Obstetric risk factors associated with the development of periventricular leukomalacia in preterm infants born to mothers complicated by placenta previa.

OBJECTIVES

This study was designed to evaluate the effect of antenatal risk factors on the occurrence of periventricular leukomalacia (PVL) in preterm infants from pregnancies complicated by placenta previa.

STUDY

DESIGN

The association between obstetric risk factors and PVL was assessed in 30 singleton live births complicated with placenta previa delivered between 24 and 33 completed weeks of gestation. Each infant underwent at least two cranial ultrasounds: the first before 72 h and the second around 14 days of life. Analysis of variance was used to compare continuous variables across groups. Comparison of groups for categorical data was analyzed with Pearson chi(2) test.

RESULTS

The obstetric factors in infants with PVL were compared to those in infants with negative cranial ultrasonographic findings. The main risk factors for PVL in preterm placenta previa were initial antepartum hemorrhage <28 weeks of gestation (OR 13.7; 95% CI 1.38-136.2), although the differences of gestational age of delivery between two groups were not statistically significant. Low Apgar score (<7) at 1 min increased the risk of PVL (OR 8.89; 95% CI 12.9-61.1), while no associations with PVL were observed in low Apgar score at 5 min, neonatal acidosis (pH <7.2), and neonatal anemia (Hb <14 g/dl).

CONCLUSIONS

This study demonstrates that initial antepartum hemorrhage during the second trimester and low Apgar score at birth increase the risk of PVL in preterm infants born to mothers with placenta previa. We speculate that the pathophysiologic mechanisms for this finding may be due to decreased placental perfusion in the second trimester of pregnancy, which is the developmental window of vulnerability for PVL.