The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study
Background: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placen...
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Frontiers Media S.A.
2021-10-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.745080/full |
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| author | Bi Shilei Zhang Lizi Li Yulian Liang Yingyu Huang Lijun Huang Minshan Huang Baoying Jia Jinping Cao Yinli Wang Shaoshuai Xu Xiaoyan Feng Ling Zhao Yangyu Zhao Xianlan Zhu Qiying Qi Hongbo Wen Suiwen Zhang Lanzhen Li Hongtian Chen Jingsi Chen Jingsi Wang Zhijian Du Lili Du Lili Chen Dunjin Chen Dunjin |
| author_facet | Bi Shilei Zhang Lizi Li Yulian Liang Yingyu Huang Lijun Huang Minshan Huang Baoying Jia Jinping Cao Yinli Wang Shaoshuai Xu Xiaoyan Feng Ling Zhao Yangyu Zhao Xianlan Zhu Qiying Qi Hongbo Wen Suiwen Zhang Lanzhen Li Hongtian Chen Jingsi Chen Jingsi Wang Zhijian Du Lili Du Lili Chen Dunjin Chen Dunjin |
| author_sort | Bi Shilei |
| collection | DOAJ |
| description | Background: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placentation following a first CD before the onset of labor (prelabor) or intrapartum CD.Methods: This multicenter, historical cohort study involved singleton, pregnant women at 28 weeks of gestation or greater with a CD history between January 2017 and December 2017 in 11 public tertiary hospitals within 7 provinces of China. PPH was analyzed in the subsequent pregnancy between women with prior prelabor CD and women with intrapartum CD. Furthermore, PPH was analyzed in pregnant women stratified by complications with PP alone [without placenta accreta spectrum (PAS) disorders], complications with PP and PAS, complications with PAS alone (without PP), and normal placentation. We performed multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% CI controlling for predefined covariates.Results: Out of 10,833 pregnant women, 1,197 (11%) women had a history of intrapartum CD and 9,636 (89%) women had a history of prelabor CD. Prior prelabor CD increased the risk of PP (aOR 1.91, 95% CI 1.40–2.60), PAS (aOR 1.68, 95% CI 1.11–2.24), and PPH (aOR 1.33, 95% CI 1.02–1.75) in a subsequent pregnancy. After stratification by complications with PP alone, PP and PAS, PAS alone, and normal placentation, prior prelabor CD only increased the risk of PPH (aOR 3.34, 95% CI 1.35–8.23) in a subsequent pregnancy complicated with PP and PAS.Conclusion: Compared to intrapartum CD, prior prelabor CD increased the risk of PPH in a subsequent pregnancy only when complicated by PP and PAS. |
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| spelling | doaj.art-8522a9f7b8a5407b8ae1a992b32f56cb2022-12-21T21:29:20ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.745080745080The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort StudyBi Shilei0Zhang Lizi1Li Yulian2Liang Yingyu3Huang Lijun4Huang Minshan5Huang Baoying6Jia Jinping7Cao Yinli8Wang Shaoshuai9Xu Xiaoyan10Feng Ling11Zhao Yangyu12Zhao Xianlan13Zhu Qiying14Qi Hongbo15Wen Suiwen16Zhang Lanzhen17Li Hongtian18Chen Jingsi19Chen Jingsi20Wang Zhijian21Du Lili22Du Lili23Chen Dunjin24Chen Dunjin25Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou, ChinaDepartment of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xian, ChinaDepartment of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, ChinaDepartment of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, ChinaDepartment of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China0Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangzhou, China1Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China2National Health Commission Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China3Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, ChinaDepartment of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China3Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, ChinaKey Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China3Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, ChinaBackground: Prior prelabor cesarean delivery (CD) was associated with an increase in the risk of placenta previa (PP) in a second delivery, whether it may impact postpartum hemorrhage (PPH) independent of abnormal placentation. This study aimed to assess the risk of PPH stratified by abnormal placentation following a first CD before the onset of labor (prelabor) or intrapartum CD.Methods: This multicenter, historical cohort study involved singleton, pregnant women at 28 weeks of gestation or greater with a CD history between January 2017 and December 2017 in 11 public tertiary hospitals within 7 provinces of China. PPH was analyzed in the subsequent pregnancy between women with prior prelabor CD and women with intrapartum CD. Furthermore, PPH was analyzed in pregnant women stratified by complications with PP alone [without placenta accreta spectrum (PAS) disorders], complications with PP and PAS, complications with PAS alone (without PP), and normal placentation. We performed multivariate logistic regression to calculate adjusted odds ratios (aOR) and 95% CI controlling for predefined covariates.Results: Out of 10,833 pregnant women, 1,197 (11%) women had a history of intrapartum CD and 9,636 (89%) women had a history of prelabor CD. Prior prelabor CD increased the risk of PP (aOR 1.91, 95% CI 1.40–2.60), PAS (aOR 1.68, 95% CI 1.11–2.24), and PPH (aOR 1.33, 95% CI 1.02–1.75) in a subsequent pregnancy. After stratification by complications with PP alone, PP and PAS, PAS alone, and normal placentation, prior prelabor CD only increased the risk of PPH (aOR 3.34, 95% CI 1.35–8.23) in a subsequent pregnancy complicated with PP and PAS.Conclusion: Compared to intrapartum CD, prior prelabor CD increased the risk of PPH in a subsequent pregnancy only when complicated by PP and PAS.https://www.frontiersin.org/articles/10.3389/fmed.2021.745080/fullpostpartum hemorrhage (PPH)cesarean delivery (CD)placenta previaplacenta accreta spectrum (PAS)trial of labor (TOL) |
| spellingShingle | Bi Shilei Zhang Lizi Li Yulian Liang Yingyu Huang Lijun Huang Minshan Huang Baoying Jia Jinping Cao Yinli Wang Shaoshuai Xu Xiaoyan Feng Ling Zhao Yangyu Zhao Xianlan Zhu Qiying Qi Hongbo Wen Suiwen Zhang Lanzhen Li Hongtian Chen Jingsi Chen Jingsi Wang Zhijian Du Lili Du Lili Chen Dunjin Chen Dunjin The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study Frontiers in Medicine postpartum hemorrhage (PPH) cesarean delivery (CD) placenta previa placenta accreta spectrum (PAS) trial of labor (TOL) |
| title | The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study |
| title_full | The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study |
| title_fullStr | The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study |
| title_full_unstemmed | The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study |
| title_short | The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study |
| title_sort | risk of postpartum hemorrhage following prior prelabor cesarean delivery stratified by abnormal placentation a multicenter historical cohort study |
| topic | postpartum hemorrhage (PPH) cesarean delivery (CD) placenta previa placenta accreta spectrum (PAS) trial of labor (TOL) |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.745080/full |
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