title: Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery.
abstract: 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 0.27; 95% confidence interval 0.09-0.82; P=0.02).
  
  
  CONCLUSIONS
  Avoiding incision of the anterior placenta previa was found to reduce frequency of maternal blood transfusion during or after cesarean delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France. Electronic address: eric.verspyck@chu-rouen.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Verspyck
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Douysset
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of Pediatrics, Rouen University Hospital, Rouen, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Marret
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000601:surgery*; D010923:Placenta Previa / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins
keywords: Blood loss; Cesarean delivery; Incision; Placenta previa; Placental position; Risk factor