ABSTRACT
OBJECTIVE: To study the effect of antepartum haemorrhage on pregnancy outcomes in placenta previa cases.METHODS: A total of 404 cases of placenta previa in the First Affiliated Hospital of Nanjing Medical University from Oc-tober 2012 to December 2017 were compared. The high-risk factors of prenatal hemorrhage were analyzed,and pregnan-cy outcomes were compared between no-bleeding group(n=254)and repeated-bleeding group(n=150).RESULTS: Uni-variate Logistic regression analysis suggested:when the number of gravidity and uterine cavity operation reached 3 times,prenatal bleeding risk was higher than those less than 3 times(OR=1.937,95%CI 1.054-3.562;OR=2.174,95%CI1.050-4.504),respectively.The risk of prenatal hemorrhage was the highest at 28-<32 weeks of gestation,and the riskof of prenatal bleeding decreased with the increase of gestational weeks.The risk of prenatal hemorrhage in patients withplacenta previa was higher than that in patients with posterior wall placenta(OR=3.978,95%CI 2.220-7.195).The riskof prenatal hemorrhage in women with central placenta previa was higher than that in women with marginal or partial pla-centa(OR=3.346,95%CI 2.050-5.460).Multivariate Logistic regression analysis suggested:the risk of recurrent prenatalbleeding in central placenta previa was higher than that in marginal and partial ones(OR=3.344,95%CI 1.955-5.722).The risk of prenatal bleeding in placenta previa was higher than that in posterior wall placenta(OR=3.954,95%CI 2.196-7.387).The risk of prenatal bleeding was significantly re-duced at ≥36 weeks of gestation,and the risk was signifi-cantly lower than that at other gestational weeks(OR=0.086,95% CI 0.030-0.240).The emergency operationrisk of pregnant women with repeated prenatal hemor-rhage was higher than that of those without prenatal hemorrhage(OR=252,95%CI 60.173-1055.359),and the risk of using blood products was higher than no-bleeding group(OR=2.103,95%CI 1.394-3.171).Compared with women in no-bleeding group,the risk of low birth weight,and mildand severe asphyxia of the newborn increased(OR=7.982,95%CI 2.410-26.426),(OR=2.987,95%CI 1.529-5.837)and(OR=13.941,95%CI 1.690-114.626),respectively,and the risk of admission and treatment in neonatal intensive careunit(NICU)was increased in repeated-bleeding group(OR=3.379,95%CI 2.102-5.430).CONCLUSION: The risk factorsof prenatal haemorrhage of placenta previa are gravidity,uterine cavity operation,gestational weeks at termination ofpregnancy,and placental type and position;central placenta and anterior placenta are independent risk factors for in-creasing prenatal bleeding;repeated prenatal bleeding increases the risk of using blood products,low birth weight of thenewborn,neonatal asphyxia and neonatal NICU admission.