[Placental complications after a previous cesarean section].
BACKGROUND
The incidence of cesarean section has been rising in the past 50 years. With the increased number of cesarean sections, the number of pregnancies with the previous cesarean section rises as well. The aim of this study was to establish the influence of the previous cesarean section on the development of placental complications: placenta previa, placental abruption and placenta accreta, as well as to determine the influence of the number of previous cesarean sections on the complication development.


METHODS
The research was conducted at the Clinic of Gynecology and Obstetrics in Nis covering 10-year-period (from 1995 to 2005) with 32358 deliveries, 1280 deliveries after a previous cesarean section, 131 cases of placenta previa and 118 cases of placental abruption. The experimental groups was presented by the cases of placenta previa or placental abruption with prior cesarean section in obstetrics history, opposite to the control group having the same conditions but without a cesarean section in medical history.


RESULTS
The incidence of placenta previa in the control group was 0.33%, opposite to the 1.86% incidence after one cesarean section (p<0.001), 5.49% after two cesarean sections and as high as 14.28% after three cesarean sections in obstetric history. Placental abruption was recorded as placental complication in 0.33% pregnancies in the control group, while its incidence was 1.02% after one cesarean section (p<0.001) and 2.02% in the group with two previous cesarean sections. The difference in the incidence of intrapartal hysterectomy between the group with prior cesarean section (0.86%) and without it (0.006%) shows a high statistical significance (p<0.001).


CONCLUSIONS
The previous cesarean section is an important risk factor for the development of placental complications.
Milosević
Jelena
J
Klinicki centar, Nis, Ginekolosko-akuserska klinika.
Lilić
Vekoslav
V
Tasić
Marija
M
Radović-Janosević
Dragana
D
Stefanović
Milan
M
Antić
Vladimir
V
D000037:Abruptio Placentae / Q000209:etiology; D017604:Cesarean Section, Repeat / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000209:etiology; D010922:Placenta Diseases / Q000209:etiology*; D010923:Placenta Previa / Q000209:etiology; D011247:Pregnancy