Abstract
Objective: Women previously giving birth with cesarean section have an increased risk of postpartum hemorrhage (PPH) and retained placenta. The objective of this study was to determine if anterior placental location increased the risk of PPH and retained placenta in such women.Materials and methods: We performed a prospective cohort study on 400 women with cesarean section delivery in a previous pregnancy. Ultrasound examinations were performed at gestational week 28–30, and placental location, myometrial thickness, and three-dimensional vascularization index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, oxytocin, preeclampsia, PPH, retained placenta, and birth weight were obtained for all women. Outcome measures were PPH (≥1,000 mL) and retained placenta.Results: The overall incidence of PPH was 11.0% and of retained placenta 3.5%. Twenty-three women (11.8%) with anterior placenta had PPH compared to 12 (6.9%) with posterior or fundal locations. The odds ratio was 1.94, but it did not reach statistical significance. There was no significant risk increase for retained placenta in women with anterior placentae. Seven of eight women with placenta previa had PPH, and four had retained placenta.Conclusions: The overall risk of PPH and retained placenta was high for women with previous cesarean section. Anterior location of the placenta in such women tended to impose an increased risk for PPH but no risk increase of retained placenta. Placenta previa in women with previous cesarean section is associated with a high risk for PPH and retained placenta.
Highlights
As rates of cesarean section continue to increase worldwide [1], methods for prediction, surveillance, and management of complications during pregnancy and delivery associated with previous cesarean section become increasingly important
Among the non-participants more had more than one previous cesarean section, more were multiparous, more were smokers, and fewer had induced labor
The frequency of postpartum hemorrhage (PPH) for women with anterior placenta tended to be higher, not significantly, than that for other placental locations (11.8% compared to 6.9%)
Summary
As rates of cesarean section continue to increase worldwide [1], methods for prediction, surveillance, and management of complications during pregnancy and delivery associated with previous cesarean section become increasingly important. Placenta previa, and placenta accreta are well-known and potentially life-threatening complications, but are still rare conditions [2,3]. They have, increased alongside the rising number of women with previous uterine surgery [4]. A decision-analytic model by Solheim et al [5] has predicted a substantial increase in the incidence of placenta previa and accreta and in maternal mortality if the cesarean section rate continues to increase. The incidence of PPH has increased during the last decades [8,9]
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