COMPARATIVE STUDY OF PLACENTA PREVIA RELATED BLEEDING RISK FOR PREGNANCY OUTCOMES WITH RESPECT TO THE MODE OF DELIVERY AND NEONATAL APGAR SCORE

Abstract

Background: Placenta previa is a high-risk obstetric condition in which the placenta partially or completely covers the cervical os, leading to substantial risks of antepartum hemorrhage, adverse pregnancy outcomes, and emergency interventions. Women with complete placenta previa often experience more severe hemorrhage, increased need for cesarean delivery, and higher neonatal risk. Early recognition through ultrasonography and Doppler assessment is essential for predicting bleeding severity and optimizing delivery planning, especially in low-resource settings where delayed diagnosis increases the likelihood of maternal–fetal complications.

Objective: To compare placenta previa–related bleeding risk for pregnancy outcomes with respect to mode of delivery and neonatal Apgar scores.

Methods: A prospective cross-sectional study was conducted on 92 pregnant women diagnosed with placenta previa after 20 weeks of gestation. Placental characteristics—including type, edge-to-os distance, vascularity, Doppler flow indices, and cervical length—were assessed using standardized ultrasonography. Data on antepartum bleeding, severity of hemorrhage, mode of delivery, gestational age at birth, neonatal birth weight, and Apgar scores were recorded. Statistical analysis using SPSS version 25 included chi-square tests and regression modelling to determine associations among placenta previa type, bleeding severity, delivery method, and neonatal outcomes.

Results: Complete placenta previa accounted for 44.6% of cases and showed the highest association with antepartum bleeding (92.7%) and severe hemorrhage (41.4%). Cesarean delivery was performed in 90.2% of participants, particularly in all complete and partial previa cases. Infants delivered via cesarean section demonstrated higher Apgar scores at 1 minute, with no score of 5 recorded in this group. Vaginal deliveries accounted for all low Apgar scores (5.4%). Bleeding severity demonstrated a borderline association with lower Apgar scores, while ultrasound parameters—such as reduced placental edge-to-os distance, increased vascularity, and thicker placentas—were strongly linked to bleeding risk.

Conclusion: Placenta previa significantly affects maternal bleeding patterns and neonatal wellbeing. Cesarean delivery provides improved neonatal outcomes, especially in high-risk complete and partial previa. Early ultrasound-based assessment remains crucial for predicting hemorrhage, guiding delivery decisions, and safeguarding maternal-fetal health.