Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery

ObjectiveTo compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery.MethodsIn a retrospective study, records were reviewed for women who had anterior placenta previa and delivered by cesarean after 24 weeks of pregnancy at a tertiary center in Rouen, France. During period A (January 2000 to December 2006), the protocol was to systematically transect the placenta when it was unavoidable. During period B (January 2007 to December 2010), the technique was to avoid incision by circumventing the placenta and passing a hand around its margin. Logistic regression was used to identify independent risk factors associated with maternal transfusion of packed red blood cells.ResultsEighty-four women were included (period A: n = 43; period B: n = 41). During period B, there was a reduction in frequency of intraoperative hemorrhage (> 1000 mL) (P = 0.02), intraoperative hemoglobin loss (P = 0.005), and frequency of blood transfusion (P = 0.02) as compared with period A. In multivariable analysis, period B was associated with a reduced risk of maternal transfusion (odds ratio 0.27; 95% confidence interval 0.09–0.82; P = 0.02).ConclusionAvoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery.