Indications for, Timing of, and Modes of Delivery in a National Cohort of Women Admitted With Antepartum Hemorrhage at 22+0 to 28+6 Weeks’ Gestation

Abstract

ObjectiveAntepartum hemorrhage is associated with preterm birthand operative delivery. Since the Canadian Perinatal Networkrecords obstetric interventions for women admitted to tertiarycare hospitals with antepartum hemorrhage, our objective was todescribe the delivery characteristics of this cohort. MethodsTrained abstractors collected data by chart review fromwomen admitted with antepartum hemorrhage between 22+0 and28+6 weeks’ gestation. We included all women with completefollow-up postpartum and used descriptive statistics to report theindications for, timing of, and modes of delivery. ResultsThe study cohort included 806 women from 13 tertiaryperinatal centres in six provinces. The most common causes ofbleeding were placental abruption (n = 256) and placenta previa(n = 171). The median gestational age at delivery was 30 weeks,and 497 (61.7%) births occurred at less than 34 weeks. Over onehalf of the women began labour spontaneously, and 238 (29.5%)were delivered prior to the onset of labour. Overall, 370 (45.9%)women delivered vaginally, including 98 who had induction oflabour. Of the 436 Caesarean sections (54.1%), 345 (79.1%)were emergencies. The most common indications for Caesareansection were placenta previa, abnormal fetal presentation, andplacental abruption or vaginal bleeding. ConclusionThis inpatient cohort of women with antepartumhemorrhage had high rates of spontaneous labour, preterm birth,and emergency Caesarean section. These results can be used ascurrent Canadian benchmark rates of preterm delivery, inductionof labour, and Caesarean section in women admitted to tertiarycare centres with antepartum hemorrhage between 22+0 and 28+6weeks’ gestation, and can aid in the counselling of similar women.