Early Morbidity and Neurodevelopmental Outcome in Low-Birthweight Infants Born after Third Trimester Bleeding

ABSTRACT

Neonatal mortality, morbidity, and neurodevelopmental sequelae were compared between a consecutive series of 77 liveborn, low-birthweight (less than 2500 g) infants delivered after third trimester bleeding and 154 appropriate control infants of similar gestational age. Infants born after abruptio placentae had lower Apgar scores at 1 minute and higher rates of acidosis in comparison with control infants. In multivariate analysis, the infants in this group had higher risks of severe intraventricular hemorrhage and poor outcome (neonatal death or cerebral palsy) in comparison with control infants. In placenta previa, the infants had a higher prevalence of respiratory distress syndrome, whereas unclassified antepartum bleeding was associated with a high rate of neonatal hypoglycemia. After adjustment, by logistic regression analysis, for the effect of confounding factors (gestational age, birthweight, social class, and education of the mother), the risk of minor infant neurodevelopmental abnormalities at 2-year follow-up was increased in infants delivered after total or partial placenta previa or after unclassified antepartum bleeding. Third trimester bleeding should be considered a strong risk factor for both short-term neonatal morbidity and subsequent infant neurodevelopmental impairment in the low-birthweight infant population.