Cesarean delivery for placenta previa.

Area of Science:

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

Background:

• Placenta previa affects 0.5%–1% of deliveries, a significant decrease from mid-trimester scans (up to 10%).
• Risk factors include prior cesarean delivery (4%–8% recurrence), twin gestations, and assisted reproduction (6-fold increased risk).
• Maternal morbidity is characterized by hemorrhage (40%–60% antepartum, 20%–35% postpartum), and neonatal risk is driven by preterm birth (over 40% before 37 weeks).

Purpose of the Study:

• To review the diagnosis, management, and outcomes of placenta previa.
• To highlight the risks associated with placenta previa for both maternal and neonatal health.
• To provide guidance on antenatal management and delivery planning.

Main Methods:

• Diagnosis relies on transvaginal ultrasound as the gold standard, confirming transabdominal findings and assessing internal os distance.
• Management strategies balance the risk of maternal hemorrhage against the risks of iatrogenic prematurity.
• Delivery planning considers asymptomatic previa (scheduled cesarean at 36–37.6 weeks) and low-lying placenta (trial of labor with internal os distance of 11–20 mm).

Main Results:

• Placenta previa is a leading indication for preterm delivery before 35 weeks (6%–7%).
• Multidisciplinary team approach and preparedness for hemorrhage are crucial for operative care.
• Postpartum support and debriefing are recommended due to the psychological burden.

Conclusions:

• Effective management of placenta previa requires a multidisciplinary team and careful consideration of delivery timing.
• Transvaginal ultrasound is essential for accurate diagnosis and exclusion of associated conditions like placenta accreta spectrum and vasa previa.
• Preparedness for major hemorrhage and structured postpartum support are vital components of care.