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. 2021 Oct 11:8:745080.
doi: 10.3389/fmed.2021.745080. eCollection 2021.

The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study

Bi Shilei  1 , Zhang Lizi  2 , Li Yulian  1 , Liang Yingyu  1 , Huang Lijun  1 , Huang Minshan  1 , Huang Baoying  1 , Jia Jinping  3 , Cao Yinli  4 , Wang Shaoshuai  5 , Xu Xiaoyan  5 , Feng Ling  5 , Zhao Yangyu  6 , Zhao Xianlan  7 , Zhu Qiying  8 , Qi Hongbo  9 , Wen Suiwen  10 , Zhang Lanzhen  11 , Li Hongtian  12 , Chen Jingsi  1   13 , Wang Zhijian  2 , Du Lili  1   13 , Chen Dunjin  1   13
Affiliations

The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study

Bi Shilei et al. Front Med (Lausanne). .

Abstract

Background: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placentation following a first CD before the onset of labor (prelabor) or intrapartum CD. Methods: This multicenter, historical cohort study involved singleton, pregnant women at 28 weeks of gestation or greater with a CD history between January 2017 and December 2017 in 11 public tertiary hospitals within 7 provinces of China. PPH was analyzed in the subsequent pregnancy between women with prior prelabor CD and women with intrapartum CD. Furthermore, PPH was analyzed in pregnant women stratified by complications with PP alone [without placenta accreta spectrum (PAS) disorders], complications with PP and PAS, complications with PAS alone (without PP), and normal placentation. We performed multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% CI controlling for predefined covariates. Results: Out of 10,833 pregnant women, 1,197 (11%) women had a history of intrapartum CD and 9,636 (89%) women had a history of prelabor CD. Prior prelabor CD increased the risk of PP (aOR 1.91, 95% CI 1.40-2.60), PAS (aOR 1.68, 95% CI 1.11-2.24), and PPH (aOR 1.33, 95% CI 1.02-1.75) in a subsequent pregnancy. After stratification by complications with PP alone, PP and PAS, PAS alone, and normal placentation, prior prelabor CD only increased the risk of PPH (aOR 3.34, 95% CI 1.35-8.23) in a subsequent pregnancy complicated with PP and PAS. Conclusion: Compared to intrapartum CD, prior prelabor CD increased the risk of PPH in a subsequent pregnancy only when complicated by PP and PAS.

Keywords: cesarean delivery (CD); placenta accreta spectrum (PAS); placenta previa; postpartum hemorrhage (PPH); trial of labor (TOL).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A flow diagram of the enrollment process of the patient.
Figure 2
Figure 2
Vaginal deliveries and the indications of repeat cesarean deliveries (CDs) in a subsequent pregnancy in women with prior prelabor CD or intrapartum CD.
See this image and copyright information in PMC

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