Previous prelabor or intrapartum cesarean delivery and risk of placenta previa
Open accessAbstract
Objective The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before the onset of labor from intrapartum cesarean delivery.Study design We conducted a retrospective cohort study of electronic medical records from 20 Utah hospitals (2002-2010) with restriction to the first 2 singleton deliveries of nulliparous women at study entry (n=26,987). First pregnancy delivery mode was classified as (1) vaginal (reference), (2) cesarean delivery before labor onset (prelabor), or (3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by previous delivery mode with the use of logistic regression and was adjusted for maternal age, insurance, smoking, comorbidities, previous pregnancy loss, and history of previa.Results Most first deliveries were vaginal (82%; n=22,142), followed by intrapartum cesarean delivery (14.6%; n=3931), or prelabor cesarean delivery (3.4%; n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by previous delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (P<.001). Relative to vaginal delivery, previous prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62; 95% confidence interval, 1.24-5.56). There was no significant association between previous intrapartum cesarean delivery and previa (adjusted odds ratio, 1.22; 95% confidence interval, 0.68-2.19).Conclusion Previous prelabor cesarean delivery was associated with a >2-fold significantly increased risk of previa in the second delivery, although the approximately 20% increased risk of previa that was associated with previous intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after previous prelabor cesarean delivery may be important when considering nonmedically indicated prelabor cesarean delivery.
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Compared with vaginal birth, a previous prelabour caesarean section is associated with an increased risk of placenta praevia in the second delivery (aOR 2.62, 95% CI 1.24-5.56).
“Compared with vaginal birth, a previous prelabour caesarean section is associated with an increased risk of placenta praevia in the second delivery (adjusted OR [aOR] 2.62, 95% CI 1.24-5.56).27”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [27]
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- Authors
- Downes, K. L., Hinkle, S. N., Sjaarda, L. A., Albert, P. S., & Grantz, K. L.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Grantz, Katherine L.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 212
- Issue
- 5
- Pages
- 669.e1-669.e6
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC4416991
- OpenAlex
- W2007718181
- Cited by
- 79
- References
- 31
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 10 · 2022: 7 · 2021: 14 · 2020: 8 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 6 · 2015: 2
- FWCI
- 6.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99HD999999)
- U.S. Public Health Service (HHSN27500004)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN275200800002C, HHSN275200800002I)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- placenta previa, intrapartum cesarean delivery, previous cesarean section, second pregnancy, nulliparous women, risk factors, vaginal delivery, singleton pregnancy, maternal age, smoking, insurance status, comorbidities, previous pregnancy loss, uterine scar
- MeSH terms
- Adolescent, Adult, Cesarean Section, Female, Humans, Maternal Age, Middle Aged, Placenta Previa, Pregnancy, Retrospective Studies, Risk Factors, Utah, Cohort Studies, Logistic Models, Odds Ratio, Delivery, Obstetric, Young Adult
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