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DOI: 10.1055/a-1974-9399
A Resolved Placenta Previa Is Still Associated with Postpartum Hemorrhage

Abstract
Objective Our objective was to determine whether resolution of a low-lying placenta or placenta previa is associated with postpartum hemorrhage (PPH).
Study Design This is a retrospective, matched-control cohort study of women who underwent transvaginal sonography during fetal anatomic survey between 18 and 24 weeks of gestation at the University of Pennsylvania from January 2017 to May 2019. Exposure was defined as low-lying placenta (≤1 cm from the internal cervical os) or placenta previa (covering the os) at anatomic survey that was found to be resolved by transvaginal ultrasound in the third trimester. For each exposure, we identified a control patient whose placenta was > 1 cm from internal os at anatomic survey performed on the same day. The primary outcome was PPH at delivery, defined as estimated blood loss ≥ 1,000 mL.
Results A total of 450 women were included (225/group). The exposed group of resolved placental previa included 85.0% with resolved low-lying placenta and 15.0% with resolved previa. The rate of PPH was significantly higher in the exposed group versus controls (9.8% vs. 4.4%, p = 0.03). Women with resolved previa were 2.5 times more likely to experience PPH than controls (adjusted odds ratio = 2.58, 95% confidence interval: 1.17–5.69), even when controlling for parity, prior cesarean, and delivery mode. Women with resolved previa were also more likely to present to triage with bleeding (16.4% vs. 8.0%, p = 0.006), receive antenatal corticosteroids, (9.3% vs. 3.1%, p = 0.006), and receive intravenous iron postpartum (7.6% vs. 3.1%, p = 0.04).
Conclusion Our data demonstrate that women with a resolved low-lying placenta or placenta previa remain at significantly increased risk of bleeding-related complications in pregnancy and during delivery when compared with those who never had a previa. Clinicians should consider this association when counseling patients and performing hemorrhage risk stratification.
Key Points
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Women with resolved previa or low-lying placenta were 2.5 times more likely to experience PPH.
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Women with resolved previa or low-lying placenta were more likely to be induced for bleeding.
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Resolved previa or low-lying placenta is still associated with adverse hemorrhage-related outcomes.
Keywords
low-lying placenta - placenta previa - postpartum hemorrhage - resolved previa - resolved placenta previa - resolved low-lying placentaPublication History
Received: 07 February 2022
Accepted: 01 November 2022
Accepted Manuscript online:
09 November 2022
Article published online:
21 December 2022
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References
- 1 Eugene Declercq LZ. Maternal mortality in the United States: a primer. Accessed May 1, 2021 at: https://doi.org/10.26099/ta1q-mw24
- 2 Hamm RF, Wang EY, Bastek JA, Srinivas SK. Assessing reVITALize: should the definition of postpartum hemorrhage differ by mode of delivery?. Am J Perinatol 2017; 34 (05) 503-507
- 3 Eichelberger KY, Haeri S, Kessler DC, Swartz A, Herring A, Wolfe HM. Placenta previa in the second trimester: sonographic and clinical factors associated with its resolution. Am J Perinatol 2011; 28 (09) 735-739
- 4 Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000; 17 (02) 101-105
- 5 Magann EF, Doherty DA, Turner K, Lanneau Jr. GS, Morrison JC, Newnham JP. Second trimester placental location as a predictor of an adverse pregnancy outcome. J Perinatol 2007; 27 (01) 9-14
- 6 Ogueh O, Morin L, Usher RH, Benjamin A. Obstetric implications of low-lying placentas diagnosed in the second trimester. Int J Gynaecol Obstet 2003; 83 (01) 11-17
- 7 Osmundson SS, Wong AE, Gerber SE. Second-trimester placental location and postpartum hemorrhage. J Ultrasound Med 2013; 32 (04) 631-636
- 8 Gabel K, Lyndon A, Main E. CMQCC Risk Factor Assessment. Accessed November 22, 2022 at: https://www.cmqcc.org/content/risk-factor-assessment
- 9 Committee on Practice Bulletins-Obstetrics. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
- 10 Postpartum Hemorrhage (PPH) RIsk Assessment Table. . Accessed May 1, 2021 at: https://cdn-links.lww.com/permalink/aog/b/aog_134_6_2019_10_06_kawakita_19-1065_sdc2.pdf
- 11 Quant HS, Friedman AM, Wang E, Parry S, Schwartz N. Transabdominal ultrasonography as a screening test for second-trimester placenta previa. Obstet Gynecol 2014; 123 (03) 628-633
- 12 Vergani P, Ornaghi S, Pozzi I. et al. Placenta previa: distance to internal os and mode of delivery. Am J Obstet Gynecol 2009; 201 (03) 266.e1-266.e5
- 13 Ende HB, Lozada MJ, Chestnut DH. et al. Risk factors for atonic postpartum hemorrhage: a systematic review and meta-analysis. Obstet Gynecol 2021; 137 (02) 305-323