INTRODUCTION
One of the most important causes of antepartum haemorrhage (APH) is
Placenta praevia (PP), which is characterised by abnormal placentation
in close proximity to the internal cervical os, with a reported
prevalence of 5 per 1000 pregnancies worldwide.1 The
Royal College of Obstetricians and Gynaecologists
(RCOG)2 defines APH as bleeding from or in to the
genital tract beyond 24 weeks of pregnancy and acknowledges that there
is no consistent definition for describing its severity. However, APH is
globally regarded as a leading cause of perinatal and maternal
mortality, complicating 3–5% of pregnancies.3
Compared to non-placenta praevia women, those with placenta praevia have
approximately a four- to ten-fold increased risk of
APH.4,5 In 2017, a systematic review of 29 studies by
Fan et al.6 reported that among women with PP the
overall prevalence of APH was 51.6%, ranging from 20% to
90%.7,8 Women with PP who experience increasing
episodes of APH have been associated with greater risks of requiring
blood transfusion, preterm caesarean section, and emergency
hysterectomy.9
Previously, RCOG has recommended that women with PP and previous
bleeding events require admission at or after 34 weeks. However, the
most recent RCOG (2018) guidelines2 recommend that
women with recurrent bleeding be given tailored antenatal care based on
recommendations from a Cochrane systematic review10that showed no clear disadvantage to a policy of home versus hospital
care. Likewise, women with PP without APH can be managed in the
outpatient setting with similar outcomes compared to
hospitalisation.11
Although APH is common in women with PP, it has not been extensively
evaluated in the literature, with previous studies recruiting small
populations of less than 250 cases.12–14 The aim of
this large scale retrospective study was to examine a range of obstetric
outcomes for women with placenta praevia complicated by any bleeding
episodes compared to those without.