Outcome of placenta previa: inpatient versus outpatient management

Abstract

Objective: To share our 10-year experience on outpatient care of patients with placenta previa with no antepartum haemorrhage (APH) prior to 34 weeks of pregnancy.
Methods: This was a retrospective observational study conducted at a regional obstetric unit in Hong Kong over a 10-year period. Patients with placenta previa with no vaginal bleeding before 34 weeks were included. Those with multiple pregnancy, preeclampsia, serious underlying medical disorders, morbidly adherent placenta, or vaginal delivery were excluded. Data analysed included maternal characteristics, delivery information, maternal morbidities (massive haemorrhage, intensive care unit admission, hysterectomy), and neonatal outcomes (delivery gestation, birth weight, Apgar scores, neonatal intensive care unit admission, perinatal mortality).
Results: A total of 419 women with minor (n=265) or major (n=154) placenta previa were evaluated. Of these cases, 149 (56%) cases of minor and 37 (24%) cases of major placenta previa (p<0.001) were managed as outpatients. For patients with major placenta previa, APH (62.2% vs 35%, p=0.004) and emergency Caesarean deliveries (70.3% vs 23.9%, p<0.001) were more common among outpatients than inpatients although APH >200 mL remained rare. Neonatal outcomes were similar between outpatients and inpatients except that patients with major placenta previa had more preterm deliveries in outpatients than inpatients (29.7% vs 10.3%, p=0.004). The maternal morbidity rate was higher in patients with major placenta previa than with minor placenta previa (31.8% vs 12.5%, p<0.001) but was similar between outpatients and inpatients.
Conclusion: Outpatient care of patients with placenta previa with no vaginal bleeding prior to 34 weeks of pregnancy was associated with more emergency deliveries, but there was no major adverse effect on maternal and neonatal outcomes.