Abstract
Objective
Estimates of the increased risk of maternal complications after caesarean section
posed by placenta praevia differ between studies and may not reflect current practice.
We assess the impact of placenta praevia on maternal complications after elective
caesarean section (CS).
Study design
We undertook a retrospective cohort study of women who had an elective CS for a singleton
at term in the English National Health Service between 1 April 2000 and 28 February
2009 using routine data from the Hospital Episode Statistics database. Multiple logistic
regression was used to estimate the effect of placenta praevia on maternal complications
after controlling for maternal age, parity, whether a woman had a previous CS, and
gestational age. Maternal complications included postpartum haemorrhage, obstetric
trauma, blood transfusion and hysterectomy.
Results
Among 131,731 women having an elective CS for a singleton, 4,332 (3.3%) women had
placenta praevia. Placenta praevia increased the risk of postpartum haemorrhage from
9.7% to 17.5% (adjusted odds ratio (OR) 1.91; 95% CI: 1.74 to 2.09), the risk of blood
transfusion from 1.4% to 6.4% (OR 4.39; 3.76 to 5.12), and the risk of hysterectomy
from 0.03% to 1% (OR 39.70; 22.42 to 70.30). Previous studies have estimated the rate
of hysterectomy among women with placenta praevia to be 5%.
Conclusion
Placenta praevia remains a risk factor for various maternal complications, although
the increased risk of hysterectomy is lower than previously reported.
Keywords
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Article info
Publication history
Published online: July 28, 2011
Accepted:
July 11,
2011
Received in revised form:
June 15,
2011
Received:
January 9,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
