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Placenta praevia and accreta after previous caesarean section
S K Chattopadhyay1, H Kharif, M M Sherbeeni
1Department of Obstetrics and Gynaecology, Maternity and Children's Hospital, Riyadh, Saudi Arabia.
European Journal of Obstetrics, Gynecology, and Reproductive Biology
|December 30, 1993
Summary
Previous C-sections significantly increase the risk of placenta praevia and placenta accreta. This condition, placenta accreta, poses a high risk of hysterectomy and maternal mortality.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Previous Cesarean sections (CS) are common, and their impact on pregnancy complications requires thorough investigation.
- Placenta praevia and placenta accreta are serious obstetric conditions with significant morbidity and mortality risks.
Purpose of the Study:
- To investigate the relationship between prior Cesarean sections (CS) and the incidence of placenta praevia.
- To determine the association between previous CS, placenta praevia, and the development of placenta accreta.
- To assess the risk of hysterectomy and maternal death in cases of placenta praevia with accreta in scarred uteri.
Main Methods:
- A prospective study was conducted on a large cohort of consecutive deliveries.
- Data collected included delivery history (specifically previous CS) and obstetric diagnoses (placenta praevia, placenta accreta).
- Statistical analysis was performed to compare complication rates between women with and without previous CS.
Main Results:
- Placenta praevia occurred in 2.54% of women with a previous CS, a five-fold increase compared to 0.44% in women without a scar.
- In cases of placenta praevia with a uterine scar, placenta accreta complicated 38.2% of instances, versus 4.5% in unscarred uteri.
- The risk of hysterectomy was 10% for placenta praevia with a scar, escalating to 66% for placenta praevia accreta. One maternal death occurred in the placenta praevia accreta group.
Conclusions:
- Previous Cesarean sections are a significant risk factor for developing placenta praevia.
- The presence of a uterine scar from a previous CS dramatically increases the risk of placenta accreta in women with placenta praevia.
- Placenta praevia accreta in scarred uteri is associated with a substantially higher risk of hysterectomy and potential maternal mortality, necessitating careful management.