Comparison of Neonatal Outcome, Including Cerebral Palsy, Between Abruptio Placentae and Placenta Previa

Abstract

Studies to date shed little light on the question of whether the newborn infant is comprised, by cerebral palsy or in other ways, if the mother has abruptio placentae or placenta previa. These conditions typically producethird-trimester bleeding. The authors undertook a case-control study determine the infant's prognosis after preterm delivery when one of these conditions was present. There were 42 women with abruptio placentae and 72 with placenta previa who delivered their infants at 26 to 36 weeks' gestation. Control subjects were 120 women in preterm labor. Patients in both study groups were older than control women. The fetal heart rate (FHR) was monitored for 2 hours or longer before delivery, which took place when active labor began, if fetal status was not reassuring, or on maternal indications such as massive vaginal bleeding. Nine of the women with abruptio placentae (21%) had preeclampsia. Ultrasonography showed abnormalities in 31 of the 42 women with this condition, but the findings did not correlate with the severity of placental separation. The most common indication for delivery was a nonreassuring FHR pattern with vaginal bleeding. Poor outcomes (dearth before discharge or cerebral palsy) did not relate to either the duration of a nonreassuring FHR pattern or massive bleeding (more than 500 mL). Four infants whose mothers had placenta previa had a 5-minute Apgar score of less than 7. Two of them, whose mothers had massive vaginal bleeding and shock, experienced poor outcomes. The other 2 infants, whose mothers did not bleed massively, did well. Poor outcomes were more frequent in the group with abruptio placentae (26%) than in cases of placenta previa (2.8%). The difference is chiefly accounted for by cerebral palsy. Logistic regression analysis that controlled for possible confounding factors indicated that the risk of a poor outcome correlated with abruptio placentae, delivery before 31 weeks' gestation, and a low Apgar score. A nonreassuring FHR pattern was not a significant predictor of poor outcome. These findings indicate that, among causes of third-trimester bleeding in preterm gestations, abruptio placentae is most predictive of a poor infant outcome.