| Title: |
Incidence and Risk Factors for Severe Postpartum Hemorrhage in Women with Anterior-Low-Lying or Previa Placenta and Prior Cesarean: Prospective Population-Based Study Authors |
| Authors: |
Pinton, Anne; Deneux-Tharaux, Catherine; Seco, Aurélien; Sentilhes, Loïc; Kayem, Gilles |
| Contributors: |
Obstetrical, Perinatal and Pediatric Epidemiology; Centre for Research in Epidemiology and Statistics; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); CHU Trousseau APHP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux) |
| Source: |
ISSN: 0306-5456 ; British Journal of Obstetrics and Gynaecology ; https://hal.science/hal-04947022 ; British Journal of Obstetrics and Gynaecology, 2023, 130 (13), pp.1653. ⟨10.1111/1471-0528.17554⟩. |
| Publisher Information: |
CCSD; Elsevier |
| Publication Year: |
2023 |
| Subject Terms: |
obstetric haemorrhage; placental pathology; delivery: caesarean section; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics |
| Description: |
International audience ; Objective: To assess the incidence and risk factors for severe postpartum hemorrhage (PPH) in women with an anterior-low-lying or previa placenta, prior cesarean, and no prenatal suspicion of placenta accreta spectrum (PAS).Design: Population-based study in 176 maternity units in France.Population: All women with anterior-low-lying (0-19 mm from the cervical internal os) or previa placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS.Methods: Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth. Main Outcome Measures: Severe PPH defined by a composite criterion either estimated blood loss of 1500 ml or more, transfusion of 4 or more units of packed red blood cells, embolization, or surgical treatment.Results: Of the 520,114 women comprising the source population, 230 (0.44 per 1000 women; 95%CI, 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24. 8% (95%CI, 19.2-30.4) overall, 27.5% (95%CI, 21.8-33.3) in women with placenta previa and 15.4% (95%CI, 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95%CI, 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% 4 (95%CI, 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8). Conclusion: Severe PPH is frequent among women with anterior-low-lying or previa placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH almost doubles when the placenta is previa versus low-lying. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/37226308; PUBMED: 37226308; WOS: 000994464200001 |
| DOI: |
10.1111/1471-0528.17554 |
| Availability: |
https://hal.science/hal-04947022; https://hal.science/hal-04947022v1/document; https://hal.science/hal-04947022v1/file/pinton_manuscript_R1.pdf; https://doi.org/10.1111/1471-0528.17554 |
| Rights: |
info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.FE3AE6FA |
| Database: |
BASE |