title: Predictors for Emergency Cesarean Delivery in Women with Placenta Previa.
abstract: ObjectiveThe objective of this study was to identify the predictors of emergency delivery in women with placenta previa.MethodsThis is a retrospective study of pregnancies complicated by placenta previa, scheduled for a cesarean delivery between 2001 and 2011. Using univariable and multivariable regression predictors for emergency delivery in these women were determined. Predictive performance was assessed using receiver operating characteristic analysis and calibration plot. Internal validation was performed by bootstrap analysis.ResultsOf 214 women with singleton pregnancies, 93 (43%) had an emergency cesarean delivery, and 43 (20%) were preterm. Independent predictors for emergency delivery were history of cesarean section (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.2-12), antepartum bleeding with one (OR, 7.5; 95% CI, 2.5-23), two (OR, 14; 95% CI, 4.3-47), and three or more episodes (OR, 27; 95% CI, 8.3-90) as well as need for blood transfusion (OR, 6.4; 95% CI, 1.7-23). For emergency preterm delivery, covariates were comparable. The area under the curve was 0.832 on the original data and 0.821 on the bootstrap samples.ConclusionPredictors for emergency delivery in women with placenta previa can be used for individualized antenatal care concerning timing of delivery and corticosteroid cover. Potentially, careful selection in women with placenta previa can result in more conservative treatment in an outpatient setting and reduction of iatrogenic preterm delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Ruiter
authors.affiliation: Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Sanne J
authors.initials: SJ
authors.lastname: Eschbach
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Mara
authors.initials: M
authors.lastname: Burgers
authors.affiliation: Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Katrien Oude
authors.initials: KO
authors.lastname: Rengerink
authors.affiliation: Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Mariëlle G
authors.initials: MG
authors.lastname: van Pampus
authors.affiliation: Department of Obstetrics and Gynecology, Spaarne Hospital, Hoofddorp, The Netherlands.
authors.forename: Birgit Y van der
authors.initials: BY
authors.lastname: Goes
authors.affiliation: The Robinson Research Institute, School of Medicine, University of Adelaide, South Australia, Australia.
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Irene M de
authors.initials: IM
authors.lastname: Graaf
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Pajkrt
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D005865:Gestational Age; D006801:Humans; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D036801:Parturition; D010923:Placenta Previa / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000453:epidemiology* / Q000209:etiology