*Article* **The Risk of Obstetrical Hemorrhage in Placenta Praevia Associated with Coronavirus Infection Antepartum or Intrapartum**

**Irina Pacu 1,2, Nikolaos Zygouropoulos 2, Alina Elena Cristea 2, Cristina Zaharia 2, George-Alexandru Rosu 1,2, Alexandra Matei 1,2, Liana-Tina Bodei 1,3, Adrian Neacsu 1,3,\* and Cringu Antoniu Ionescu 1,2**


**Abstract:** *Background and Objectives*: The aim was to evaluate the severity of obstetrical bleeding in the third trimester associated with COVID infection in placenta previa and accreta. *Materials and Methods*: A retrospective study was conducted to compare the risk of obstetrical bleeding in the case of placenta previa with or without associated SARS-CoV-2 infection. Patients presenting with placenta previa before labor were classified into three groups: group A (control) as no infection throughout their pregnancy, group B as confirmed infection during the 1st trimester, and group C as confirmed infection at the time of delivery. Infected patients were stratified according to the severity of signs and symptoms. The severity of obstetrical hemorrhage at birth was assessed quantitatively and qualitatively. All placentas were analyzed histologically to identify similarities. *Results*: Prematurity and pregnancy-induced hypertension appear significantly related to SARS-CoV-2 infection during the 3rd trimester. Placenta accreta risk increases significantly with infection during the 1st trimester. No statistically significant differences in the severity of hemorrhage associated with childbirth in cases with placenta previa between groups A and C but increased obstetrical bleeding mainly due to emergency hemostatic hysterectomy in group B driven by placenta accrete were detected. Obstetrical hemorrhage at birth in the case of coexistence of the infection was found not to correlate with the severity of the viral disease. Meanwhile, the number of days of hospitalization after birth is related to the specific treatment of COVID infection and not related to complications related to birth. *Conclusions*: The study finds an increased incidence of placenta accreta associated with placenta previa in cases where the viral infection occurred in the first trimester of pregnancy, associated with an increased incidence of hemostasis hysterectomies in these patients. Placental histological changes related to viral infection are multiple and more important in patients who had COVID infection in the first trimester.

**Keywords:** obstetrical bleeding; SARS-CoV-2; placenta previa; placenta accreta

**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).
