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Korean Journal of Obstetrics & Gynecology 2001;44(5):858-860.
Published online May 1, 2001.
Placenta previa totalis and previous cesarean section.
H K Ahn, E S Kim, J Y Han, M Y Kim, H M Ryu, K H Choi, J H Yang
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Samsung Cheil Hospital & Women's Healthcare Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
Abstract
OBJECTIVE
To determine the relationship between previous cesarean section and subsequent development of placenta previa totalis and placenta previa totalis with accreta. MATERIALS AND METHODS: A retrospective review of the case records of all women delivered with the diagnosis of placenta previa totalis during the 5-year period from August 1, 1994, to July 31, 1999, at the Samsung Cheil Hospital. RESULTS: There were 38,215 deliveries in the study period. 237(0.62%) had placenta previa totalis and 56(23.6%) of whom had a history of previous cesarean section. The incidence of placenta previa totalis was significantly increased in those with a previous cesarean section(1.19%) compared with those with an unscarred uterus(0.54%). In the group without antecedent of cesarean section, accretism risk was 11.6%, with one section or more 32.1%. The need for cesarean hysterectomy occurred more commonly in patients who had a prior cesarean delivery, 14 of 56(25%), as compared with patients with no prior cesarean delivery, 6 of 181(3.3%). CONCLUSION: There is a strong association between previous cesarean section and risk of subsequent development of placenta previa totalis. Patients with an antepartum diagnosis of placenta previa who have had a previous cesarean section should be considered at high risk of developing placenta accreta. patients with previous cesarean section have a significantly higher incidence of postpartum hemorrhage and are more likely to undergo emergency hysterectomy.
Key Words: Placenta previa totalis, cesarean section, accreta, postpartum hemorrhage


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