Impact of Prior Cesarean Delivery on Pregnancy Outcomes and Hemorrhage Risks in Complete Placenta Previa: A Decade-Long Retrospective Analysis

Abstract

Background: Complete placenta previa (CPP) is a life-threatening condition with increasing incidence worldwide. This retrospective study investigated the impact of prior cesarean delivery on pregnancy outcomes in women with CPP. Material/Methods: The data of 476 patients with CPP who underwent cesarean delivery in a tertiary hospital in Shanghai, China, from January 2013 to December 2022 were retrospectively analyzed. Patients were divided into prior cesarean delivery and no-prior cesarean delivery groups. Diagnosis of CPP was confirmed by last preoperative ultrasound/MRI. Maternal characteristics, intrapartum conditions, maternal complications, and neonatal outcomes were compared between groups. Independent predictors of hemorrhage were analyzed by logistic regression analysis. Results: The prior cesarean delivery group had significantly higher maternal age (36 [3.7)] vs 34.2 [4.2)], P=0.012), rates of intraoperative bleeding (982.9 [202.9] vs 588.8 [134.2], P=0.001), hysterectomy (6.4% vs 0.9%, P=0.002), premature birth (60.9% vs 36.6%, P<0.001), and neonatal hospitalization (13.5% vs 6.3%, P=0.008). The no-prior cesarean delivery group had higher rates of assisted reproduction (30.0% vs 3.8%, P<0.001) and endometriosis history (14.1% vs 8.3%, P<0.001). Multivariate logistic regression showed a history of cesarean delivery (adjusted odds ratio (aOR) 1.67), 2 or more previous cesarean deliveries (aOR 5.22), anterior placenta (aOR 2.53), abnormal percreta (aOR 5.24), and antepartum bleeding (aOR 1.90) were strongly associated with massive hemorrhage (P<0.05). Conclusions: Prior cesarean delivery increases risks of hemorrhage, hysterectomy, premature birth, and neonatal hospitalization in patients with CPP. Independent risk factors for hemorrhage in these patients include prior cesarean delivery (especially 2 or more), anterior placenta, abnormal placentation, and prenatal bleeding.