The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study

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; Wang Zhijian; Du Lili; Chen Dunjin

doi:10.3389/fmed.2021.745080

The Risk of Postpartum Hemorrhage Following Prior Prelabor Cesarean Delivery Stratified by Abnormal Placentation: A Multicenter Historical Cohort Study

Front Med (Lausanne). 2021 Oct 11:8:745080. doi: 10.3389/fmed.2021.745080. eCollection 2021.

Authors

Bi Shilei¹, Zhang Lizi², Li Yulian¹, Liang Yingyu¹, Huang Lijun¹, Huang Minshan¹, Huang Baoying¹, Jia Jinping³, Cao Yinli⁴, Wang Shaoshuai⁵, Xu Xiaoyan⁵, Feng Ling⁵, Zhao Yangyu⁶, Zhao Xianlan⁷, Zhu Qiying⁸, Qi Hongbo⁹, Wen Suiwen¹⁰, Zhang Lanzhen¹¹, Li Hongtian¹², Chen Jingsi^{1

13}, Wang Zhijian², Du Lili^{1

13}, Chen Dunjin^{1

13}

Affiliations

¹ Key Laboratory for Major Obstetric Diseases of Guangdong Province, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
³ Department of Obstetrics and Gynecology, Guangzhou Huadu District Maternal and Child Health Hospital, Guangzhou, China.
⁴ Department of Obstetrics and Gynecology, Northwest Women's and Children's Hospital, Xian, China.
⁵ Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
⁷ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁸ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
⁹ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁰ Department of Obstetrics and Gynecology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Guangzhou, China.
¹¹ Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
¹² National Health Commission Key Laboratory of Reproductive Health, Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing, China.
¹³ Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institute, Guangzhou, China.

Abstract

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.

Keywords: cesarean delivery (CD); placenta accreta spectrum (PAS); placenta previa; postpartum hemorrhage (PPH); trial of labor (TOL).

Copyright © 2021 Shilei, Lizi, Yulian, Yingyu, Lijun, Minshan, Baoying, Jinping, Yinli, Shaoshuai, Xiaoyan, Ling, Yangyu, Xianlan, Qiying, Hongbo, Suiwen, Lanzhen, Hongtian, Jingsi, Zhijian, Lili and Dunjin.