Predicting Placental Abruption and Previa in Women with a Previous Cesarean Delivery

 

 Buy Article Permissions and Reprints

ABSTRACT

The purpose of this study was to determine if placental abruption or previa in women with a history of a prior cesarean delivery (CD) can be predicted. A retrospective cohort study of pregnant women with previous CD was conducted in 17 centers between 1996 and 2000. Women developing placenta previa or abruption in the subsequent pregnancy were compared with those without these complications. Bivariate and multivariable techniques were used to develop predictive models for placenta previa or abruption. The area under the receiver-operator characteristic curves, sensitivity, specificity, and accuracy of the models were compared. Among 25,076 women with prior CD, there were 361 (15 per 1000 births) with placenta previa and 309 (13 per 1000 births) with abruption. The significant risk factors for these complications include advanced maternal age, Asian race, increased parity, illicit drug use, history of spontaneous abortion, and three or more prior cesarean deliveries. Prediction models for abruption and previa had poor sensitivity (12% and 13% for abruption and previa, respectively). In women with at least one prior cesarean delivery, the risk factors for placental previa and abruption can be identified. However, prediction models combining these risk factors were too inefficient to be useful.

REFERENCES

• 1 Getahun D, Oyelese Y, Salihu H M, Ananth C V. Previous cesarean delivery and risks of placenta previa and placental abruption.  Obstet Gynecol. 2006;  107 771-778
  CrossrefPubMedGoogle Scholar
• 2 Lydon-Rochelle M, Holt V L, Easterling T R, Martin D P. First-birth cesarean and placental abruption or previa at second birth.  Obstet Gynecol. 2001;  97 765-769
  CrossrefPubMedGoogle Scholar
• 3 Ananth C V, Smulian J C, Vintzileos A M. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis.  Am J Obstet Gynecol. 1997;  177 1071-1078
  CrossrefPubMedGoogle Scholar
• 4 Martin J A, Hamilton B E, Sutton P D, Ventura S J, Menacker F, Munson M L. Births: final data for 2003.  Natl Vital Stat Rep. 2005;  54 1-116
  PubMedGoogle Scholar
• 5 Macones G A, Peipert J, Nelson D A et al.. Maternal complications with vaginal birth after cesarean delivery: a multicenter study.  Am J Obstet Gynecol. 2005;  193 1656-1662
  CrossrefPubMedGoogle Scholar
• 6 Maldonado G, Greenland S. Simulation study of confounder selection strategies.  Am J Epidemiol. 1993;  138 923-936
  PubMedGoogle Scholar
• 7 Hosmer D W, Lemeshow S. Assessing the fit of the model. In: Hosmer DW, Lemeshow S Applied Logistic Regression. New York; Wiley-Interscience 1989: 135-173
  Google Scholar
• 8 Efron B. Estimating the error rate of a prediction rule: improvement on cross-validation.  J Am Stat Assoc. 1983;  78 316-331
  CrossrefPubMedGoogle Scholar
• 9 Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity.  Obstet Gynecol. 2002;  99 976-980
  CrossrefPubMedGoogle Scholar
• 10 Barrett J M, Boehm F H, Killam A P. Induced abortion: a risk factor for placenta previa.  Am J Obstet Gynecol. 1981;  141 769-772
  PubMedGoogle Scholar
• 11 Zhu B P, Rolfs R T, Nangle B E, Horan J M. Effect of the interval between pregnancies on perinatal outcomes.  N Engl J Med. 1999;  340 589-594
  CrossrefPubMedGoogle Scholar
• 12 Skjaerven R, Wilcox A J, Lie R T. The interval between pregnancies and the risk of preeclampsia.  N Engl J Med. 2002;  346 33-38
  CrossrefPubMedGoogle Scholar
• 13 Toivonen S, Heinonen S, Anttila M, Kosma V, Saarikoski S. Reproductive risk factors, Doppler findings, and outcomes of affected births in placental abruption: a population-based analysis.  Am J Perinatol. 2002;  19 451-460
  Article in Thieme ConnectPubMedGoogle Scholar

Anthony OdiboM.D. 

Washington University, Department of Obstetrics and Gynecology, Division of MFMU

4990 Childrens Place, Campus Box 8064, St. Louis, MO 63110