Risk factor for postoperative hemorrhage after cesarean section for placenta previa : A retrospective study

Abstract

Background Placenta previa can cause postoperative hemorrhage. Even cases with less intraoperative hemorrhages during cesarean section have the potential risk of developing postoperative hemorrhage. However, there are few reports on the predictive factors of postoperative hemorrhage associated with placenta previa. The aim of this study was to identify the predictive factor for postoperative hemorrhage after cesarean section in women with placenta previa. Methods We identified women with placenta previa who underwent cesarean section at our institution between January 2003 and February 2015. All women who received any hemostatic procedure, such as intrauterine balloon tamponade and gauze infiltration during cesarean section were excluded. All women were classified into two groups: Group A, women with massive postoperative hemorrhage, defined as over 500 ml of hemorrhage after cesarean section, and Group B, women without postoperative hemorrhage. A retrospective analysis to identify the predictive factors for postoperative hemorrhage was conducted. Results Out of 128 women, 10 (7.8%) were included in Group A and 118 (92.2%) in Group B. There was no statistically significant difference in maternal history between the groups. The number of women suspected to have placental adhesion was higher in Group A than in Group B (p=0.006). Furthermore, the amount of intraoperative hemorrhage in Group A was higher than that in Group B (p=0.025). As treatment for postoperative hemorrhage, more women in Group A received allogenic blood transfusion (p=0.003) and uterine artery embolization (p = 0.010). In univariate analysis, placental adhesion suspected by the surgeon during cesarean section was the predictive factor for postoperative hemorrhage with placenta previa (p=0.002). Conclusions When placental adhesion is suspected by surgeons during a cesarean section, additional hemostatic procedures should be performed to prevent possible postoperative hemorrhage.