Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Health

Background:

• Placenta previa and low-lying placenta are common diagnoses in early pregnancy.
• Resolution of low placentation before delivery is often associated with favorable outcomes.
• However, the long-term maternal morbidity associated with resolved low placentation requires further investigation.

Purpose of the Study:

• To determine if resolved low placentation increases the risk of postpartum hemorrhage (PPH).
• To evaluate the association between resolved low placentation and PPH-related morbidity.
• To compare outcomes in individuals with resolved low placentation versus those with normal placental location.

Main Methods:

• Prospective, multicenter, matched cohort study.
• Included pregnant individuals with singleton gestations diagnosed with low placentation (exposed) and normal placentation (unexposed).
• Matched 1:3 based on parity; analyzed PPH (≥1000 mL) and secondary outcomes using multivariable logistic regression.

Main Results:

• Resolved low placentation was associated with higher rates of smoking, prior dilation and curettage, posterior placenta, and labor induction.
• Exposed individuals had significantly higher odds of PPH (aOR 3.1), use of second-line uterotonics (aOR 2.69), tranexamic acid (aOR 2.19), and extended hospital stay (aOR 2.63).

Conclusions:

• Resolved low placentation presents an increased risk for postpartum hemorrhage.
• Individuals with resolved low placentation are also at higher risk for related morbidities, including need for additional interventions and prolonged hospitalization.
• These findings underscore the importance of vigilant postpartum monitoring in women with a history of low placentation.