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Comparison of Adverse Maternal and Neonatal Outcomes in Women Affected by Placenta Previa With and Without a History of Cesarean Delivery: A Cohort Study

Published:January 23, 2021DOI:https://doi.org/10.1016/j.jogc.2020.12.022

      ABSTRACT

      Objective

      Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis.

      Methods

      We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes.

      Results

      A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed.

      Conclusions

      History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.

      RÉSUMÉ

      Objectif

      Dans la littérature, il existe peu de données sur la comparaison détaillée des issues maternelles et néonatales en cas de placenta prævia avec et sans antécédent de césarienne. Cette étude avait pour objectif de réaliser une telle analyse.

      Méthodologie

      Nous avons mené une étude de cohorte rétrospective sur tous les cas de placenta prævia parmi 56 070 naissances monofœtales dans deux hôpitaux de soins tertiaires de Guangdong, en Chine, entre janvier 2014 et décembre 2018. Les cas de placenta prævia ont été répartis en deux groupes : les cas avec antécédent de césarienne et les cas sans antécédent de césarienne. Nous avons d'abord comparé les caractéristiques de référence, et avons ensuite comparé les issues maternelles et néonatales entre les deux groupes. Plusieurs analyses de régression logistique binomiale et de régression linéaire multiple ont été réalisées pour estimer la corrélation indépendante entre l'antécédent de césarienne et les issues maternelles et néonatales indésirables.

      Résultats

      Au total, 773 cas de placenta prævia ont été inclus dans l'analyse. De ce nombre, 546 avaient un antécédent de césarienne et 227 n'en avait pas. Par rapport aux cas de placenta prævia sans antécédent de césarienne, ceux avec antécédent de césarienne présentaient un risque accru de placenta accreta ou increta, de rupture utérine, de choc, d'anémie sévère, d'hystérectomie et d'augmentation des saignements et des coûts d'hospitalisation. Aucune différence dans les issues néonatales n'a été observée entre les deux groupes.

      Conclusions

      L'antécédent de césarienne est associé à un risque accru d'issues indésirables chez la mère, mais pas chez les nouveau-nés en cas de placenta prævia.

      Keywords

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