1. Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey.
Bora Coskun, Iltac Akkurt, Riza Dur, Mehmet Ozgur Akkurt,
Seval Yilmaz Ergani, Bugra Coskun

2. Aim
Placenta previa (PP) poses both maternal and fetal risks and its incidence has been increasing in parallel with the cesarean delivery (CD) rates.
In the present study we aimed to determine the risk factors for complicated CD in placenta previa.

3. Methods
This retrospective study was performed at Etlik Zubeyde Hanim Maternity and Women’s Health Teaching and Research Hospital during 6-year study period.
Women with total and partial PP were included.
Complicated CD was identified according to modified World Health Organization (WHO) maternal near-miss criteria.

4. WHO near-miss criteria
Coagulation and hematological dysfunction defined as transfusion of 4 and more units of red blood cells, a rapid drop in hemoglobin levels (>4 g/dl) and acute thrombocytopenia <75.000/ml
Reoperation, hysterectomy, balloon placement and uterine artery and/or hypogastric artery ligation for hemorrhage,
Prolonged postoperative hospitalization (>4 days),
Intra-and/or post-operative complications such as bladder, ureter, bowel injury,
Renal dysfunction (creatinine >3.5 mg/dl),
Admission to intensive care unit.

5. Comparison of variables between complicated and non-complicated groups
p-value
Mean±SD
median
range
mean±SD
Maternal age (year)
30±5.6 30
21-40
30.7±5.5 31
19-44
0.909m
Body mass index (kg/m2)
28.6±4.7 27
19-42
28.9±3.8 29
20-39
0.141m
Number of previous CD
1.2±1.2 1
0-4
0.5±0.8
0-3
0.001m
GA at birth (week)
35±3.5
36.3
36.2±2.9 37
24-39
0.009m
Number of vaginal bleeding episode
3.7±1.2
3.5
0-5
0.8±0.9
0.000m
Preoperative Hb (gr/dl)
10.7±1.3
10.5
11.5±1.4
11.5
Preoperative Htc
32.8±3.5
32.7
25-40
34.8±3.6 35
25-45
0.003m
Preoperative thrombocyte (109/L)
240.2±85
220
239±68.8
232
98-536
0.881m
Drop in Hb (gr/dl)
3.6±1
3.3
1.7-6
1.5±0.9
1.4
Drop in Htc
10.1±3.5
10.4
3.4-18
4.5±2.6
3.8
Drop in thrombocyte
23±6.6 25
22±5.5 22
5-55
0.112m
Hospitalization length (day)
5.0±1.3 5
3-8
2.7±0.7 3
1-5
Number of erythrocyte transfusion
2.8±1.5 2
0-6
0.3±0.7
0-2
CL < 10. percentile
8/20 (40%)
3/48 (6%)
0.000 X²
Anterior placentation
25 (67.6%)
51 (23.3%)
0.003 X²
Coexistent abruption
9 (24.3%)
6 (2.7%)
Adherent placenta
14 (37.8%)
3 (1.3%)
General anesthesia
10 (27%)
24 (11%)
0.012 X²
Weekend delivery
54 (24.7%)
0.102 X²

6. Multivariable analysis
Logistic regression analysis for identification of independent risk factors for maternal near-miss in placenta previa
Univariate analysis
Multivariable analysis OR
95% CI p
Maternal age
1.00
0.903
Gravida
1.17
0.178
Parity
1.20
0.251
Smoking
2.61
0.064
Body mass index
0.92
0.082
General anesthesia
1.62
0.181
Weekend delivery
1.86
0.112
Adherent placenta
12.02
0.000
11.92
Anterior placentation
1.05
0.111
Previous cesarean delivery
2.05
Gestational age at birth
0.90
0.044
Cervical length < 10. percentile
8.1
5.5
<0.05
Coexistent abruption
18.1
13.2
Increased number of vaginal bleeding episodes (>3)
11.8
8.88
<0.001

7. Results
37 and 219 women formed complicated and non-complicated group, respectively.
Logistic regression analysis demonstrated that following features were associated with complicated CD in PP; 1) coexistent abruption (aOR 13.2, 95% CI ), 2) adherent placenta (aOR 11.92, 95% CI ), 3) 3 and more hospitalization for vaginal bleeding (aOR 8.88, 95% CI ), 4) cervical length (CL) measurement < 10. Percentile (aOR 5.5, 95% CI ).

8. Conclusion
Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe morbidity in women with placenta previa.
Early identification of these factors during follow-up may improve outcome.

9. Teşekkürler…