Hemorrhagic Morbidity in Nulliparous Patients with Placenta Previa without Placenta Accrete Spectrum Disorders

Abstract

Background: Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known  high-risk condition associated with placental previa. Aim: The morbidity of nulliparous women with placenta previa without PAS disorders  is unknown.

Patients and Methods: The data from nulliparous women who underwent cesarean delivery were collected retrospectively. The women were dichotomized into malpresentation (MP) and placenta previa groups. The placenta previa group was  categorized into previa (PS) and low-lying (LL) groups. When the placenta covers the internal cervical os, it is called placenta previa, when  the placenta is near the cervical os, it is called the low-lying placenta. Their maternal hemorrhagic morbidity and neonatal outcomes were  analyzed and adjusted using multivariate analysis based on univariate analysis.

Results: A total of 1269 women were enrolled: 781  women in the MP group and 488 women in the PP-LL group. Regarding packed red blood cell transfusion, PP and LL had adjusted odds  ratio (aOR) of 14.7 (95% confidence interval (CI): 6.6 – 32.5), and 11.3 (95% CI: 4.9 – 26) during admission, and 51.2 (95% CI: 22.1 – 122.7)  and 10.3 (95% CI: 3.9 – 26.6) during operation, respectively. For intensive care unit admission, PS and LL had aOR of 15.9 (95% CI: 6.5 –  39.1) and 3.5 (95% CI: 1.1 – 10.9), respectively. No women had cesarean hysterectomy, major surgical complications, or maternal death.  

Conclusion: Despite placenta previa without PAS disorders, maternal hemorrhagic morbidity was significantly increased. Thus, our  results highlight the need for resources for those women with evidence of placenta previa including a low-lying placenta, even if those  women do not meet PAS disorder criteria. In addition, placenta previa without PAS disorder was not associated with critical maternal  complications.