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Risk of placenta previa in second birth after first birth cesarean section: a population-based study and
Ipek Gurol-Urganci1, David A Cromwell, Leroy C Edozien
1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. ipek.gurol@lshtm.ac.uk
BMC Pregnancy and Childbirth
|November 23, 2011
Summary
Women who had a cesarean section (CS) for their first birth face a higher risk of placenta previa in their next pregnancy. This risk, while significant, is lower than previously thought, with about one extra case per 359 CS first births.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Health
- Perinatal Epidemiology
Background:
- Placenta previa is a pregnancy complication where the placenta partially or totally covers the cervix.
- Previous cesarean section (CS) delivery is a known risk factor for placenta previa.
- Understanding the magnitude of this risk is crucial for clinical management and patient counseling.
Purpose of the Study:
- To compare the incidence of placenta previa in a second pregnancy following a first birth by cesarean section (CS) versus vaginal delivery.
- To quantify the association between first birth CS and subsequent placenta previa risk.
- To synthesize evidence from existing literature through meta-analysis.
Main Methods:
- Retrospective cohort study of nearly 400,000 women in England (2000-2009).
- Logistic regression analysis adjusted for key confounding factors.
- Meta-analysis of 37 published studies on the association between CS and placenta previa.
Main Results:
- The rate of placenta previa was 8.7 per 1000 births after a first CS, compared to 4.4 per 1000 births after a vaginal first birth.
- Adjusted analysis showed CS at first birth increased placenta previa risk (OR=1.60).
- Meta-analysis of prior studies indicated a higher pooled OR of 2.20, with population-based studies yielding an OR of 1.51 for second births.
Conclusions:
- Cesarean section for first birth is associated with an elevated risk of placenta previa in subsequent pregnancies.
- The risk is confirmed but appears lower than suggested by some previous pooled analyses.
- Approximately 359 women undergoing CS for their first birth will experience one additional case of placenta previa in their next pregnancy.
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