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

Objective: To compare maternal outcomes after transection and after avoiding incision of the anterior placenta previa during cesarean delivery. Methods: In 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. Results: Eighty-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 027; 95% confidence interval 0.09-0.82; P = 0.02). Conclusion: Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.