Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study.

PURPOSE: Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes. METHODS: This study was conducted in The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital between January 2009 and 2019. PP was traditionally classified into four types, namely low-lying placenta, marginal, partial, and complete PP. Previous studies have classified PP into two types, namely low-lying placenta and PP. Based on our clinical experience, we proposed the classification of PP into three types, for the first time, which included low-lying placenta, "marpartial" (marginal and partial) PP, and complete PP. Multivariate logistic regression analysis was performed to determine the effects of different types of PP on maternal and neonatal outcomes. RESULTS: In total, 4490 singleton pregnancies were complicated with PP. In the four-classification method, compared with women with low-lying placenta, women with complete PP had a risk of placenta accrete spectrum disorders, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and neonatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and neonatal outcomes, compared with low-lying placenta. CONCLUSION: Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification of PP may be practical from the clinical perspective.

Which type of placenta previa requires blood transfusion more frequently? A new concept of indiscernible edge total previa.

AIM: During cesarean section (CS) for placenta previa (PP), the size/area/portion of the lower uterine segment occupied by the placenta may affect the bleeding amount and the subsequent need for a blood transfusion (BT). We propose a new concept, indiscernible edge total PP (IEPP), when vaginal ultrasound does not discern the lower placental edge because the placenta covers the visible lower segment. We characterized IEPP, focusing on its allogeneic BT requirement. METHODS: We classified PP (n = 307) into four types: marginal, partial, discernible edge total PP (DEPP) and IEPP: internal ostium (os)-placental edge distance measurable or unmeasurable on vaginal ultrasound in DEPP or IEPP, respectively. We determined the clinical characteristics according to the four types; the relationship between the intraoperative blood loss and os-edge distance in DEPP; and risk factors for allogeneic BT. RESULTS: The following were significantly higher/larger in cases of IEPP: previous CS; anterior placentation; lacunae; elective cesarean hysterectomy; intraoperative blood loss; autologous BT; allogeneic BT; intensive care unit admission; and an abnormally invasive placenta (AIP). In DEPP, the os-edge distance was weakly correlated with the bleeding amount (r = 0.214). Multivariate logistic regression analysis showed that previous CS, lacunae, AIP and IEPP were independent risk factors for allogeneic BT (odds ratios 3.8, 3.1, 13.8 and 4.6, respectively). After excluding patients undergoing hemostatic procedures during CS, IEPP remained the only independent risk factor for allogeneic BT (odds ratio 5.2). CONCLUSIONS: The new concept of IEPP may be useful for predicting BT in CS for patients with PP.

[Analysis of obstetric outcomes for different types of placenta previa].

OBJECTIVE: To explore the maternal and perinatal outcomes for different types of placenta previa (PP). METHODS: A total of 343 pregnancies with PP from January 2003 to December 2012 at our hospital were retrospectively reviewed. The general profiles, maternal and perinatal outcomes of different types of 325 singleton PP were evaluated. RESULTS: Among them, 221 pregnancies were of complete PP. There were partial (n = 22) and marginal (n = 82) PP. Proportions of previous vaginal and cesarean deliveries in women with complete and partial PP were higher than those with marginal PP (P < 0.05). Compared with marginal PP group, ratio of placenta in the uterus posterior wall prepartum hemorrhage and probability of blood transfusion and neonatal asphyxia were much higher in complete and partial PP. The gestational age at delivery and neonatal body weight with complete PP and partial PP marginal PP were higher than those of the other two groups (P < 0.05). As for the placenta adhesion, placenta accrete or postpartum hemorrhage, no difference existed among three groups placenta location. CONCLUSION: The gestational age at delivery, prepartum hemorrhage, probability of blood transfusion and perinatal outcome in women with PP are related with the type of PP. Both complete and partial PP have relatively worse outcomes. The type of PP has no effect on placenta adhesion, placenta accrete or postpartum hemorrhage.

Anesthesia management of complete versus incomplete placenta previa: a retrospective cohort study.

PURPOSE: Placenta previa (PP) is a major cause of obstetric hemorrhage. Clinical diagnosis of complete versus incomplete PP has a significant impact on the peripartum outcome. Our study objective is to examine whether distinction between PP classifications effect anesthetic management. METHODS AND MATERIALS: This multi-center, retrospective, cohort study was performed in two tertiary university-affiliated medical centers between the years 2005 and 2013. Electronic delivery databases were reviewed for demographic, anesthetic, obstetric hemorrhage, and postoperative outcomes for all cases. RESULTS: Throughout the study period 452 cases of PP were documented. We found 134 women (29.6%) had a complete PP and 318 (70.4%) had incomplete PP. Our main findings were that women with complete PP intraoperatively had higher incidence of general anesthesia (p = .017), higher mean estimated blood loss (p < .001), increased blood components transfusions (p < .001), and significant increase in cesarean hysterectomy rate (p < .001) than women with incomplete PP. Additionally, complete PP was associated with more postoperative complications: higher incidence of admission to the intensive care unit (ICU) (p < .001), more mechanical ventilation (p = .02), a longer median postoperative care unit (PACU) (p = .02), ICU (p = .002), and overall length of stay in the hospital (p < .001). CONCLUSIONS: Complete PP is associated with increased risk of hemorrhage compared with incomplete PP. Therefore distinction between classifications should be factored into anesthetic management protocols.

Marginal sinus placenta previa is a different entity in placenta previa: A retrospective study using magnetic resonance imaging.

