Timing of cesarean delivery in women with uncomplicated placenta previa

Anat Schwartz*, Daniela Chen, Shiri Shinar, Swati Agrawal, Yariv Yogev

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)10559-10564
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume35
Issue number26
DOIs
StatePublished - 2022

Keywords

  • Placenta previa
  • adverse maternal outcome
  • elective cesarean
  • expectant management
  • neonatal morbidity

Fingerprint

Dive into the research topics of 'Timing of cesarean delivery in women with uncomplicated placenta previa'. Together they form a unique fingerprint.

Cite this