Fetal and Neonatal Outcomes in Pregnancies Complicated by Antenatal Vaginal Bleeding: A Retrospective Study at a Tertiary Care Center

Background: Vaginal bleeding during later pregnancy is an important obstetric complication that may be associated with placental pathology, preterm delivery, and adverse fetal and neonatal outcomes.Evidence describing neonatal outcomes according to the underlying causes of bleeding remains limited in Lebanon.This study aimed to characterize fetal and neonatal outcomes among pregnancies complicated by vaginal bleeding in later pregnancy and to describe these outcomes according to the documented etiology of bleeding.Materials and methods: This retrospective observational study included 172 pregnancies complicated by vaginal bleeding during later pregnancy, with deliveries occurring at Rafik Hariri University Hospital, a tertiary referral center in Lebanon, between January 2022 and December 2025.Maternal, obstetric, fetal, and neonatal data were retrospectively extracted from medical records.Outcomes included preterm delivery, neonatal intensive care unit (NICU) admission and its recorded indication, intrauterine fetal death (IUFD), and neonatal mortality.Outcomes were also described according to the documented etiology of vaginal bleeding.Results: Mean maternal age was 30.4 ± 6.3 years, and mean gestational age at delivery was 34.0 ± 4.7 weeks.Gestational-age classification was available for 170 pregnancies; 121 (71.2%) resulted in preterm delivery.Placental abruption or hematoma was the most frequently documented etiology of bleeding in later pregnancy (36.6%), followed by placenta previa (27.3%) and placenta accreta/percreta (25.6%).Among the 162 live births, 73 neonates (45.1%) required NICU admission, while 72 (44.4%) were discharged home without NICU admission.IUFD occurred in 10 of 172 pregnancies (5.8%), and neonatal death occurred in 17 of 162 live births (10.5%).Among live births, neonatal mortality was 11 of 55 (20.0%) in the placental abruption or hematoma group, 3 of 47 (6.4%) in the placenta previa group, and 3 of 43 (7.0%) in the placenta accreta/percreta group.IUFD occurred in 8 of 63 pregnancies (12.7%), 0 of 47 (0%), and 1 of 44 (2.3%) in these groups, respectively.Conclusions: Pregnancies complicated by vaginal bleeding in later pregnancy in this tertiary-care cohort were characterized by substantial prematurity, NICU utilization, and fetal and neonatal mortality.Placental abruption or hematoma was the most frequently documented bleeding etiology and accounted for the highest observed proportions of IUFD and neonatal mortality among the three main bleeding etiologies.These findings highlight the importance of identifying the underlying cause of bleeding, providing close antenatal surveillance, and coordinating obstetric and neonatal management, particularly in pregnancies complicated by placental abruption.