HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grobman, W. A. Search for Related Content PubMed PubMed Citation Articles by Grobman, W. A. Related Collections Epidemiology/public health Obstetric complications of pregnancy

Pregnancy Outcomes for Women With Placenta Previa in Relation to the Number of Prior Cesarean Deliveries

From the Departments of Obstetrics and Gynecology at ¹Northwestern University, Chicago, Illinois; the² Ohio State University, Columbus, Ohio; ³University of Texas Southwestern Medical Center, Dallas, Texas; ⁴University of Alabama at Birmingham, Birmingham, Alabama; ⁵University of Utah, Salt Lake City, Utah; ⁶University of Chicago, Chicago, Illinois; ⁷University of Pittsburgh, Pittsburgh, Pennsylvania; ⁸Wake Forest University, Winston-Salem, North Carolina; ⁹Thomas Jefferson University, Philadelphia, Pennsylvania; ¹⁰Wayne State University, Detroit, MI; ¹¹University of Cincinnati, Cincinnati, Ohio; ¹²Columbia University, New York, New York; ¹³Brown University, Providence, Rhode Island; ¹⁴University of Miami, Miami, Florida; ¹⁵University of Tennessee, Memphis, Tennessee; ¹⁶University of Texas at San Antonio, San Antonio, Texas; ¹⁷University of North Carolina, Chapel Hill, North Carolina; ¹⁸University of Texas at Houston, Houston, Texas; ¹⁹Case Western Reserve University, Cleveland, Ohio; the ²⁰George Washington University Biostatistics Center, Washington, DC; and the ²¹National Institute of Child Health and Human Development, Bethesda, Maryland.

OBJECTIVE: To estimate the association between the number of prior cesarean deliveries and pregnancy outcomes among women with placenta previa.

METHODS: Women with a placenta previa and a singleton gestation were identified in a concurrently collected database of cesarean deliveries performed at 19 academic centers during a 4-year period. Maternal and perinatal outcomes were analyzed after stratifying by the number of cesarean deliveries before the index pregnancy.

RESULTS: Of the 868 women in the analysis, 488 had no prior cesarean delivery, 252 had one prior cesarean delivery, 76 had two prior cesarean deliveries, and 52 had at least three prior cesarean deliveries. Multiple measures of maternal morbidity (eg, coagulopathy, hysterectomy, pulmonary edema) increased in frequency as the number of prior cesarean deliveries rose. Even one prior cesarean delivery was sufficient to increase the risk of an adverse maternal outcome (a composite of transfusion, hysterectomy, operative injury, coagulopathy, venous thromboembolism, pulmonary edema, or death) from 15% to 23%, which corresponded, in multivariable analysis, to an adjusted odds ratio of 1.9 (95% confidence interval 1.2–2.9). Conversely, gestational age at delivery and adverse perinatal outcome (a composite measure of respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage grade 3 or 4, seizures, or death) were unrelated to the number of prior cesarean deliveries.

CONCLUSION: Among women with a placenta previa, an increasing number of prior cesarean deliveries is associated with increasing maternal, but not perinatal, morbidity.

LEVEL OF EVIDENCE: II

This article has been cited by other articles:

				D. Pasupathy and G. C S Smith Neonatal outcomes with caesarean delivery at term Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2008; 93(3): F174 - F175. [Full Text] [PDF]