OBJECTIVE: The current definition of placenta previa does not include whether the placental edge is parenchyma or marginal sinus defined as placenta previa in which the placental marginal sinus just reached the internal os and/or in which the placental parenchyma might be located at > 2 cm from internal os. MATERIALS AND METHODS: Cases with placenta previa were identified through the review of magnetic resonance imaging (MRI) from among 210 cases at our institution between 2007 and 2016. The clinical outcomes of patients with marginal sinus placenta previa (Group A) were compared with patients with low-lying placenta and marginal placenta (Group B) and patients with partial placenta and total placenta previa (Group C), respectively. This study was a retrospective analysis. RESULTS: Twenty-seven (12.7%) cases were included in Group A. The patients in Group B and Group C were 72 and 108 cases, respectively. First, Group A more frequently underwent emergency cesarean section than Group B (p = 0.02). There was no statistical significance with other maternal history, post-or pre-operative hemorrhage, and/or additional treatment for hemorrhage between the two groups. Additionally, Group A delivered at a later gestational age (p < 0.01); were less frequently complicated with antenatal bleeding (p < 0.01); underwent emergency cesarean section (p < 0.01), allogenic blood transfusion (p < 0.01), and uterine artery embolization (p < 0.01) for postpartum hemorrhage less often; and had less perioperative hemorrhage (p < 0.01) than Group C. CONCLUSIONS: Marginal sinus placenta previa may be a mild type of placenta previa. This new classification could be useful in the management of placenta previa.

Early placenta previa and delivery outcome.

Ultrasound scan showed some degree of placenta previa in 503 patients. Of this group, 5.6% (28) had clinically significant bleeding or documented placenta previa at delivery. A scoring system based on placental localization was not successful in predicting who was at high risk for bleeding. However, the likelihood of clinically excessive bleeding did significantly increase if the placenta previa was noted after 30 weeks' gestation. The study did not find a greater incidence of small-for-gestational-age babies in women with low-lying placentas.

Placenta previa--the identification of low- and high-risk subgroups.

Among a group of 155 women with placenta previa (PP), two subgroups were identified: subgroup A consisted of 56 pregnancies (56 newborns) in women who had an asymptomatic antenatal course and who were delivered following a single episode of uterine bleeding; subgroup B consisted of 99 pregnancies (103 newborns) in women who had multiple antepartum bleeding episodes. The women in subgroup B were older, more parous, had more abortions and caesarean sections compared to those in subgroup A. Although the distribution of women in both subgroups with respect to the types of PP was similar, the prognosis in subgroup A was better with respect to various maternal and perinatal aspects. The recognition of low- and high-risk subgroups among women with PP may have practical implications for management protocols.

[Pathological positioning of the placenta at 20 weeks' gestation--its significance for the course of the pregnancy and labor]. / Patologichno razpolozhenie na platsentata v 20. gestatsionna sedmitsa--znachenie za protichaneto na bremennostta i razhdaneto.

The authors found pathologically located placenta in 5.2% of pregnant women during ultrasound examinations at 20 weeks' gestation. The pregnant women were examined periodically by the echograph every 4 weeks. Hundred women with normal localization of the placenta were included in the control group. There were 5-fold more frequent bleedings in the investigated group as 86.5% of bleedings were manifested for the first time after 20 weeks' gestation. The frequency and strength of bleedings were in close connection with the gravity of the pathological insertion. Asymptomatically progressing pregnancies with abnormally localized placenta were 66%. The authors found percentage dependence of pathological placental localization on the gestational period and the possibility for reliable diagnosis. They recommend follow-up of placental localization dynamically till the end of pregnancy on the basis of the possibility for a change in placental localization and its significance for the course of pregnancy and delivery.

Placenta praevia--a review with emphasis on the role of ultrasound.

Considerable confusion exists in the literature as a result of the wide range of classification systems for placenta praevia (PP) and low-lying placenta. The discrepancy between frequency of low-lying placentas in the second trimester and PP at term reflects to a certain extent the lack of understanding of the anatomy and physiology of the pregnant uterus. It seems that 'placental conversion' is a real phenomenon and is probably due to the differential growth rates of the placenta and uterus. Maternal bladder overdistension and myometrial contractions account for only a small part of the discrepancy. Diagnostic ultrasound obviously has an important role in placental localization. The role of Magnetic Resonance Imaging remains to be determined. The management of patients with low-lying placenta diagnosed in the second trimester, and the frequency of repeat scans is determined largely by the management protocol of the attending obstetrician.

Placenta previa: does its type affect pregnancy outcome?

Our objective was to compare pregnancy outcomes associated with different types of placenta previa. This is a retrospective analysis of pregnancies complicated by placenta previa, from January 1990 to December 1997. Descriptive statistics and comparison analyses were performed. One hundred seventy-five singleton pregnancies beyond 24 weeks that were complicated by complete, partial, or marginal previa were included. Differences in pregnancy outcomes between complete, partial, and marginal previas were: onset of bleeding (29.9 +/- 4.5 versus 32.5 +/- 6.9 versus 32.7 +/- 5.0 weeks, respectively, p < 0.05), antepartum hospitalization (60.7% versus 38.1% versus 35.1%, respectively, p < 0.05), gestation at delivery (34.7 +/- 3.1 versus 37.4 +/- 2.6 versus 36.1 +/- 3.0 weeks, respectively, p < 0.05), birth weight (2498.3 +/- 746.8 versus 2978.8 +/- 568.3 versus 2813.4 +/- 728.4 g, respectively, p < 0.05), and hysterectomy at time of cesarean delivery (20.5% versus 0% versus 8.1%, respectively, p < 0.05). For all outcome parameters, the partial and marginal previa groups did not differ. Women with complete placenta previa, as diagnosed with modern ultrasound techniques, had poorer pregnancy outcome. They were more likely to deliver prematurely and were more likely to require a hysterectomy at the time of cesarean delivery.