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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Article info
Publication history
Published online: January 23, 2021
Footnotes
Disclosures: This study was supported in part by grants from the Canadian Institute of Health Research (FND-148438), Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education (LC2019ZD019), and Nanhai Hospital of Southern Medical University (YNKT201802).
All authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
