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Placental location, postpartum haemorrhage and retained placenta in women previously delivered by caesarean section: a prospective cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Obstetrik)
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective The objective was to determine if anterior placental location increased the risk of postpartum haemorrhage (PPH) and retained placenta in women previously delivered by caesarean section.

 

Design Prospective cohort study.

 

Setting Fetal medicine unit, Uppsala University hospital, Sweden.

Population. Four hundred women previously delivered by caesarean section.

Methods Ultrasound scans were performed at gestational week 28-30. Placental location, myometrial thickness and three-dimensional vascularisation index (VI) were recorded. Data on maternal age, parity, BMI, smoking, gestational week at delivery, induction, delivery mode, Oxytocin, preeclampsia, PPH, retained placenta and birth weight was obtained.

Main Outcome Measures PPH (≥ 1000 ml) and retained placenta.

Results Twenty-four women (11.6%) of 213 with anterior placentas had PPH compared to 13 (7.3%) with placentas in other locations. This difference was not significant. No significant risk increase was found for retained placenta in women with anterior placentae. Of the 23 women with low anterior placentae six (26.1%) had PPH compared to 38 (10.3%) with other placental locations (p = 0.032). Three women (13.0%) with low anterior placentae had retained placenta compared to 11 (2.9%) with other locations (p = 0.04). All women but one with low-lying anterior placentae and PPH and all with retained placentae had placenta praevia.

Conclusion Low anterior placentae in women previously delivered by caesarean section increased the risk of PPH and retained placenta, mostly due to placenta praevia. Other anterior locations of the placenta may add to the increased risk of PPH. 

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-246178OAI: oai:DiVA.org:uu-246178DiVA, id: diva2:792241
Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2015-04-17
In thesis
1. Retained Placenta and Postpartum Haemorrhage
Open this publication in new window or tab >>Retained Placenta and Postpartum Haemorrhage
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to explore the possibility to diagnose retained placental tissue and other placental complications with 3D ultrasound and to investigate the impact of previous caesarean section on placentation in forthcoming pregnancies.

3D ultrasound was used to measure the volumes of the uterine body and cavity in 50 women with uncomplicated deliveries throughout the postpartum period. These volumes were then used as reference, to diagnose retained placental tissue in 25 women with secondary postpartum haemorrhage. All but three of the 25 women had retained placental tissue confirmed at histopathology. The volume of the uterine cavity in women with retained placental tissue was larger than the reference in most cases, but even cavities with no retained placental tissue were enlarged (Studies I and II).

Women with their first and second birth, recorded in the Swedish medical birth register, were studied in order to find an association between previous caesarean section and retained placenta. The risk of retained placenta with heavy bleeding (>1,000 mL) and normal bleeding (≤1,000 mL) was estimated for 19,459 women with first caesarean section delivery, using 239,150 women with first vaginal delivery as controls. There was an increased risk of retained placenta with heavy bleeding in women with previous caesarean section (adjusted OR 1.61; 95% CI 1.44-1.79). There was no increased risk of retained placenta with normal bleeding (Study III).

Placental location, myometrial thickness and Vascularisation Index were recorded on 400 women previously delivered by caesarean section. The outcome was retained placenta and postpartum haemorrhage (≥1,000 mL). There was a trend towards increased risk of postpartum haemorrhage for women with anterior placentae. Women with placenta praevia had an increased risk of retained placenta and postpartum haemorrhage. Vascularisation Index and myometrial thickness did not associate (Study IV).

In conclusion: 3D ultrasound can be used to measure the volume of the uterine body and cavity postpartum, but does not increase the diagnostic accuracy of retained placental tissue. Previous caesarean section increases the risk of retained placenta in subsequent pregnancy, and placenta praevia in women with previous caesarean section increases the risk for retained placenta and postpartum haemorrhage.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1077
Keywords
postpartum haemorrhage, retained placenta, secondary postpartum haemorrhage, retained placental tissue, threedimensional ultrasound, previous caesarean section
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-246185 (URN)978-91-554-9182-6 (ISBN)
Public defence
2015-04-23, Rosénsalen, Ing 95/96, Akademiska sjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2015-04-02 Created: 2015-03-03 Last updated: 2015-04-17

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Belachew, Johanna

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