Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa

Abstract

Background:The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 36 0/7 and 37 6/7 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery. Methods: This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated. Results: Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, P=0.013) and first antepartum bleeding episode ࣘ28 weeks of gestation (36.1% and 14.4%, P<0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, P=0.042), first antepartum bleeding episode ࣘ28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, P=0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, P<0.001) were the independent predictors significantly associated with emergency cesarean delivery. Conclusion: Three factors-antepartum bleeding episode during pregnancy, first antepartum bleeding episode ࣘ28 weeks of gestation, and lower preoperative hemoglobin level-might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis

“…Six studies reported the numbers of newborns with a low Apgar score (<7), instead of the means, at 5 minutes after birth. [18,19,21,23,28,34] When delivered by emergency, neonates had a higher likelihood of having a low 5-minute Apgar score (OR: 0.27; 95% CI: 0.11–0.69; P = .01; I 2 = 65%) (Fig. 2E).…”

“…Thirteen studies compared the birth weights between the PCD and ECD groups. [16][17][18][19][20][21][22][23][24][25]27,28,33] However, one study [16] reported the medians of birth weight in 3 gestational ranges and therefore could not be pooled. In comparison to the ECD group, the pooled birth weight was significantly higher in the PCD group (SMD: 1.64; 95% CI: 1.00-2.27; P < .001; I 2 = 97%).…”

“…Accumulating data has suggested that ECD is associated with a higher risk of adverse maternal outcomes compared to PCD, including more profound intraoperative blood loss, increased need for blood transfusion and intensive care unit admission, and a longer hospital stay. [17][18][19][20][21][22][23][24][25][26][27][28] Regardless, a recent multicenter study found that less than half of prenatally diagnosed PAS patients (39%) in the United States reached a scheduled delivery within the recommended gestational age. [29] As a result, ECD remains an unavoidable and yet common practice for women with abnormal placentation, and understanding the differences between ECD and PCD is critical for optimizing maternal-fetal care.…”

The Effect of Levothyroxine Treatment on Maternal and Perinatal Outcomes in Pregnant Women With Subclinical Hypothyroidism: A 5-Year Retrospective Study at a Tertiary Care Hospital in Turkey

“…Rupture of membranes before 37 th gestational week was designated as PPROM [13]. Pregnant women with gestational diabetes mellitus [14] who had a positive oral glucose tolerance test were excluded from the study, but pregnant women with placenta previa [15] were included. In our study, the normal ranges for TSH, T4, and anti-TPO levels were considered 0.1-2.5 mIU/L, 0.93-1.71 ng/dl, and <5.60 IU/mL, respectively.…”

The Implications of Multiple Repeat Cesarean Deliveries On Maternal Morbidity

“…Repeated CDs are associated with additional risks, including difficulties in surgical dissection, placenta previa, abnormal placental invasion, and peripartum hysterectomy. These complications could be life-threatening for both the pregnant woman and the baby (11,12). However, it remains uncertain whether the frequency of adverse outcomes differs with increasing numbers of CDs.…”