When should women with placenta previa be delivered? A decision analysis.
OBJECTIVE
To determine the optimal gestational age of delivery for women with placenta previa by accounting for both neonatal and maternal outcomes.


METHODS
A decision-analytic model was designed comparing total maternal and neonatal quality-adjusted life years for delivery of women with previa at gestational ages from 34 to 38 weeks. At each week, we allowed for four different delivery strategies: (1) immediate delivery, without amniocentesis or steroids; (2) delivery 48 hours after steroid administration (without amniocentesis); (3) amniocentesis with delivery if fetal lung maturity (FLM) positive or retesting in one week if FLM negative; (4) amniocentesis with delivery if FLM testing is positive or administration of steroids if FLM negative.


RESULTS
Delivery at 36 weeks, 48 hours after steroids, for women with previa optimizes maternal and neonatal outcomes. In sensitivity analyses, these results were robust to a wide range of variation in input assumptions. If it is assumed that steroids offer no neonatal benefit at this gestational age, outright delivery at 36 weeks' gestation is the best strategy.


CONCLUSIONS
Steroid administration at 35 weeks and 5 days followed by delivery at 36 weeks for women with placenta previa optimizes maternal and neonatal outcomes.
Center for Clinical and Policy Perinatal Research, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California 94143, USA. zlatnikm@obgyn.ucsf.edu
Marya G
MG
Zlatnik
Sarah E
SE
Little
Puja
P
Kohli
Anjali J
AJ
Kaimal
Naomi E
NE
Stotland
Aaron B
AB
Caughey
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000649:Amniocentesis; D002585:Cesarean Section; D003661:Decision Support Techniques; D036861:Delivery, Obstetric; D005260:Female; D005325:Fetal Organ Maturity; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D010923:Placenta Previa / Q000188:drug therapy / Q000601:surgery; D011247:Pregnancy; D047928:Premature Birth; D019057:Quality-Adjusted Life Years
D000305:Adrenal Cortex Hormones