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Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study

Archives of Gynecology and Obstetrics volume 304, pages 65–72 (2021)Cite this article

Abstract

Purpose

Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.

Methods

This study was conducted in The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital between January 2009 and 2019. PP was traditionally classified into four types, namely low-lying placenta, marginal, partial, and complete PP. Previous studies have classified PP into two types, namely low-lying placenta and PP. Based on our clinical experience, we proposed the classification of PP into three types, for the first time, which included low-lying placenta, “marpartial” (marginal and partial) PP, and complete PP. Multivariate logistic regression analysis was performed to determine the effects of different types of PP on maternal and neonatal outcomes.

Results

In total, 4490 singleton pregnancies were complicated with PP. In the four-classification method, compared with women with low-lying placenta, women with complete PP had a risk of placenta accrete spectrum disorders, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and neonatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and neonatal outcomes, compared with low-lying placenta.

Conclusion

Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification of PP may be practical from the clinical perspective.

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Fig. 1

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PP:

Placenta previa

PAS:

Placenta accrete spectrum

PPH:

Postpartum hemorrhage

ICU:

Intensive care unit

NICU:

Neonatal intensive care unit

AIUM:

American Institute of Ultrasound in Medicine

CI:

Confidence interval

aOR:

Adjusted odds ratios

ART:

Assisted reproductive technology

DM:

Diabetes mellitus

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Acknowledgements

This study was supported by grants from the National Key R&D Program of China (No. 2016YFC1000405, 2017YFC1001402, 2018YFC1004104, and 2018YFC10029002), Guangzhou clinical high-tech, major characteristic technology project - treatment optimization of placental percreta disease diagnosed based on 3D technology and the National Natural Science Foundation (No. 81830045, 81671533, 81971415, and 82071652).

Funding

This study was supported by grants from the National Key R&D Program of China (No. 2016YFC1000405, 2017YFC1001402, 2018YFC1004104, and 2018YFC10029002), Guangzhou clinical high-tech, major characteristic technology project - treatment optimization of placental percreta disease diagnosed based on 3D technology and the National Natural Science Foundation (No. 81830045, 81671533, 81971415, and 82071652). The funding sources had no influence on the content of the study.

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Author notes

  1. Lizi Zhang, Shilei Bi, and Zhijian Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China

    Shilei Bi, Jingsi Chen, Jingman Tang, Jingjin Gong, Sushan Xie, Lin Lin, Luwen Ren, Shanshan Zeng, Lijun Huang, Lili Du & Dunjin Chen

  2. Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, People’s Republic of China

    Jingsi Chen, Lili Du & Dunjin Chen

  3. Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, People’s Republic of China

    Jingsi Chen, Lili Du & Dunjin Chen

  4. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China

    Lizi Zhang & Zhijian Wang

  5. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People’s Republic of China

    Shaoshuai Wang

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  1. Shilei Bi
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Contributions

LZ, SB, and ZW contributed to the study design, data analysis, and manuscript writing and revision. JC, JT, JG, SX, and LL contributed to the data analysis and manuscript revision. LR, SZ, and LH contributed to data collection and management, SW, LD, and DC contributed to the manuscript revision and project development. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dunjin Chen.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval and consent to participate

This study was approved by the Research Ethics Board of the Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.

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Bi, S., Zhang, L., Wang, Z. et al. Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study. Arch Gynecol Obstet 304, 65–72 (2021). https://doi.org/10.1007/s00404-020-05912-9

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  • DOI: https://doi.org/10.1007/s00404-020-05912-9

Keywords

  • Previa placenta
  • Classification
  • Ultrasound
  • Maternal outcome
  • Neonatal outcome