Skip to main content

Placental Lesions and Pregnancy Outcome in Anterior as Compared to Posterior Placenta Previa

Reproductive Sciences volume 28, pages 3241–3247 (2021)Cite this article

Abstract

The uterine location of placenta previa (PP), anterior vs. posterior has an impact on pregnancy outcome. We aimed to study maternal and neonatal outcome and placental histopathology lesions in anterior vs. posterior PP. The medical records and histopathology reports of all singleton cesarean deliveries (CD) performed due to PP, from 24 to 41 weeks, between 12.2008 and 10.2018, were reviewed. Placental lesions were classified into maternal and fetal vascular malperfusion lesions (MVM, FVM), maternal and fetal inflammatory responses (MIR, FIR). Gestational age (GA) at delivery was similar between the anterior PP (n = 67) and posterior PP (n = 105) groups. As compared to the posterior PP group, the anterior PP group had higher rate of previous CD (p < 0.001), placental accreta spectrum (p = 0.04), lower neonatal Hb at birth (p = 0.03), higher rate of neonatal blood transfusion (p = 0.007) and prolonged maternal hospitalization (p = 0.02). Placentas from the anterior PP group had lower weights (p = 0.035), with increased rate of MVM lesions (p = 0.017). The anterior PP location is associated with increased adverse maternal and neonatal outcome, lower placental weights and increased rate of malperfusion lesions. Abnormal placentation in the scarred uterine wall probably has an impact on placental function.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927–41. https://doi.org/10.1097/01.AOG.0000207559.15715.98.

    Article  PubMed  Google Scholar 

  2. Fan D, Wu S, Liu L, Xia Q, Wang W, Guo X, et al. Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Sci Rep. 2017;7. https://doi.org/10.1038/srep40320.

  3. Young BC, Nadel A, Kaimal A. Does previa location matter? Surgical morbidity associated with location of a placenta previa. J Perinatol. 2014;34:264–7. https://doi.org/10.1038/jp.2013.185.

    CAS  Article  PubMed  Google Scholar 

  4. Jang DG, We JS, Shin JU, Choi YJ, Ko HS, Park IY, et al. Maternal outcomes according to placental position in placental previa. Int J Med Sci. 2011;8:439–44. https://doi.org/10.7150/ijms.8.439.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and metaanalysis. Am J Obstet Gynecol. 2019;221:208–18. https://doi.org/10.1016/j.ajog.2019.01.233.

    Article  PubMed  Google Scholar 

  6. Marcellin L, Delorme P, Bonnet MP, Grange G, Kayem G, Tsatsaris V, et al. Placenta percreta is associated with more frequent severe maternal morbidity than placenta accreta. Am J Obstet Gynecol. 2018;219:193.e1–9. https://doi.org/10.1016/j.ajog.2018.04.049.

    Article  Google Scholar 

  7. Schneiderman M, Balayla J. A comparative study of neonatal outcomes in placenta previa versus cesarean for other indication at term. J Matern Neonatal Med. 2013;26:1121–7. https://doi.org/10.3109/14767058.2013.770465.

    Article  Google Scholar 

  8. Jang DG, Jo YS, Lee SJ, Lee GSR. Risk factors of neonatal anemia in placenta previa. Int J Med Sci. 2011;8:554–7. https://doi.org/10.7150/ijms.8.554.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jauniaux E, Burton GJ. Pathophysiology of placenta accreta spectrum disorders: a review of current findings. Clin Obstet Gynecol. 2018;61:743–54. https://doi.org/10.1097/GRF.0000000000000392.

    Article  PubMed  Google Scholar 

  10. Jansen CHJR, de Mooij YM, Blomaard CM, et al. Vaginal delivery in women with a low-lying placenta: a systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2019;126:1118–26. https://doi.org/10.1111/1471-0528.15622.

    Article  Google Scholar 

  11. Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birthweight standards in the live-born population in Israel. Isr Med Assoc J. 2005.

  12. Redline RW, Heller D, Keating S, Kingom J. Placental diagnostic criteria and clinical correlation — a workshop report. Placenta. 2005;26:S114–7. https://doi.org/10.1016/j.placenta.2005.02.009.

    Article  PubMed  Google Scholar 

  13. Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions Amsterdam placental workshop group consensus statement. In: Archives of Pathology and Laboratory Medicine. ; 2016. https://doi.org/10.5858/arpa.2015-0225-CC

  14. Weiner E, Fainstein N, Schreiber L, Sagiv R, Bar J, Kovo M. The association between umbilical cord abnormalities and the development of non-reassuring fetal heart rate leading to emergent cesarean deliveries. J Perinatol. 2015;35:919–23. https://doi.org/10.1038/jp.2015.102.

    CAS  Article  PubMed  Google Scholar 

  15. Kovo M, Schreiber L, Ben-Haroush A, Cohen G, Weiner E, Golan A, et al. The placental factor in early- and late-onset normotensive fetal growth restriction. Placenta. 2013;34:320–4. https://doi.org/10.1016/j.placenta.2012.11.010.

    CAS  Article  PubMed  Google Scholar 

  16. Weiner E, Miremberg H, Grinstein E, et al. Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa. Early Hum Dev. 2016. https://doi.org/10.1016/j.earlhumdev.2016.08.012.

  17. Thompson JMD, Irgens LM, Skjaerven R, Rasmussen S. Placenta weight percentile curves for singleton deliveries. BJOG An Int J Obstet Gynaecol. 2007;114:715–20. https://doi.org/10.1111/j.1471-0528.2007.01327.x.

    CAS  Article  Google Scholar 

  18. Strong TH, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. Am J Obstet Gynecol. 1994;170:29–32. https://doi.org/10.1016/S0002-9378(94)70378-7.

