Hemorrhagic Morbidity in Invasive Placentation With and Without Placenta Previa

Abstract

TITLE: Hemorrhagic morbidity in invasive placentation with and without placenta previa Bethany M. Mulla, MD, Robert D. Weatherford, BA, Allyson M. Redhunt, BA, Anna M. Modest, PhD, Michele R. Hacker, ScD, Jonathan L. Hecht, MD, PhD, Melissa H. Spiel, DO, Scott A. Shainker, DO Purpose: To compare hemorrhagic morbidity associated with invasive placentation with and without placenta previa Methods: A retrospective cohort was assembled of all deliveries with histologically confirmed invasive placentation that delivered at a tertiary care referral center from 1997 to 2017. Risk ratios and 95% confidence intervals were calculated and adjusted for depth of placental invasion Results: 105 pregnancies with invasive placentation were identified. Pregnancies with co-morbid placenta previa were more likely to require blood transfusion than those without (RR: 2.0; 95% CI: 1.3-3.1). Women with previa had larger median estimated blood loss and more units of packed red blood cells transfused (both p<0.03). Women with previa were more likely to have a hysterectomy (crude RR: 2.7; 95% CI: 1.8-3.8) and be admitted to the intensive care unit (aRR: 3.3; 95% CI: 1.1-9.6). Conclusions: Among women with invasive placentation, those with a co-existing previa experienced greater hemorrhagic morbidity compared to those without. Pregnancies complicated by both invasive placentation and previa warrant multi-disciplinary planning and assurance of resource availability.