TY - JOUR
T1 - Timing of cesarean delivery in women with uncomplicated placenta previa
AU - Schwartz, Anat
AU - Chen, Daniela
AU - Shinar, Shiri
AU - Agrawal, Swati
AU - Yogev, Yariv
N1 - Publisher Copyright:
© 2022 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022
Y1 - 2022
N2 - Objective: The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 360/7 and 376/7weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 360/7 to 386/7weeks compared with expectant management in women with uncomplicated placenta previa. Methods: A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 360/7 and 386/7weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management. Results: At 360/7–366/7weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p =.68). Similarly, at 370/7–376/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p =.54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 360/7–366/7, 76.4% of urgent cesarean delivery at 370/7–376/7, and for 70.6% of all urgent cesarean delivery at 380/7–386/7weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75–92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management. Conclusion: Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 380/7 and 386/7weeks of gestation, especially in women without ante-partum bleeding.
AB - Objective: The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 360/7 and 376/7weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 360/7 to 386/7weeks compared with expectant management in women with uncomplicated placenta previa. Methods: A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 360/7 and 386/7weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management. Results: At 360/7–366/7weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p =.68). Similarly, at 370/7–376/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p =.54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 360/7–366/7, 76.4% of urgent cesarean delivery at 370/7–376/7, and for 70.6% of all urgent cesarean delivery at 380/7–386/7weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75–92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management. Conclusion: Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 380/7 and 386/7weeks of gestation, especially in women without ante-partum bleeding.
KW - Placenta previa
KW - adverse maternal outcome
KW - elective cesarean
KW - expectant management
KW - neonatal morbidity
UR - http://www.scopus.com/inward/record.url?scp=85140109057&partnerID=8YFLogxK
U2 - 10.1080/14767058.2022.2134772
DO - 10.1080/14767058.2022.2134772
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C2 - 36261133
AN - SCOPUS:85140109057
SN - 1476-7058
VL - 35
SP - 10559
EP - 10564
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 26
ER -