Antepartum bleeding second and third trimester of pregnancy and fetal outcome

Objective:

To retrospectively evaluate the causes and neonatal outcome in term pregnancies in a hospital in a rural area complicated with middle and late antepartum hemorrhage (APH), defined as vaginal bleeding during the late second and the total third trimester of pregnancy.

Methods:

We retrospectively identified all the selected patients at a single institution from January 2005 to December 2015. The various reasons of APH were compared to each other regarding the parameters of the neonatal outcome.

Results:

250 (8.33%) pregnant women were included in the study, in a total of 3000 pregnancies. The reasons of APH were concerned to: cervical dilatation (n = 31, 12.6%), central placental abruption (n = 37,14.9%), peripheral placental abruption (n = 33, 13.3%), placenta previa (n = 75, 30.2%), others non-related to pregnancy (n = 17, 6.8%), and unknown etiology (n = 57, 22.8%). Overall, the neonates (52.8%) which were born prematurely at gestational age below 37^th week of pregnancy (5.7%) resulted in giving birth prior to 34 weeks of gestation, which their admission in a tertium hospital was necessary.

Placenta anomalies was the most founded reason for occurrence of bleeding. Placenta pathology was also associated with a high rate of hypertensive disorders in pregnancy and history of performance caesarean sections and general uterine surgical interventions.

Conclusions:

The occurrence of APH in the late second and the subsequent third trimester needs immediate evaluation of the general condition of the pregnant woman and the fetus and possible admission in a reference centre with intensive neonatal care unit.