The comparison of maternal and neonatal outcomes between planned and emergency cesarean deliveries in placenta previa patients without placenta accreata spectrum

Abstract

Objectives: This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency cesarean delivery (ECD) in placenta previa (PP) patients without placenta accreata spectrum (PAS) in a tertiary referral hospital. Material and methods:This retrospective cohort study included 237 singleton pregnant women who were diagnosed with PP without PAS at the time of delivery. PP patients who were delivered at the scheduled time were included in the PCD group. Patients with PP delivered in an emergency setting before the scheduled date were assigned to the ECD group. We recorded demographic and clinical characteristics, maternal and neonatal outcomes. Results:Of the 237 patients who met the inclusion criteria, 157 patients (66.8%) underwent PCD, and 80 patients required ECD (33.2%). Patients' hospitalization and pre-discharge hemoglobin levels were significantly lower in the ECD group (11.25 ± 1.97 g/dL and 9.74 ± 2.09 g/dL, respectively) than in the PCD group (10.77 ± 2.67 g/dL and 9.27 ± 2.70, p = 0.002 and p = 0.004, respectively). While six patients (7.5%) were required intensive care unit (ICU) admission in the ECD group, no patient was required to follow up in ICU in the PCD group (p < 0.001). The hospital length of stay (LOS) was tended to be significantly longer in the ECD group (2.8 ± 0.7 days) than in the PCD group (2.4 ± 0.6 days, p < 0.001). Neonatal outcomes of birth weight, Apgar scores, NICU admission, and neonatal death were significantly better in the PCD group than in the ECD group. Conclusions:The PCD group has better maternal outcomes, including preoperative and discharge hemoglobin levels, ICU admission and hospital LOS, and better neonatal outcomes than the ECD group. Clinicians should pay regard to that scheduling the delivery to advanced pregnancy weeks has a failure possibility, and patients could not reach the scheduled day due to the emergency states.

Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa

“…22 Gedik Özköse et al observed that 33.2% of patients with placenta previa underwent unscheduled delivery in the preterm period principally because of vaginal bleeding, labor pains, and fetal distress. 25 Erfani et al showed that 42.8% of pregnant patients with placenta previa (without placenta accreta spectrum) required emergent delivery because of premature labor contractions or vaginal bleeding. 26 Ruiter et al showed that of all patients with placenta previa who were planned for cesarean delivery after 37 weeks of gestation, 43% were unable to reach the scheduled delivery date, and the reason for 55% of these patients was severe hemorrhage.…”

The Implications of Multiple Repeat Cesarean Deliveries On Maternal Morbidity

“…Previous studies also confirmed the significant relationship between PAS and the increasing number of CDs in cases with placenta previa (10,22,23). All women with placenta previa and PAS, regardless of history of previous CD, were at substantially increased risk of massive intraoperative hemorrhage, blood transfusion, additional surgical interventions such as cesarean hysterectomy, and maternal ICU admission (9,(23)(24)(25)(26). Our study also revealed a significant increase in the rates of placenta previa, placenta accreta, massive intraoperative hemorrhage, blood transfusion, uterine artery ligation, internal iliac artery ligation, cesarean hysterectomy, maternal ICU admission in cases undergoing multiple repeat CD compared with women having CDs after fewer previous CDs.…”

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis

“…Thirteen studies compared the birth weights between the PCD and ECD groups. [16][17][18][19][20][21][22][23][24][25]27,28,33] However, one study [16] reported the medians of birth weight in 3 gestational ranges and therefore could not be pooled. In comparison to the ECD group, the pooled birth weight was significantly higher in the PCD group (SMD: 1.64; 95% CI: 1.00-2.27; P < .001; I 2 = 97%).…”

“…Nine studies reported the means of gestational age at delivery in the PCD and ECD gro ups. [18][19][20][21][22]24,25,27,33] The overall pooled estimate for gestational age was significantly higher in the PCD group compared to the ECD group (SMD: 2.20; 95% CI: 1.25-3.15; P < .001; I 2 = 98%). This finding was also seen in the subgroups of women with PP alone (SMD: 1.29; 95% CI: 1.02-1.56; P < .001; I 2 = 22%) and PAS patients with or without coexistent PP (SMD: 2.51; 95% CI: 1.21-3.81; P < .001; I 2 = 98%) (Fig.…”

“…Accumulating data has suggested that ECD is associated with a higher risk of adverse maternal outcomes compared to PCD, including more profound intraoperative blood loss, increased need for blood transfusion and intensive care unit admission, and a longer hospital stay. [17][18][19][20][21][22][23][24][25][26][27][28] Regardless, a recent multicenter study found that less than half of prenatally diagnosed PAS patients (39%) in the United States reached a scheduled delivery within the recommended gestational age. [29] As a result, ECD remains an unavoidable and yet common practice for women with abnormal placentation, and understanding the differences between ECD and PCD is critical for optimizing maternal-fetal care.…”