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Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S57, January 01, 2013

101: Does placenta previa location matter? Surgical morbidity associated with previa location

      Objective

      To evaluate the effect of placenta previa location (anterior versus posterior) on surgical morbidity in primary and repeat cesarean deliveries.

      Study Design

      Retrospective cohort undergoing cesarean for placenta previa. The rate of operative morbidity for women with an anterior previa was compared to women with a posterior previa. Stratified analysis was performed based on primary versus repeat cesarean. Logistic regression was performed to control for potential confounders.

      Results

      48,229 women delivered during the study timeframe. 285 women (0.6%) underwent cesarean delivery for placenta previa. 42 (14.5%) women received a hysterectomy or blood transfusion.
      The anterior and posterior previa groups were similar with respect to age, tobacco use and BMI. Women with an anterior previa were more likely to have a prior cesarean delivery, be multiparous and have a singleton gestation compared to women with a posterior previa. The mean blood loss during cesarean was higher for women with an anterior previa (p=0.0005) compared to those with a posterior previa. Women with an anterior previa were more likely to require a blood transfusion (p=0.014) and to undergo hysterectomy (p=0.0001).
      Consistent with prior studies, women undergoing repeat cesarean had higher likelihoods of hysterectomy (OR 9.8, 95% CI 3.1-31.5), blood transfusion (OR 2.1, 95% CI 1.0-4.2) and accreta (OR 5.3, 95% CI 2.1-13.4). In stratified analysis, primary cesareans with anterior previa had higher rates of blood transfusion (aOR 3.09; 95% CI: 1.16-8.17) and hysterectomy (p=0.001) than posterior previas. Women undergoing repeat cesarean with anterior previa had higher rates of hysterectomy (aOR 4.72; 95% CI 1.12-19.78) compared to those with posterior previa.

      Conclusion

      Compared to a posterior placenta previa, an anterior previa increases the risk of hysterectomy for both primary and repeat cesareans and increases the likelihood of blood transfusion at primary cesareans. This information may be useful for pre-operative planning.
      Tabled 1Subgroup analysis of operative morbidity based on cesarean order and placental location
      Table thumbnail grr11