title: Placenta previa and maternal hemorrhagic morbidity.
abstract: OBJECTIVE
  Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage.
  
  
  METHODS
  This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated.
  
  
  RESULTS
  Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia.
  
  
  CONCLUSIONS
  Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.|b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Gibbins
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.|b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Einerson
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.|b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , University of Utah School of Medicine , Salt Lake City , UT , USA.|b Intermountain Healthcare Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , Salt Lake City , UT , USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008274:Magnesium / Q000009:adverse effects; D010923:Placenta Previa / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D008274:Magnesium
keywords: Placenta previa; maternal morbidity; obstetric hemorrhage