Factors associated with severe postpartum hemorrhage in women with posterior low‐lying placenta and prior cesarean: A prospective population‐based study
Anne Pinton, Catherine Deneux‐Tharaux, Aurélien Seco, Loïc Sentilhes, Gilles KayemAbstract
Objective
Our objective was to conduct an exploratory assessment of the incidence and factors associated with severe postpartum hemorrhage (PPH) in women with posterior low‐lying placenta and prior cesarean without prenatal suspicion of placenta accreta spectrum (PAS).
Methods
The study population was derived from the PACCRETA population‐based study conducted in the 176 maternity units of 12 French regions from November 2013 through October 2015. All women with posterior low‐lying placenta and prior Cesarean without prenatal suspicion of PAS were included in this analysis. The main outcome measure was a composite criterion of severe PPH defined by either estimated blood loss of ≥1500 mL, transfusion of 4 or more units of packed red blood cells, embolization, or surgical treatment.
Results
Of the 520 114 women in the source population, 75 met the inclusion criteria (0.14 per 1000 women; 95% confidence interval [CI] 0.11–0.18). Among these women, severe PPH occurred in seven (i.e., severe PPH incidence of 9.3% [95% CI 4.2–18.9]). Unsuspected PAS was diagnosed at delivery in four women of the study population (5.3%). Without these cases of PAS, the severe PPH incidence was 7.0% (95% CI 2.6–16.3). Factors associated with severe PPH were unsuspected PAS diagnosed at delivery (severe PPH incidence of 50% vs. 7%, P = 0.04) and placenta‐os distance 1–9 mm compared with 10–19 mm (severe PPH incidence of 19% vs. 0%, P = 0.03).
Conclusion
About 1 in 11 women with posterior low‐lying and prior cesarean without antenatal suspicion of PAS has severe PPH. Factors associated with severe PPH are unsuspected PAS diagnosed at delivery and 1–9 mm versus 10–19 mm placenta‐os distance. These associations should be considered exploratory and require confirmation in larger studies.