title: Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey.
abstract: OBJECTIVE
  To determine risk factors for severe complications during and after cesarean delivery (CD) in placenta previa (PP).
  
  
  METHODS
  We reviewed retrospectively collected data from women with PP who underwent CD during a 6-year study period. We identified the complicated group based on the modified WHO near-miss criteria. Complicated and noncomplicated groups were compared considering clinical, laboratory, and sonographic features.
  
  
  RESULTS
  Thirty-seven of 256 cases classified as near miss consisting of 14 peripartum hysterectomies, 12 uterine balloon placements, 10 great artery ligations, and four B-lynch suture placement procedures without maternal mortality. Perioperative complications included surgical wound infections (n = 5), bladder injury (n = 4), pelvic abscess (n = 1), and uterine rupture (n = 1). Logistic regression analyses demonstrated following features to be associated with maternal near miss in PP: (1) coexistent abruption (aOR 13.2, 95% CI 5.8-75.3), (2) morbidly adherent placenta (aOR 11.92, 95% CI 3.24-43.82), (3) number of hospitalizations for vaginal bleeding (≥3) (aOR 8.88, 95% CI 3.32-26.69), and (4) transvaginal cervical length (CL) measurement <10th percentile (aOR 5.5, 95% CI 2.1-15.4).
  
  
  CONCLUSIONS
  Short cervical length, recurrent vaginal bleeding, morbidly adherent placenta, and concurrent placental abruption are independent predictors for subsequent severe maternal morbidity in PP cases. Early identification of these risk factors during PP follow-up may improve maternal outcome.
authors.affiliation: a Department of Obstetrics and Gynecology , Polatlı State Hospital , Ankara , Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Coskun
authors.affiliation: b Department of Obstetrics and Gynecology , Isparta Maternity and Children's Hospital , Isparta , Turkey.
authors.forename: Iltac
authors.initials: I
authors.lastname: Akkurt
authors.affiliation: c Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital , Ankara , Turkey.
authors.forename: Rıza
authors.initials: R
authors.lastname: Dur
authors.affiliation: d Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology , Suleyman Demirel University , Isparta , Turkey.
authors.forename: Mehmet O
authors.initials: MO
authors.lastname: Akkurt
authors.affiliation: c Department of Obstetrics and Gynecology , Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital , Ankara , Turkey.
authors.forename: Seval Y
authors.initials: SY
authors.lastname: Ergani
authors.affiliation: e College of Arts and Sciences , University of Miami , Coral Gables , FL , USA.
authors.forename: Ozerk T
authors.initials: OT
authors.lastname: Turan
authors.affiliation: f Department of Obstetrics and Gynecology , Sincan State Hospital , Ankara , Turkey.
authors.forename: Bugra
authors.initials: B
authors.lastname: Coskun
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D000067491:Near Miss, Healthcare; D010923:Placenta Previa; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Abruption placenta; cesarean delivery; maternal near-miss; placenta previa