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Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery
Eric Verspyck1, Xavier Douysset1, Horace Roman1
1Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
Objective:
To compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery.
Methods:
In a retrospective study, records were reviewed for women who had anterior placenta previa and delivered by cesarean after 24 weeks of pregnancy at a tertiary center in Rouen, France. During period A (January 2000 to December 2006), the protocol was to systematically transect the placenta when it was unavoidable. During period B (January 2007 to December 2010), the technique was to avoid incision by circumventing the placenta and passing a hand around its margin. Logistic regression was used to identify independent risk factors associated with maternal transfusion of packed red blood cells.
Results:
Eighty-four women were included (period A: n=43; period B: n=41). During period B, there was a reduction in frequency of intraoperative hemorrhage (>1000 mL) (P=0.02), intraoperative hemoglobin loss (P=0.005), and frequency of blood transfusion (P=0.02) as compared with period A. In multivariable analysis, period B was associated with a reduced risk of maternal transfusion (odds ratio 0.27; 95% confidence interval 0.09-0.82; P=0.02).
Conclusion:
Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery.
