Dr Alexis Shub1
1PIPER, Parkvillle, Australia
Background:
Antepartum haemorrhage (APH) from placenta praevia (PP) at preterm gestation is a common indication for transfer to a hospital with capability to manage the neonate if delivery is required.
Aim:
To determine the outcome of preterm transfers for antepartum haemorrhage with placenta praevia
Method:
We reviewed all interhospital transfers managed by the statewide retrieval service for APH in women with PP at less than 37 weeks gestation. Exclusions were ruptured membranes, abruption, unknown placental location or abnormal CTG, or not transferred after obstetric consultation.
Results
495 women were included from January 2011 to December 2021.
26 women (5.3%) delivered after more than 24 hours and less than 7 days, 27 (5.4%) delivered within 24 hours, 289 (58.4%) remained in the receiving hospital undelivered at 7 days, and 153 (30.9%) were discharged undelivered from the receiving hospital at less than 7 days.
Among the 52 women who presented with contractions, these rates were 6 (3.8), 7 (13.5), 17 (3.7), 22 (42.3) (n(%)).
Among 375 women without contractions, without vasa praevia or placenta accreta, rates were 19(5.1), 17(4.5), 226 (61.1), 113 (30.1) (n(%)).
Among 193 women at less than 28 weeks, rates were 6 (3.1), 4 (2.1), 131 (67.9), 52(26.9). Among 245 women at 28 to 31 weeks, rates were 14 (5.7), 13(5.3), 139(56.7), 79 (32.2). Among 57 women at 32 to 36 weeks gestation, rates were 6 (10.5), 10 (17.4), 19 (33.3), 22 (38.6) (n(%)).
Conclusion
9.6% of women who are transferred with APH from isolated PP without contractions deliver within 7 days. The rate is higher in women who are contracting at presentation, and lower under 28 weeks gestation. Consideration should be given to providing care in a centre able to manage maternal status, rather than transfer to a tertiary centre for neonatal capability, especially under 28 weeks gestation.
Biography:
A Prof Alexis Shub is an Obstetrician and Head of PIPER perinatal, the obstetric retrieval service for Victoria.