Shira Fishman

Risk factors for preterm delivery with placenta previa.

Abstract Aims: To identify factors associated with preterm delivery in cases of sonographically identified placenta previa. Methods: Pregnancies with sonographic evidence of placenta previa at ≥28 weeks were identified. Demographic information, antepartum course, and delivery information were extracted from electronic medical records. Statistical analysis was performed with Fisher’s exact test, Mann-Whitney U, Spearman’s ρ (correlation), and logistic regression. Continuous data are presented as median (interquartile range). Results: Of 113 singleton pregnancies with placenta previa, 54 (48%) delivered at term and 59 (52%) delivered preterm. Fifty-one (45%) experienced antepartum bleeding at a median gestational age of 31 weeks (29–33 weeks) with a median interval of 20 days (11–33 days) between first bleeding episode and delivery. Women with antepartum bleeding were more likely to be delivered for hemorrhage (36 of 51 vs. 8 of 62, P<0.001) and delivered emergently (40 of 51 vs. 14 of 62, P<0.001). Antepartum bleeding before 34 weeks had a positive predictive value of 88% for preterm birth and 83% for emergent delivery. Conclusion: In pregnancies with placenta previa, antepartum bleeding is a strong predictor of preterm delivery.

Risk factors for emergent preterm delivery in women with placenta previa and ultrasound findings suspicious for placenta accreta

Abstract Aim: To identify factors associated with emergent preterm delivery in women with placenta previa and suspected accreta. Methods: Pregnancies with placenta previa and ultrasound findings suspicious for accreta were identified. Demographic information and obstetric and neonatal outcomes were obtained from electronic medical records. Mann-Whitney U, Fisher’s exact test, and Kaplan-Meier analysis were used. Continuous data are expressed as median (interquartile range). Results: Twenty-one patients with placenta previa and suspicion for accreta delivered at a median of 34 weeks [32–37]. Fourteen bled prior to delivery, 10 at <32 weeks. Fifty-seven percentage of deliveries were planned at a median gestational age of 36.5 weeks [34–37] vs. 32 weeks [29.5–32.5] for emergent deliveries (P<0.001). Emergent delivery was associated with transfusion of a median of nine units packed red blood cells (PRBCs) [4–16] compared to 4.5 units [1–7] with planned delivery (P=0.05). Conclusion: Planned late perterm delivery is reasonable and likely women with placenta previa and ultrasound findings suspicious for placenta accreta who do not experience antepartum bleeding. Those women with multiple episodes of antepartum bleeding or bleeding prior to 32 weeks gestation are at increased risk of emergent preterm delivery.

Risk Factors for Emergent Preterm Delivery in Women With Placenta Previa and Ultrasound Findings Suspicious for Placenta Accreta

Abnormal implantation can prevent normal placental separation in patients with placenta accreta (PA), resulting in massive hemorrhage. Antepartum diagnosis of PA during routine ultrasound permits planned cesarean hysterectomy and can lessen hemorrhagic morbidity associated with this condition. There are no clear guidelines for the timing of planned delivery. To reduce the risk of unscheduled emergent deliveries at term, planned late preterm delivery has been recommended for cases without antepartum bleeding or other complications of pregnancy. Identifying women at highest risk for emergent preterm delivery is desirable because of the ongoing risk of hemorrhage with delayed delivery. This retrospective cohort study was designed to identify risk factors for emergent preterm delivery in women with placenta previa who have ultrasound findings suspicious for accreta. Demographic data, including risk factors for preterm birth, as well as obstetric and neonatal outcomes, were extracted from electronic medical records. Statistical analysis was performed using Fisher exact test, Mann-Whitney U test, logistic regression, and Kaplan-Meier log rank analysis; continuous data was presented as median (interquartile range). Twenty-one patients with placenta previa and suspected accreta were delivered at a median gestational age of 34 weeks (32–37). Fourteen of the patients (67%) had at least one bleeding episode before delivery; 10 bled at 32 weeks. Among the 21 patients, 12 had planned deliveries (57%) at a gestational age of 36.5 weeks (34–37) and 9 had emergent deliveries (43%) at a gestational age of 32 weeks (29.5–32.5; P 0.001). A median of 9 units of packed red blood cells (range: 4–16) was transfused with emergent delivery compared with 4.5 units (range: 1–7) with planned delivery (P 0.05). These findings suggest that planned late preterm delivery is reasonable for women with placenta previa and suspected PA who do not experience antepartum bleeding. Multiple episodes of antepartum bleeding or bleeding before 32 weeks of gestation among women with suspected accreta are associated with increased risk of emergent preterm delivery.