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Elective vs Emergent Cesarean Deliveries for Placenta Previa: A Retrospective Cohort Study
Abstract Number: T1D-420
Abstract Type: Original Research
Patients with placenta previa (PP) can cause repeated bleeding during pregnancy. Obstetricians always attempted to arrange scheduled cesarean delivery to prevent unexpected bleeding in prenatal period and to improve maternal and neonatal outcomes. The study was to evaluate the different outcomes between the scheduled and emergent cesarean deliveries (CD) of parturients with PP.
We retrospectively reviewed the records of parturients who had PP that underwent cesarean delivery at Partner Healthcare System from October 2015 to October 2018. 259 cases were identified. A total of 153 cases with vaginal delivery, resolved previa in 3rd trimester, parturient with multi-parity or other concomitant severe comorbidities were excluded. Women who delivered via electively scheduled CD (Group SCD) were compared with those who had an emergent CD (Group ECD). Demographic data, anesthesia and procedure situation and laboratory data were collected. Continuous data were analyzed using the independent two sample t-test or non-parametric Wilcoxon test, and frequency data were analyzed using the Chi-square test or Fisher exact test, depending on data distribution.
There was no significant different demographic characteristics between either groups. Group ECD had lower preoperative hemoglobin (P=0.005) and hematocrit (P=0.002) than group SCD. There were significantly lower gestational age (p=0.03) and baby’s birth weight (p=0.002) with group SCD. There was no difference between the 2 groups with regards to anesthesia and/or procedure time, intraoperative estimated blood loss, blood transfusion, rate of cesarean hysterectomy, newborn resuscitation and neonatal intensive admission.
As the risk of major hemorrhage increases rapidly after 36 weeks of gestation, expert opinions have highlighted that timing of delivery must be individualized and women with uncomplicated PP should undergo SCD on an optimize day. While the neonatal risk of preterm is well established, the timing of delivery must balance the maternal and neonatal risk. ECD might be triggered by prenatal hemorrhage, but no difference was identified in outcomes between the 2 groups. Our study implied that in asymptomatic patients, attempt to prolong gestational age might be warranted to achieve better neonatal prognosis and reduce complications from unnecessary preterm birth.
1. ACOG committee opinion, Obstet Gynecol 2013
2. Jauniaux ERM, BJOG 2018