Poster Session 4
Category: Clinical Obstetrics
Poster Session 4
Nirit Maliyanker, MD
Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Lital Shaham, MD, PhD (she/her/hers)
Resident Physician, Department of Obstetrics and Gynecology, Sheba Medical Center
Department of Obstetrics and Gynecology, Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Michal Fishel Bartal, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Noa Gonen, MD
MFM Fellow
Wolfson Medical Center
Holon, HaMerkaz, Israel
.jpg "Avishag Abecassis, MD, MSc photo")
Avishag Abecassis, MD, MSc
MFM Fellow
Department of Obstetrics and Gynecology, Sheba Medical Center
Ramat Gan, HaMerkaz, Israel
Michal Axelrod, MD, MPH (she/her/hers)
Sheba Medical Center
Sheba Medical Center, HaMerkaz, Israel
Individuals with placenta previa undergoing unplanned cesarean delivery (CD) may have worse outcomes than those with planned CD. We compared maternal and neonatal outcomes between planned and unplanned CD.
Study Design:
We conducted a retrospective cohort study (2011-2015) at a single tertiary center, including singleton pregnancies with placenta previa. Suspected placenta accreta spectrum cases were excluded. Primary outcomes were composite maternal and neonatal morbidity. Maternal composite included postpartum fever, hemorrhage, transfusion, surgical intervention (CT drainage, relaparotomy), ICU admission, hospitalization >6 days or readmission. Neonatal composite included Apgar scores < 7 at 5min, cord pH < 7.1, NICU admission, RDS, TTN, hypoglycemia, or sepsis. Significant clinically relevant variables were adjusted for using logistic regression models.
Results:
Of 144,601 deliveries, 422 (0.3%) met inclusion criteria; 274 (64.9%) had a planned CD and 148 (35.1%) an unplanned CD. Groups were similar in baseline. Unplanned CD was associated with more antepartum bleeding (70.3% vs. 28.5%, OR 5.94, 95% CI 3.83–9.22). Gestational age was lower in the unplanned group (35.4 vs. 37.3 weeks, p< 0.001), with increased use of general anesthesia (41.9% vs. 8.4%, OR 7.87).
Maternal morbidity was higher following unplanned CD (34.5% vs. 12.0%, aOR 3.23, 95% CI 1.80–5.81, p< 0.001), even after adjustment. Neonatal morbidity was also higher (62.2% vs. 24.1%) but not significant after adjustment for gestational age (aOR 1.037, 95% CI 0.57-1.89, p=905).
Conclusion:
About one-third of individuals with placenta previa undergo unplanned delivery before 37 weeks, independently increasing maternal morbidity. Neonatal complications were more frequent but largely driven by earlier gestational age at birth. These findings highlight the value of anticipatory planning, especially in cases with antepartum bleeding, to reduce the likelihood of urgent cesarean and improve maternal outcomes without compromising neonatal safety.