Placenta praevia and the risk of adverse outcomes during second trimester abortion: A retrospective cohort study

Perriera L

Arslan AA

Masch R

Australian and New Zealand Journal of Obstetrics and Gynaecology
Feb 2017

BACKGROUND:

There are few reports in the literature of the risks associated with second trimester abortion in women with placenta praevia(PP). We hypothesise that PP increases the risk of complications.

AIMS:

We sought to determine if PP is associated with a higher risk of blood loss and blood transfusion at the time of dilation and evacuation (D&E).

MATERIALS AND METHODS:

The records of 612 consecutive women undergoing abortion at 15-24 weeks of gestation were reviewed. Participant characteristics, need for blood transfusion, estimated blood loss (EBL) during the abortion and other complications were compared between women with and without ultrasound-documented PP.

RESULTS:

Eighty-seven of 612 (14.2%, 95% CI 11.5-17.2%) women had ultrasound-documented PP. The rate of blood transfusion was 3.4 and 1.3% in the group with PP and without PP, respectively (adjusted relative risk (RR = 2.8, 95% CI 0.7-11.3). An estimated blood loss of 500 cc or greater during the D&E procedure was observed in 12.6% of women in the PP group compared with 4.2% of women in the group without PP (adjusted RR 3.1, 95% CI 1.4-6.8, P = 0.004).

CONCLUSIONS:

Second-trimester abortion in women with PP is associated with a higher risk of blood loss of 500 cc or greater. Our study represents a larger sample size of patients with PP undergoing second-trimester abortion than previously reported in the literature. Women with PP may have a higher estimated blood loss and may require access to blood transfusion.