRR=3.36,p<0.001), and longer post-operative hospital stay (IRR=1.27,p=0.001). There was a total of four hysterectomies and no intensive care unit admissions or maternal deaths. Conclusions: Women with PP who experienced APH had a tendency for preterm delivery, emergency caesarean section, greater blood loss requiring more blood transfusion and longer hospital admissions. However, a lack of serious maternal morbidity among these women provides support for an individualised approach towards management of bleeding in PP. Funding: No funding body. Keywords: Antepartum Haemorrhage, Placenta Praevia, maternal outcomes.