Placenta previa and previous cesarean section

Abstract

Objective: To assess the relationship between previous cesarean section and subsequent development of placenta previa and placenta previa with accreta.

Method: The records of all patients delivered with the diagnosis of placenta previa during the 10-year period from 1984 to 1993 were reviewed.

Results: From a total of 50,485 deliveries, 421 (0.83%) had placenta previa, 43 (10.2%) of whom had a history of previous cesarean section. The incidence of placenta previa was significantly increased in those with a previous cesarean section (1.31%) compared with those with an unscarred uterus (0.75%) (R.R. 1.64). This risk increased as the number of previous cesarean sections increased (R.R. 1.53 for one previous section, 2.63 for two or more). The incidence of an anterior placenta previa and placenta accreta was significantly increased in those with previous cesarean scars. The incidence of placenta accreta was 1.18% among patients with placenta previa, 80% being in patients with previous cesarean section. The relative risk for placenta accreta in patients with placenta previa was 35 times higher in those with a previous cesarean section than in those with an unscarred uterus.

Conclusion: The association of previous cesarean section with placenta previa and placenta previa accreta is confirmed. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk for developing placenta accreta.