Placenta previa totalis and previous cesarean section

Ahn, H K; Kim, E S; Han, J Y; Kim, M Y; Ryu, H M; Choi, K H; Yang, J H

Abstract

OBJECTIVE
To determine the relationship between previous cesarean section and subsequent development of placenta previa totalis and placenta previa totalis with accreta.
MATERIALS AND METHODS
A retrospective review of the case records of all women delivered with the diagnosis of placenta previa totalis during the 5-year period from August 1, 1994, to July 31, 1999, at the Samsung Cheil Hospital.
RESULTS
There were 38,215 deliveries in the study period. 237(0.62%) had placenta previa totalis and 56(23.6%) of whom had a history of previous cesarean section. The incidence of placenta previa totalis was significantly increased in those with a previous cesarean section(1.19%) compared with those with an unscarred uterus(0.54%). In the group without antecedent of cesarean section, accretism risk was 11.6%, with one section or more 32.1%. The need for cesarean hysterectomy occurred more commonly in patients who had a prior cesarean delivery, 14 of 56(25%), as compared with patients with no prior cesarean delivery, 6 of 181(3.3%).
CONCLUSION
There is a strong association between previous cesarean section and risk of subsequent development of placenta previa totalis. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk of developing placenta accreta. patients with previous cesarean section have a significantly higher incidence of postpartum hemorrhage and are more likely to undergo emergency hysterectomy.