Timing of cesarean delivery in women with uncomplicated placenta previa

The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 36^0/7 and 37^6/7weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 36^0/7 to 38^6/7weeks compared with expectant management in women with uncomplicated placenta previa.

A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 36^0/7 and 38^6/7weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management.

At 36^0/7-36^6/7weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p = .68). Similarly, at 37^0/7-37^6/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p = .54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 36^0/7-36^6/7, 76.4% of urgent cesarean delivery at 37^0/7-37^6/7, and for 70.6% of all urgent cesarean delivery at 38^0/7-38^6/7weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75-92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management.

Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 38^0/7 and 38^6/7weeks of gestation, especially in women without ante-partum bleeding.