Risk factors associated with unplanned caesarean section in women with placenta previa: a cohort study

Abstract

Unplanned/emergency caesarean section (CS) can lead to an increased risk of increased risk of adverse maternal and perinatal outcomes. This prospective observational study was conducted in a tertiary centre in South India to determine the factors associated with increased risk of unplanned/emergency CS among women with placenta previa (PP). Primary outcome was the unplanned CS defined as emergency CS performed, prior to the scheduled date of delivery, for profuse vaginal bleeding or onset of labour pains. Obstetric morbidity and maternal–foetal outcomes were also compared between major and minor degree of PP. Major degree PP (OR 3.56; 95% CI: 1.73–7.32), first episode of bleeding at less than 29 weeks of gestation (OR 6.25; 95% CI: 2.14–18.24), and the haemoglobin level at admission (OR: 0.72; 95% CI: 0.57–0.91) were found to be associated with higher odd for undergoing unplanned CS. Identifying these women at high risk of unplanned CS, especially in limited resource setting, helps for a timely and early referral to tertiary centres with expertise to manage complications along with facilities for blood transfusion and interventional radiology can help to optimise maternal and perinatal outcomes.

Impact Statement

• What is already known on this subject? With increasing numbers of caesarean sections (CSs) and assisted reproductive techniques, the rate of PP is constantly on the rise. Unplanned CS is associated with increased risk of adverse maternal and perinatal complications.

• What do the results of this study add? Nearly, 40% among those who underwent CS were unplanned. Major degree placenta previa (PP) (OR 3.56; 95% CI: 1.73–7.32), first episode of bleeding at less than 29 weeks of gestation (OR 6.25; 95% CI: 2.14–18.24), and the haemoglobin level at admission (OR: 0.72; 95% CI: 0.57–0.91) were found to be associated with higher odd for undergoing unplanned CS.

• What are the implications of these findings for clinical practice and/or further research? Identifying women with PP at high risk of unplanned CS, especially in limited resource setting, helps for a timely and early referral to tertiary centres with expertise to manage complications, facilities for blood transfusion and interventional radiology, which optimise maternal and perinatal outcomes.

Keywords:

• Antepartum haemorrhage
• placenta previa
• emergency caesarean section

Acknowledgements

Ethical approval: This study was done as per the ethical standards set by the Institute Scientific Advisory and Ethical Committee (Human Studies), in accordance with the 1964 Helsinki Declaration and its later amendments. The protocol for this study was approved by the Institute Ethics Committee for human studies (JIP/IEC/SC/2014/1/527). Informed consent was obtained from the patients before suction evacuation.

Authors contributions

DKM, SPR and AK conceived the study. All authors contributed to the design. SPR, AR, AM and PV carried out the data collection and SPR and AR guarantees data integrity. AK performed statistical analyses. DKM, AM, RK and AK reviewed the analysis and wrote the first draft. All authors contributed to revising and finalisation of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.