Predicting factors for emergency peripartum hysterectomy in women with placenta previa

The aim of the study was to identify predictive factors for peripartum hysterectomy in women with placenta previa.

We retrospectively reviewed all singleton pregnancies with a diagnosis of placenta previa, with the distance between the lower placenta edge and the internal cervical os is ≤2 cm, during the period June 2006-May 2010. Antepartum characteristics of women who did and did not undergo peripartum hysterectomy were compared: they include demographical data, obstetrics history, clinical course of the index pregnancy and sonographic findings.

Two-hundred and forty-seven women were selected. peripartum hysterectomy was required in 12 cases (4.9%). A statistically significant increased risk emerged for a history of cesarean section (p < 0.001), major placenta previa (p < 0.001), sonographic suspect of placenta accreta (p < 0.001) and gestational age at delivery <34 weeks' gestation (p < 0.001). These four variables were entered into an unconditioned logistic regression model. The resulting adjusted ORs were 23.1 (95% CI 2.3-235.3, p = 0.008), 14.6 (95% CI 0.6-346.5, p = 0.097), 42.4 (95% CI 5.1-354.5, p = 0.001) and 9.3 (95% CI 1.1-76.9, p = 0.037), respectively.

This study confirms that placenta previa is a condition at substantial risk of peripartum hysterectomy. A history of cesarean section, the sonographic suspect of placenta accreta and gestational age at delivery were found to be independently associated with this risk. Antepartum ultrasonography in particular plays a crucial role in predicting hysterectomy in these cases.