The Incidence of Postpartum Hemorrhage in Pregnant Women with Placenta Previa: A Systematic Review and Meta-Analysis.

Dazhi Fan,Guo Tian,Zhengping Liu,Qing Xia,Song Wu,Wen Wang,Xiaoling Guo,Shuzhen Wu,Li Liu,Cassandra Nichole Spracklen

doi:10.1371/journal.pone.0170194

Abstract

BackgroundThe global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them.ObjectiveThe aim of this study was to calculate the average point incidence of PPH in women with placenta previa.MethodsA systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard.ResultsFrom 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8–28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%).ConclusionsThe summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies.

Highlights

Placenta previa (PP) is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics [1, 2]
The overall pooled incidence of postpartum hemorrhage (PPH) was 22.3%
The prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95% confidence interval (95%CI) 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%)

Summary

Introduction

Placenta previa (PP) is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics [1, 2]. All placentas overlying the os (to any degree) are termed previas and those near to but not overlying the os are termed low-lying [3]. There appears to be an association between endometrial damage and uterine scarring and subsequent placenta previa [4]. The condition is frequently complicated by invasion of placental villi beyond the decidua basalis causing placenta accreta or increta [5]. Placenta increta can unexpectedly lead to catastrophic blood loss, multiple complications, and even death [6]. Women with placenta previa have often increased the risk of postpartum hemorrhage (PPH). The global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. There are different reports on the incidence of PPH in different countries, to date, no research has reviewed them

Methods

Results

Conclusion