Placenta previa and maternal hemorrhagic morbidity

Karen J. Gibbins, Brett D. Einerson, Michael W. Varner, Robert M. Silver

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Objective: Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. Methods: This is a secondary cohort analysis of the NICHD Maternal–Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. Results: Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9–3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0–4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5–5.7), and hysterectomy (aRR 5.1, 95% CI 1.5–17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. Conclusion: Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.

Original languageEnglish (US)
Pages (from-to)494-499
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number4
StatePublished - Feb 16 2018
Externally publishedYes


  • Placenta previa
  • maternal morbidity
  • obstetric hemorrhage

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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