    Article  PubMed  Google Scholar 

  19. Romero R, Kim YM, Pacora P, Kim CJ, Benshalom-Tirosh N, Jaiman S, et al. The frequency and type of placental histologic lesions in term pregnancies with normal outcome. J Perinat Med. 2018;46:613–30. https://doi.org/10.1515/jpm-2018-0055.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kibel M, Kahn M, Sherman C, Kingdom J, Zaltz A, Barrett J, et al. Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies. Placenta. 2017;60:28–35. https://doi.org/10.1016/j.placenta.2017.10.002.

    Article  PubMed  Google Scholar 

  21. Spinillo A, Gardella B, Adamo L, Muscettola G, Fiandrino G, Cesari S. Pathologic placental lesions in early and late fetal growth restriction. Acta Obstet Gynecol Scand. 2019;98:1585–94. https://doi.org/10.1111/aogs.13699.

    Article  PubMed  Google Scholar 

  22. Jing L, Wei G, Mengfan S, Yanyan H. Effect of site of placentation on pregnancy outcomes in patients with placenta previa. PLoS One. 2018;13:e0200252. https://doi.org/10.1371/journal.pone.0200252.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cao Y, Wei Y, Yu Y, Wang Z. Safety and efficacy of a novel three-dimensional magnetic resonance imaging model for uterine incision in placenta previa. Int J Gynecol Obstet. 2017;139:336–41. https://doi.org/10.1002/ijgo.12311.

    Article  Google Scholar 

  24. Kayem G, Davy C, Goffinet F, Thomas C, Cléent D, Cabrol D. Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol. 2004;104:531–6. https://doi.org/10.1097/01.AOG.0000136086.78099.0f.

    Article  PubMed  Google Scholar 

  25. Kotsuji F, Nishijima K, Kurokawa T, Yoshida Y, Sekiya T, Banzai M, et al. Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series. BJOG An Int J Obstet Gynaecol. 2013;120:1144–9. https://doi.org/10.1111/1471-0528.12252.

    CAS  Article  Google Scholar 

  26. Roberge S, Boutin A, Chaillet N, Moore L, Jastrow N, Demers S, et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012;29:465–72. https://doi.org/10.1055/s-0032-1304829.

    Article  PubMed  Google Scholar 

  27. Bustamante Helfrich B, Chilukuri N, He H, Cerda SR, Hong X, Wang G, et al. Maternal vascular malperfusion of the placental bed associated with hypertensive disorders in the Boston Birth Cohort. Placenta. 2017;52:106–13. https://doi.org/10.1016/j.placenta.2017.02.016.

    Article  PubMed  Google Scholar 

  28. Brosens I, Dixon HG, Robertson WB. Fetal growth retardation and the arteries of the placental bed. BJOG An Int J Obstet Gynaecol. 1977;84:656–63. https://doi.org/10.1111/j.1471-0528.1977.tb12676.x.

    CAS  Article  Google Scholar 

  29. Tarca AL, Romero R, Benshalom-Tirosh N, Than NG, Gudicha DW, Done B, et al. The prediction of early preeclampsia: results from a longitudinal proteomics study. PLoS One. 2019;14:e0217273. https://doi.org/10.1371/journal.pone.0217273.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Parra-Saavedra M, Simeone S, Triunfo S, Crovetto F, Botet F, Nadal A, et al. Correlation between histological signs of placental underperfusion and perinatal morbidity in late-onset small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2015;45:149–55. https://doi.org/10.1002/uog.13415.

    CAS  Article  PubMed  Google Scholar 

  31. Triunfo S, Lobmaier S, Parra-Saavedra M, Crovetto F, Peguero A, Nadal A, et al. Angiogenic factors at diagnosis of late-onset small-for-gestational age and histological placental underperfusion. Placenta. 2014;35:398–403. https://doi.org/10.1016/j.placenta.2014.03.021.

    CAS  Article  PubMed  Google Scholar 

  32. Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Peguero A, Nadal A, et al. Placental findings in late-onset SGA births without Doppler signs of placental insufficiency. Placenta. 2013;34:1136–41. https://doi.org/10.1016/j.placenta.2013.09.018.

    CAS  Article  PubMed  Google Scholar 

  33. Balayla J, Desilets J, Shrem G. Placenta previa and the risk of intrauterine growth restriction (IUGR): A systematic review and meta-Analysis. J Perinat Med. 2019;47:577–84. https://doi.org/10.1515/jpm-2019-0116.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Tairy, Eran Weiner, Hadas Miremberg, Liat Gindes, Roni Hochman, Jacob Bar & Michal Kovo

  2. Department of Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Letizia Schreiber

Authors
  1. Daniel Tairy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eran Weiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Letizia Schreiber
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hadas Miremberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Liat Gindes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roni Hochman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jacob Bar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michal Kovo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors state that each of the authors have provided substantial contribution and are in agreement with all aspects of the final manuscript.

Corresponding author

Correspondence to Daniel Tairy.

Ethics declarations

Ethics approval and consent to participate

All procedures were in accordance with the ethical standards of the institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Decision number 9-2010-0223 dated 18/03/2019.

Conflict of interest

All authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(XLSX 22 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tairy, D., Weiner, E., Schreiber, L. et al. Placental Lesions and Pregnancy Outcome in Anterior as Compared to Posterior Placenta Previa. Reprod. Sci. 28, 3241–3247 (2021). https://doi.org/10.1007/s43032-021-00558-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43032-021-00558-7

Keywords

  • Anterior placenta previa
  • Posterior placenta previa
  • Placental histopathology
  • Maternal outcome
  • Neonatal outcome