International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Matern Fetal Neonatal Med. 2020 Nov;33(21):3608-3613. doi: 10.1080/14767058.2019.1581167. Epub 2019 Feb 27.
We aimed to evaluate the relationship between mode of first delivery with subsequent placenta previa, placenta accreta/increta, and significant postpartum hemorrhage (PPH). This retrospective cohort study included women with two consecutive singleton deliveries between 2007 and 2017 at our institution if the women were nulliparous and delivered at term at the time of first delivery. The first pregnancy delivery mode was classified as (1) vaginal delivery, (2) antepartum cesarean delivery (CD) without labor, or (3) intrapartum CD after the onset of labor. Within these three groups, rates of placenta previa, placenta accreta/increta, and significant PPH at the time of the second delivery were compared. Significant PPH was defined as hemorrhage requiring a blood transfusion. A total of 8208 women were analyzed. Most first deliveries were vaginal ( = 5210, 63.5%), followed by antepartum CD ( = 2432, 29.6%) and intrapartum CD ( = 566, 6.9%). The incidence of placenta previa in subsequent deliveries differed by previous delivery mode: vaginal, 0.9%; antepartum CD, 2.0%; intrapartum CD, 1.6% ( < .001). Similar differences were also observed with respect to placenta accreta/increta (0.5 versus 1.5 versus 0.9%, < .001) and PPH (0.6 versus 1.2 versus 0.4%, = .017). Compared to the previous vaginal delivery group, the antepartum CD group had increased risks of placenta previa (aORs 2.02, 95% CI 1.35-3.05), placenta accreta/increta (aOR 2.52; 95% CI 1.53-4.14) and PPH (aOR 1.78, 95% CI 1.14-2.98) in subsequent pregnancies. However, the previous intrapartum CD was not significantly associated with increased risks of these complications. Previous antepartum CD was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery compared to women with a prior vaginal delivery. The increased risks of subsequent abnormal placentation following primary antepartum CD may be important for counseling concerning nonmedically indicated elective cesarean. Previous antepartum cesarean delivery (CD) was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery.
我们旨在评估初次分娩方式与后续前置胎盘、胎盘粘连/植入和产后大出血（PPH）之间的关系。这项回顾性队列研究纳入了 2007 年至 2017 年在我院连续两次单胎分娩的妇女，如果妇女是初产妇且在初次分娩时足月分娩。初次妊娠分娩方式分为（1）阴道分娩，（2）无临产的产前剖宫产（CD），或（3）临产开始后的产时 CD。在这三组中，比较了第二次分娩时前置胎盘、胎盘粘连/植入和显著 PPH 的发生率。显著 PPH 定义为需要输血的出血。共分析了 8208 名妇女。大多数初次分娩为阴道分娩（=5210，63.5%），其次为产前 CD（=2432，29.6%）和产时 CD（=566，6.9%）。后续分娩中前置胎盘的发生率因先前的分娩方式而异：阴道分娩 0.9%；产前 CD 2.0%；产时 CD 1.6%（<.001）。胎盘粘连/植入（0.5 比 1.5 比 0.9%，<.001）和 PPH（0.6 比 1.2 比 0.4%，=0.017）也有类似的差异。与之前的阴道分娩组相比，产前 CD 组前置胎盘（OR 2.02，95%CI 1.35-3.05）、胎盘粘连/植入（OR 2.52；95%CI 1.53-4.14）和 PPH（OR 1.78，95%CI 1.14-2.98）的风险增加。然而，之前的产时 CD 与这些并发症的风险增加没有显著关联。与阴道分娩相比，初产妇产前 CD 与第二次分娩中前置胎盘、胎盘粘连/植入和显著 PPH 的风险增加两倍相关。与原发性产前 CD 相关的后续异常胎盘形成风险增加可能对非医学指征的选择性剖宫产的咨询很重要。初产妇产前剖宫产（CD）与第二次分娩中前置胎盘、胎盘粘连/植入和显著 PPH 的风险增加两倍相关。
