Impact of Prior Cesarean Delivery on Pregnancy Outcomes and Hemorrhage Risks in Complete Placenta Previa: A Decade-Long Retrospective Analysis

BACKGROUND Complete placenta previa (CPP) is a life-threatening condition with increasing incidence worldwide. This retrospective study investigated the impact of prior cesarean delivery on pregnancy outcomes in women with CPP. MATERIAL AND METHODS The data of 476 patients with CPP who underwent cesarean delivery in a tertiary hospital in Shanghai, China, from January 2013 to December 2022 were retrospectively analyzed. Patients were divided into prior cesarean delivery and no-prior cesarean delivery groups. Diagnosis of CPP was confirmed by last preoperative ultrasound/MRI. Maternal characteristics, intrapartum conditions, maternal complications, and neonatal outcomes were compared between groups. Independent predictors of hemorrhage were analyzed by logistic regression analysis. RESULTS The prior cesarean delivery group had significantly higher maternal age (36 [3.7)] vs 34.2 [4.2)], P=0.012), rates of intraoperative bleeding (982.9 [202.9] vs 588.8 [134.2], P=0.001), hysterectomy (6.4% vs 0.9%, P=0.002), premature birth (60.9% vs 36.6%, P<0.001), and neonatal hospitalization (13.5% vs 6.3%, P=0.008). The no-prior cesarean delivery group had higher rates of assisted reproduction (30.0% vs 3.8%, P<0.001) and endometriosis history (14.1% vs 8.3%, P<0.001). Multivariate logistic regression showed a history of cesarean delivery (adjusted odds ratio (aOR) 1.67), 2 or more previous cesarean deliveries (aOR 5.22), anterior placenta (aOR 2.53), abnormal percreta (aOR 5.24), and antepartum bleeding (aOR 1.90) were strongly associated with massive hemorrhage (P<0.05). CONCLUSIONS Prior cesarean delivery increases risks of hemorrhage, hysterectomy, premature birth, and neonatal hospitalization in patients with CPP. Independent risk factors for hemorrhage in these patients include prior cesarean delivery (especially 2 or more), anterior placenta, abnormal placentation, and prenatal bleeding.