Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results

Placenta previa is abnormal localization of the placenta, associated with high rates of maternal-fetal morbidity and mortality. This abnormal implantation may also be in the form of invasion to surroundings defined as placenta accreta spectrum (PAS). The increasing rates of cesarean section raise the frequency of placenta previa and PAS in recent years. Although there are some recommendations, the optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear. The aim of this study is to compare maternal, surgical and perinatal outcomes of placenta previa cases who underwent emergency or planned surgery.

The women who underwent cesarean section for placenta previa between October 2013 and February 2019 at a tertiary care center were retrospectively analyzed. They were divided into two main groups as planned and urgent, and into two subgroups as complicated (PAS) and uncomplicated (non-PAS).

Of the 313 women who met the inclusion criteria, 176 were planned and 137 were urgent cesarean sections. In the urgent group, gestational age, duration of surgery, maternal preoperative and pre-discharge hemoglobin levels, requirement of blood and blood product, additional surgical interventions, length of maternal postoperative intensive care unit and hospital stay, neonatal birthweight, Apgar scores, length of the follow-up in neonatal intensive care unit, invasive and non-invasive mechanical ventilation were significantly different.

Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa. Perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37 weeks.