94: Placenta previa: an outcomes based cohort study in a contemporary obstetrics population

Placenta previa (PP) is believed to be increasing, yet little has been documented regarding the impact on neonatal outcomes. Our purpose is to report the prevalence of PP in a multicenter contemporary obstetrics population and to characterize maternal and neonatal morbidities. This retrospective cohort study used the Consortium on Safe Labor electronic database, including 12 clinical centers, totaling 19 hospitals. All patients with PP noted at delivery or as a reason for Cesarean were included. Maternal and neonatal variables were extracted and compared to a control group of women undergoing elective repeat Cesarean (RCS). Logistic regression and general linear regression were used to calculate odds ratios and 95% confidence intervals, with p<0.05 significant. There were 684 PP and 8281 elective RCS patients. The prevalence of PP was 0.3%. 34.3% (154) of PP and 55.8% (3561) of elective RCS were admitted electively for CS. 25.3% (114) of PP versus 3.8% (241) of controls were admitted for maternal reasons, and 6.2% (28) of PP and 0.94% (60) of RCS were admitted for fetal indications. PP was associated with significantly more maternal hemorrhage, blood transfusion, ICU admission, Cesarean hysterectomy and placenta accreta; there were no maternal deaths in either cohort. Neonates born to mothers with PP had lower gestational ages, birth weights and 5 minute APGARs. These neonates were also at increased risk of NICU admission, anemia, respiratory distress syndrome, mechanical ventilation, and intraventricular hemorrhage. There was no association of PP with congenital anomalies or death. While the prevalence of PP, 0.3%, and increased maternal morbidity have been previously reported, our work documents significant neonatal morbidities associated with the rising prevalence of PP. As PP continues to increase along with the growing CS rate, information regarding the associated neonatal morbidities can be used to discourage CS on request and to encourage TOLAC rather than multiple RCS. Tabled 1