Late midtrimester pregnancy termination in the presence of placenta previa

Abstract

Objective: To examine the operative outcome in women undergoing late midtrimester pregnancy termination by dilatation and evacuation in the presence of complete placenta previa.

Study design: The records of 306 consecutive women undergoing pregnancy termination at 19-24 weeks' gestation from January 1997 to December 2000 were reviewed and divided into those with and without complete placenta previa based on an ultrasound examination before the procedure. These two groups were then compared for differences in patient characteristics, previous gynecologic history and operative outcome, reflected by operative time, need for blood transfusion, discharge time, postoperative bleeding and postoperative fever.

Results: Complete placenta previa occurred in 2.6% of patients (8 of 306). Significantly more women with placenta previa were married (P = .04). There was also a significant difference between the two groups considering the indication for pregnancy termination, as all patients with placenta previa underwent late midtrimester termination due to structural and chromosomal fetal malformations, whereas 33.8% of patients without placenta previa demonstrated fetal malformations (P = .005). Furthermore, significantly more women with placenta previa had had previous pelvic surgery (P = .01). However, there was no significant difference between the two groups with regard to age, percentage of smokers, number of previous abortions, parity or number of previous cesarean sections. There was no significant difference in the number of inserted Laminaria, operative time, need for blood transfusion, postoperative morbidity and duration of hospital stay.

Conclusion: Late midtrimester pregnancy termination by dilatation and evacuation in the presence of placenta previa appears to be safe and apparently does not increase maternal morbidity as compared with the outcome in patients without placenta previa undergoing the same procedure.