Antepartum Risk Factors Associated with Peripartum Cesarean Hysterectomy in Women with Placenta Previa

ABSTRACT

The objective of this study was to identify antepartum risk factors for peripartum hysterectomy in women with placenta previa. The medical records of women with placenta previa who underwent cesarean section (C/S) were reviewed retrospectively. Data regarding the reproductive history and peripartum outcomes were analyzed. Multivariable analysis was used to identify factors independently associated with hysterectomy. During an 8.5-year period, 346 cases of placenta previa were identified in 24,987 deliveries (1.4%). An emergent hysterectomy was performed in 31 patients (9.0%). Multiparity, total previa, history of abortion, C/S, and placenta previa was more common in the hysterectomy group. An increasing number of abortions and C/S were associated with a higher frequency of hysterectomy. By the multivariable analysis, previous abortion, previous C/S, and total previa were significant risk factors for hysterectomy. We concluded that in women with placenta previa, history of abortion as well as prior C/S, and a total previa are strong antepartum risk factors for peripartum hysterectomy.

KEYWORDS

Placenta previa - cesarean hysterectomy - previous cesarean section - previous abortion

REFERENCES

• 1 Ananth C V, Smulian J C, Vintzileos A M. 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 1299-1304
• 2 Crane J M, Van den Hof M C, Dodds L, Armson B A, Liston R. Maternal complications with placenta previa.  Am J Perinatol. 2000;  17 101-105
• 3 Iyasu S, Saftlas A K, Rowley D L, Koonin L M, Lawson H W, Atrash H K. The epidemiology of placenta previa in the United States, 1979 through 1987.  Am J Obstet Gynecol. 1993;  168 1424-1429
• 4 Ananth C V, Demissie K, Smulian J C, Vintzileos A M. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions.  Am J Obstet Gynecol. 2003;  188 275-281
• 5 Frederiksen M C, Glassenberg R, Stika C S. Placenta previa: a 22-year analysis.  Am J Obstet Gynecol. 1999;  180 1432-1437
• 6 Sheiner E, Shoham-Vardi I, Hallak M, Hershkowitz R, Katz M, Mazor M. Placenta previa: obstetric risk factors and pregnancy outcome.  J Matern Fetal Med. 2001;  10 414-419
• 7 Faiz A S, Ananth C V. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies.  J Matern Fetal Neonatal Med. 2003;  13 175-190
• 8 Oyelese Y, Smulian J C. Placenta previa, placenta accreta, and vasa previa.  Obstet Gynecol. 2006;  107 927-941
• 9 Castaneda S, Karrison T, Cibils L A. Peripartum hysterectomy.  J Perinat Med. 2000;  28 472-481
• 10 Sheiner E, Levy A, Katz M, Mazor M. Identifying risk factors for peripartum cesarean hysterectomy. A population-based study.  J Reprod Med. 2003;  48 622-626
• 11 Stanco L M, Schrimmer D B, Paul R H, Mishell Jr D R. Emergency peripartum hysterectomy and associated risk factors.  Am J Obstet Gynecol. 1993;  168 879-883
• 12 Zaki Z M, Bahar A M, Ali M E, Albar H A, Gerais M A. Risk factors and morbidity in patients with placenta previa accreta compared to placenta previa non-accreta.  Acta Obstet Gynecol Scand. 1998;  77 391-394
• 13 Clark S L, Yeh S Y, Phelan J P, Bruce S, Paul R H. Emergency hysterectomy for obstetric hemorrhage.  Obstet Gynecol. 1984;  64 376-380
• 14 Yaegashi N, Chiba-Sekii A, Okamura K. Emergency postpartum hysterectomy in women with placenta previa and prior cesarean section.  Int J Gynaecol Obstet. 2000;  68 49-52
• 15 Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome.  Int J Gynaecol Obstet. 2006;  93 110-117
• 16 Silver R M, Landon M B, Rouse D J et al.. Maternal morbidity associated with multiple repeat cesarean deliveries.  Obstet Gynecol. 2006;  107 1226-1232
• 17 Clark S L. Placenta previa and abruptio placentae. In: Creasy RK, Resnik R, Iams JD Maternal-Fetal Medicine. Principles and Practice. Philadelphia; WB Saunders 2004: 707-713
• 18 Clark S L, Koonings P P, Phelan J P. Placenta previa/accreta and prior cesarean section.  Obstet Gynecol. 1985;  66 89-92
• 19 Miller D A, Chollet J A, Goodwin T M. Clinical risk factors for placenta previa-placenta accreta.  Am J Obstet Gynecol. 1997;  177 210-214