Obstet Gynecol Sci.  2017 Nov;60(6):520-526. 10.5468/ogs.2017.60.6.520.

Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall

• Lee HJ
• Lee YJ
• Ahn EH
• Kim HC
• Jung SH
• Chang SW
• Lee JY

• KMID: 2418352
• DOI: http://doi.org/10.5468/ogs.2017.60.6.520

Abstract

OBJECTIVE
To identify factors associated with massive postpartum bleeding in pregnancies complicated by incomplete placenta previa located on the posterior uterine wall.
METHODS
A retrospective case-control study was performed. We identified 210 healthy singleton pregnancies with incomplete placenta previa located on the posterior uterine wall, who underwent elective or emergency cesarean section after 24 weeks of gestation between January 2006 and April 2016. The cases with intraoperative blood loss (≥2,000 mL) or transfusion of packed red blood cells (≥4) or uterine artery embolization or hysterectomy were defined as massive bleeding.
RESULTS
Twenty-three women experienced postpartum profuse bleeding (11.0%). After multivariable analysis, 4 variables were associated with massive postpartum hemorrhage (PPH): experience of 2 or more prior uterine curettage (adjusted odds ratio [aOR], 4.47; 95% confidence interval [CI], 1.29 to 15.48; P=0.018), short cervical length before delivery (<2.0 cm) (aOR, 7.13; 95% CI, 1.01 to 50.25; P=0.049), fetal non-cephalic presentation (aOR, 12.48; 95% CI, 1.29 to 121.24; P=0.030), and uteroplacental hypervascularity (aOR, 6.23; 95% CI, 2.30 to 8.83; P=0.001).
CONCLUSION
This is the first study of cases with incomplete placenta previa located on the posterior uterine wall, which were complicated by massive PPH. Our findings might be helpful to guide obstetric management and provide useful information for prediction of massive PPH in pregnancies with incomplete placenta previa located on the posterior uterine wall.

Keyword

Placenta previa; Postpartum hemorrhage; Placenta diseases

MeSH Terms

Case-Control Studies
Cesarean Section
Curettage
Emergencies
Erythrocytes
Female
Hemorrhage*
Humans
Hysterectomy
Odds Ratio
Placenta Diseases
Placenta Previa*
Placenta*
Postpartum Hemorrhage
Postpartum Period*
Pregnancy*
Retrospective Studies
Risk Factors*
Uterine Artery Embolization

Figure

• 

  Fig. 1 Ultrasound findings of placenta previa. Placental lacunae (arrow) consisting of irregular area of low echogenicity in the placental parenchyma (A), absent of echolucent area (ellipse) between uterus and placenta (B) and hypervascularity of the cervix on color Doppler (C). BL, bladder; IO, internal orifice of the cervix; PL, placenta; UT, uterus.

• 

  Fig. 2 Flow diagram for identification of participants with incomplete placenta previa located on the posterior uterine wall.

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