Page 82 - JCTR-11-3

Journal of Clinical and
Translational Research Outcomes of placenta previa with APH

are common histopathological findings of PP. It can be syndrome), hospitalization in the neonatal ICU, and lower
attributed to increased villous agglutination, with a higher birth weight. The present findings are consistent with the
number of syncytial knots and hypoplasia observed in outcomes of other studies, confirming that preterm birth
the distal villus. 18,19 In addition, the thinness of the lower (p<0.0001, OR = 21.00 [106.22 – 4.15]), respiratory distress
segment limits the contraction ability of the uterine wall syndrome (p=0.03, OR = 8.25 [70.50 – 0.97]), and neonatal
as it cannot stop bleeding from the ruptured vessels ICU admissions (p=0.05, OR = 7.04 [60.82 – 0.82])
effectively, thus exacerbating bleeding in the case of APH. contribute to a higher risk for APH. 10,15 Similarly, Im
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In a study that investigated pregnant women affected by PP, et al. also reported that the risk for APH was significantly
Im et al. found that compared with those without APH, raised by preterm births (p=0.0001), lower birth weight
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women who had APH suffered from increased antepartum (p<0.0001), and neonatal ICU admission (p=0.0001).
contractions of the uterus (33.3% vs. 10.2%, p=0.002), short Similar findings have also been reported by Rosenberg
cervical length (<2.5 cm, 53.0% vs. 27.1%, p=0.003), lower et al. (p<0.001). 21
placental weight (0.44 ± 0.11 vs. 0.49 ± 0.12 kg, p=0.03), Given the unpredictable outlook of PP with APH and
and a higher rate of lesions due to villous agglutination the associated dangers for both the mother and the baby,
(42.4% vs. 22.0%, p=0.01). 20 these findings offer evidence to endorse the guideline
There are multiple risk factors for APH in patients put forth by the Society for Maternal–fetal Medicine,
with PP. Scarring and fibrosis in the uterus lining can which recommends delivery rescheduling in the instances
be a probable cause that can affect normal placental of bleeding or difficulties during pregnancy at the late
implantation. Moreover, multiparity can contribute to PP preterm stage. PP and placental abruption are the
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as well, since multiple pregnancies introduce changes in the leading causes of APH. Other risk factors include minor
normal uterus environment, affecting the normal placental bleeding in the sinus, battledore placenta, vasa previa,
implantation. Additionally, maternal age, lifestyle factors, cervicitis, velamentous cord insertion, genital trauma,
20
surgical history, and cervical length can complicate the tumors, infections, and coagulation disorders. 10,26 Our
condition. A maternal age of 35 years or more is associated study recognized blood loss (OR = 1.01 [1.01 – 1.00],
with higher PP risk due to age-related morphological p<0.0001) as a potential contributor to APH, which is
and vascular changes in the uterus, similar to our study concordant with Vergani et al.’s findings that blood loss
10
in which maternal age (OR = 1.22 [1.45 – 1.03], p=0.03) at delivery (p=0.09) is related to APH in patients with PP.
was a significant factor for APH. Similar findings were PP is the primary cause of APH during the advanced stages
reported by Im et al. (OR = 4.15 [1.51 – 11.49], p<0.01), of pregnancy. Women who are diagnosed with PP face a
Rosenberg et al. (OR = 1.08 [1.07 – 1.09], p<0.001), and substantially elevated risk, approximately four times higher,
Fan et al. (prevalence = 51.6%, 95% CI = 42.7 – 60.6%). 20-22 of encountering vaginal bleeding in the second trimester
Lifestyle factors such as malnutrition and smoking can of pregnancy. In exceptional cases, some women may
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further exacerbate the condition. Surgical histories such require an early cesarean surgery and hysterectomy due
as myomectomy or dilation and curettage further add to to a severe and potentially life-threatening hemorrhage,
the risks. However, cervical length is found to be inversely which poses surgical risks with long-term complications
associated with the risk of APH in patients with PP. 23,24 such as fertility and psychological issues. Moreover,
Thus, proper antenatal care is crucial in identifying such APH is further associated with higher septicemia rates,
risk factors and preventing severe maternal and fetal involvement of more invasive procedures, and prolonged
outcomes. stays at the hospital. 27
The current study’s findings indicate that APH is a The prevalence of APH, due to PP, varies from region
notable concern for pregnant women with PP, and there to region. According to a meta-analysis conducted by Fan
is a large variation in its prevalence among different et al., the pooled prevalence of APH in PP individuals
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studies. The findings of our study suggest that pregnancies was estimated to be 51.6% (95% CI: 45.8 – 61.0). However,
complicated by PP and APH have shown a greater individual studies report a wider range. Such differences
vulnerability to adverse outcomes for both the mother and can be attributed to the complexity of maternal, neonatal,
the infant. The APH group exhibited a higher incidence of and demographic factors. The calculated prevalence was
emergency cesarean section and complications associated the highest in Asia (53.4%, 95% CI: 42.7 – 60.6) and North
with hemorrhage. Furthermore, APH is strongly correlated America (53.2%, 95% CI: 34.1 – 72.2), followed by Europe
with prematurity, as indicated by its connection with (48.5%, 95% CI: 20.3 – 76.7) and Africa (33.8%, 95%
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shorter gestational periods, higher chances of preterm CI: 22.3 – 45.3). Demographic factor has a significant
labor, newborn complications (e.g., respiratory distress influence on the prevalence, followed by the healthcare

Volume 11 Issue 3 (2025) 76 doi: 10.36922/jctr.25.00002