Predictors for Emergency Cesarean Delivery in Women with Placenta Previa

Abstract

Objective The objective of this study was to identify the predictors of emergency delivery in women with placenta previa.

Methods This is a retrospective study of pregnancies complicated by placenta previa, scheduled for a cesarean delivery between 2001 and 2011. Using univariable and multivariable regression predictors for emergency delivery in these women were determined. Predictive performance was assessed using receiver operating characteristic analysis and calibration plot. Internal validation was performed by bootstrap analysis.

Results Of 214 women with singleton pregnancies, 93 (43%) had an emergency cesarean delivery, and 43 (20%) were preterm. Independent predictors for emergency delivery were history of cesarean section (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.2–12), antepartum bleeding with one (OR, 7.5; 95% CI, 2.5–23), two (OR, 14; 95% CI, 4.3–47), and three or more episodes (OR, 27; 95% CI, 8.3–90) as well as need for blood transfusion (OR, 6.4; 95% CI, 1.7–23). For emergency preterm delivery, covariates were comparable. The area under the curve was 0.832 on the original data and 0.821 on the bootstrap samples.

Conclusion Predictors for emergency delivery in women with placenta previa can be used for individualized antenatal care concerning timing of delivery and corticosteroid cover. Potentially, careful selection in women with placenta previa can result in more conservative treatment in an outpatient setting and reduction of iatrogenic preterm delivery.

Keywords

placenta previa - prediction - cesarean section - emergency delivery

Note

This study was presented at the 35th Annual Meeting, The Pregnancy Meeting, Hilton San Diego Bayfront, San Diego, CA, February 2–7, 2015.

• References

• 1 Johnston TA, Paterson-Brown S. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Royal College of Obstetricians and Gynaecologists. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_27.pdf.Accessed 2011
• 2 Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol 2003; 188 (5) 1299-1304
• 3 Zlatnik MG, Cheng YW, Norton ME, Thiet MP, Caughey AB. Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med 2007; 20 (10) 719-723
• 4 Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000; 17 (2) 101-105
• 5 Fishman SG, Chasen ST, Maheshwari B. Risk factors for preterm delivery with placenta previa. J Perinat Med 2012; 40 (1) 39-42
• 6 Lam CM, Wong SF, Chow KM, Ho LC. Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 2000; 20 (1) 27-31
• 7 Onwere C, Gurol-Urganci I, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH. Maternal morbidity associated with placenta praevia among women who had elective caesarean section. Eur J Obstet Gynecol Reprod Biol 2011; 159 (1) 62-66
• 8 Crane JM, van den Hof MC, Dodds L, Armson BA, Liston R. Neonatal outcomes with placenta previa. Obstet Gynecol 1999; 93 (4) 541-544
• 9 Nørgaard LN, Pinborg A, Lidegaard Ø, Bergholt T. A Danish national cohort study on neonatal outcome in singleton pregnancies with placenta previa. Acta Obstet Gynecol Scand 2012; 91 (5) 546-551
• 10 (NVOG) DAoOaG. Guideline Blood Loss in the Second Half of Pregnancy. Utrecht: The Dutch Society of Obstetrics and Gynecology; 2011
• 11 Smith GC, Seaman SR, Wood AM, Royston P, White IR. Correcting for optimistic prediction in small data sets. Am J Epidemiol 2014; 180 (3) 318-324
• 12 Neilson JP. Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2003; (2) CD001998
• 13 Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. Int J Gynaecol Obstet 2006; 93 (2) 110-117
• 14 Luangruangrong P, Sudjai D, Wiriyasirivaj B, Paloprakarn C. Pregnancy outcomes of placenta previa with or without antepartum hemorrhage. J Med Assoc Thai 2013; 96 (11) 1401-1407
• 15 Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome?. Am J Perinatol 2003; 20 (7) 353-360
• 16 Ghi T, Youssef A. Ultrasonographic cervical length and risk of hemorrhage in pregnancies with placenta previa. Obstet Gynecol 2010; 116 (6) 1458-1459 , author reply 1458–1459
• 17 Balayla J, Wo BL, Bédard MJ. A late-preterm, early-term stratified analysis of neonatal outcomes by gestational age in placenta previa: defining the optimal timing for delivery. J Matern Fetal Neonatal Med 2015; 28 (15) 1756-1761
• 18 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3) CD004454
• 19 Melamed N, Shah J, Soraisham A , et al. Association between antenatal corticosteroid administration-to-birth interval and outcomes of preterm neonates. Obstet Gynecol 2015; 125 (6) 1377-1384
• 20 French NP, Hagan R, Evans SF, Mullan A, Newnham JP. Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior. Am J Obstet Gynecol 2004; 190 (3) 588-595
• 21 Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed 2013; 98 (3) F195-F200