Acute and massive bleeding from placenta previa and infants' brain damage

• Bleeding of placenta previa is a risk factor for poor infantile neurological outcome
• Acute and massive bleeding > 500 grams within 8 hours is clinically significant
• Placental bleeding around 30 weeks of gestation requires careful neonatal follow-up

BackgroundAmong the causes of third trimester bleeding, the impact of placenta previa on cerebral palsy is not well known.AimsTo clarify the effect of maternal bleeding from placenta previa on cerebral palsy, and in particular when and how it occurs.Study designA descriptive study.SubjectsSixty infants born to mothers with placenta previa in our regional population-based study of 160,000 deliveries from 1998 to 2012. Premature deliveries occurring at <26 weeks of gestation and placenta accreta were excluded.Outcome measuresPrevalence of cystic periventricular leukomalacia (PVL) and cerebral palsy (CP).ResultsFive infants had PVL and 4 of these infants developed CP (1/40,000 deliveries). Acute and massive bleeding (> 500 g within 8 h) occurred at around 30–31 weeks of gestation, and was severe enough to deliver the fetus. None of the 5 infants with PVL underwent antenatal corticosteroid treatment, and 1 infant had mild neonatal hypocapnia with a PaCO2 < 25 mm Hg. However, none of the 5 PVL infants showed umbilical arterial acidemia with pH <7.2, an abnormal fetal heart rate monitoring pattern, or neonatal hypotension.ConclusionsOur descriptive study showed that acute and massive bleeding from placenta previa at around 30 weeks of gestation may be a risk factor for CP, and requires careful neonatal follow-up. The underlying process connecting massive placental bleeding and PVL requires further investigation.