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:



      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.


      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.


      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.


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



      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.


      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.


      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.


      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.


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        • Cresswell JA
        • Ronsmans C
        • Calvert C
        • et al.
        Prevalence of placenta praevia by world region: a systematic review and meta-analysis.
        Trop Med Int Health. 2013; 18: 712-724
      1. Dulay AT. Placenta previa: 2019. Available at: Accessed on August 15, 2020.

        • Fan DZ
        • Xia Q
        • Liu L
        • et al.
        The incidence of postpartum hemorrhage in pregnant women with placenta previa: a systematic review and meta-analysis.
        PLoS One. 2017; 12e170194
        • Allahdin S
        • Voigt S
        • Htwe TT
        Management of placenta praevia and accreta.
        J Obstet Gynaecol. 2011; 31: 1-6
        • Palacios-Jaraquemada JM
        Caesarean section in cases of placenta praevia and accreta.
        Best Pract Res Clin Obstet Gynaecol. 2013; 27: 221-232
        • Jansen CHJ
        • Kleinrouweler CE
        • van Leeuwen L
        • et al.
        Final outcome of a second trimester low-positioned placenta: a systematic review and meta-analysis.
        Eur J Obstet Gynecol Reprod Biol. 2019; 240: 197-204
        • Fan D
        • Wu S
        • Wang W
        • et al.
        Prevalence of placenta previa among deliveries in Mainland China: a PRISMA-compliant systematic review and meta-analysis.
        Medicine (Baltimore). 2016; 95: e5107
        • Senkoro EE
        • Mwanamsangu AH
        • Chuwa FS
        • et al.
        Frequency, risk factors, and adverse fetomaternal outcomes of placenta previa in northern Tanzania.
        J Pregnancy. 2017; 20175936309
        • Fan DZ
        • Wu S
        • Liu L
        • et al.
        Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis.
        Sci Rep. 2017; 7: 40320
      2. (editors)Judith C Murray L Oxford handbook of clinical specialties. 7th edition. Oxford University Press, Oxford2006
        • Dashe JS
        • McIntire DD
        • Ramus RM
        • et al.
        Persistence of placenta previa according to gestational age at ultrasound detection.
        Obstet Gynecol. 2002; 99: 692-697
      3. (editors)Reece EA Hobbins JC Clinical obstetrics: the fetus and mother. 3rd edition. Wiley-Blackwell, Hoboken2006: 1050
        • Weerasekera DS
        Placenta previa and scarred uterus—an obstetrician's dilemma.
        J Obstet Gynaecol. 2000; 20: 484-485
        • Timor-Tritsch IE
        • Monteagudo A
        Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accrete and cesarean scar pregnancy. A review.
        Am J Obstet Gynecol. 2012; 207: 14-29
        • Zhou M
        • Chen M
        • Zhang L
        • et al.
        Severe adverse pregnancy outcomes in placenta previa and prior cesarean delivery.
        Sichuan Da Xue Xue Bao Yi Xue Ban. 2017; 48: 783-787
        • Liang J
        • Mu Y
        • Li X
        • et al.
        Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births.
        BMJ. 2018; 360: k817
        • Hu HT
        • Xu JJ
        • Lin J
        • et al.
        Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study.
        BMC Pregnancy Childbirth. 2018; 18: 273-284
        • Chen S
        • Cheng W
        • Chen Y
        • et al.
        The risk of abnormal placentation and hemorrhage in subsequent pregnancy following primary elective cesarean delivery.
        J Matern Fetal Neonatal Med. 2020; 33: 3608-3613
        • Keag OE
        • Norman JE
        • Stock SJ
        Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis.
        PLoS Med. 2018; 15e1002494
        • Ishibashi H
        • Miyamoto M
        • Soyama H
        • et al.
        Marginal sinus placenta previa is a different entity in placenta previa: a retrospective study using magnetic resonance imaging.
        Taiwan J Obstet Gynecol. 2018; 57: 532-535
        • Balayla J
        • Desilets J
        • Shrem G
        Placenta previa and the risk of intrauterine growth restriction (IUGR): a systematic review and meta-analysis.
        J Perinat Med. 2019; 47: 577-584
        • Kancherla V
        • Räisänen S
        • Gissler M
        • et al.
        Placenta previa and risk of major congenital malformations among singleton births in Finland.
        Birth Defects Res A Clin Mol Teratol. 2015; 103: 527-535
        • Walfisch A
        • Sheiner E
        Placenta previa and immediate outcome of the term offspring.
        Arch Gynecol Obstet. 2016; 294: 739-744
        • Jung EJ
        • Cho HJ
        • Byun JM
        • et al.
        Placental pathologic changes and perinatal outcomes in placenta previa.
        Placenta. 2018; 63: 15-20
        • Mastrolia SA
        • Baumfeld Y
        • Loverro G
        • et al.
        Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study.
        J Matern Fetal Neonatal Med. 2016; 29: 3467-3471