Placenta previa and maternal hemorrhagic morbidity
Open accessAbstract
OBJECTIVE: Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. METHODS: This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. RESULTS: Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. CONCLUSION: Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.
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Regional anaesthesia is considered safe and is associated with lower risks of haemorrhage than general anaesthesia for caesarean delivery in women with placenta praevia or a low-lying placenta.
“Regional anaesthesia is considered safe and is associated with lower risks of haemorrhage than general anaesthesia for caesarean delivery in women with placenta praevia or a low-lying placenta.”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [86]
The Results report that general anaesthesia was associated with greater maternal haemorrhagic morbidity among women having caesarean delivery for placenta praevia (aOR 4.29, 95% CI 2.25–8.16). The paper does not establish that regional anaesthesia is safe or report this association for women with a low-lying placenta. The Discussion also cautions that general anaesthesia may be a marker of emergency delivery rather than a cause of bleeding. (LLM, conf=0.87)
Experimental — accuracy not yet measuredMaternal haemorrhagic morbidity is more common in women with praevia (19% versus 7%, adjusted RR 2.6, 95% CI 1.9-3.5).
“maternal haemorrhagic morbidity is more common in women with praevia (19% versus 7%, adjusted RR 2.6, 95% CI 1.9-3.5)”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [86]
The recent case-control study from the NICHD/MFMU Network Cesarean Section Registry found general anaesthesia to be one of the main factors associated with maternal haemorrhage in women with placenta praevia.
“The recent case-control study from the NICHD/MFMU Network Cesarean Section Registry found general anaesthesia to be one of the main factors associated with maternal haemorrhage in women with placenta praevia.86”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [86]
Main factors associated with maternal haemorrhage in women with placenta praevia include pre-delivery anaemia, thrombocytopenia, diabetes and magnesium use.
“the main factors associated with maternal haemorrhage include pre-delivery anaemia, thrombocytopenia, diabetes and magnesium use.86”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [86]
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References 20 · Cited by 101
- Authors
- Gibbins, K. J., Einerson, B. D., Varner, M. W., & Silver, R. M.
- Affiliations
- Intermountain Healthcare (US)
- Corresponding author
- Gibbins, Karen J.
- Venue
- The Journal of Maternal-Fetal & Neonatal Medicine
- Publisher
- Informa UK Limited
- Published
- 2017-02-21
- Volume
- 31
- Issue
- 4
- Pages
- 494-499
- ISSN
- 1476-4954 (ISSN-L)
- 1476-7058
- PMC
- PMC6687304
- OpenAlex
- W2584620814
- Cited by
- 101
- References
- 20
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 9 · 2023: 22 · 2022: 20 · 2021: 14 · 2020: 11 · 2019: 3 · 2018: 4 · 2017: 2 · 2012: 1
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Maternal-Fetal & Neonatal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Center for Clinical and Translational Sciences (05)
- Utah WRHR (16])
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (1K12HD085816)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- placenta previa, maternal hemorrhage, postpartum hemorrhage, cesarean section, uterine atony, red blood cell transfusion, hysterectomy, risk factors, thrombocytopenia, diabetes mellitus, general anesthesia
- MeSH terms
- Adult, Anemia, Cesarean Section, Female, Postpartum Hemorrhage, Humans, Magnesium, Placenta Previa, Pregnancy, Retrospective Studies, Risk Factors, Thrombocytopenia, Case-Control Studies
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