Abstract：
OBJECTIVE: To compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients.
METHODS: This is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children\'s Hospital over the last ten-years (January 2012-December 2021), Aseer region, Saudi Arabia.
RESULTS: Compared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849).
CONCLUSIONS: (1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.
METHODS: This is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children\'s Hospital over the last ten-years (January 2012-December 2021), Aseer region, Saudi Arabia.
RESULTS: Compared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849).
CONCLUSIONS: (1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.
摘要：
目的：比较重度前置胎盘（PP）伴或不伴剖宫产（CS）患者的产妇特征和结局。并确定以前的CS是否单独是这些患者相关不良母体结局的风险因素。
方法：这是一项回顾性分析，包括两组主要PP患者，以前有CS（n=184）和没有CS（n=115）；在过去的十年（2012年1月至2021年12月）中被送往Abha妇产和儿童医院，Aseer地区,沙特阿拉伯。
结果：与以前没有CS的结果相比，既往CS的主要PP患者的年龄明显提前，妊娠和产次的平均数较高，但以前的子宫手术和IVF妊娠率明显较低。此外，他们更有可能获得更高的不良产妇结局.以同样的方式,这些患者的剖宫产子宫切除术的几率增加（OR为20.462），尿路损伤（OR为12.361），相关PAS（OR为4.375），术中/重度出血（OR为2.153），需要输注3个单位的打包红细胞（OR为1.849）。
结论：（1）合并存在主要PP和既往CS的患者，其不良母婴结局的发生率明显较高（2）单独，主要PP患者的既往CS增加了剖宫产子宫切除术的几率，尿道损伤,PAS的诊断，术中过度出血和反复充血红细胞输血。(3)在我们患有既往CS的PP患者中，PAS诊断率和OR的升高可以部分解释不良产妇结局.
方法：这是一项回顾性分析，包括两组主要PP患者，以前有CS（n=184）和没有CS（n=115）；在过去的十年（2012年1月至2021年12月）中被送往Abha妇产和儿童医院，Aseer地区,沙特阿拉伯。
结果：与以前没有CS的结果相比，既往CS的主要PP患者的年龄明显提前，妊娠和产次的平均数较高，但以前的子宫手术和IVF妊娠率明显较低。此外，他们更有可能获得更高的不良产妇结局.以同样的方式,这些患者的剖宫产子宫切除术的几率增加（OR为20.462），尿路损伤（OR为12.361），相关PAS（OR为4.375），术中/重度出血（OR为2.153），需要输注3个单位的打包红细胞（OR为1.849）。
结论：（1）合并存在主要PP和既往CS的患者，其不良母婴结局的发生率明显较高（2）单独，主要PP患者的既往CS增加了剖宫产子宫切除术的几率，尿道损伤,PAS的诊断，术中过度出血和反复充血红细胞输血。(3)在我们患有既往CS的PP患者中，PAS诊断率和OR的升高可以部分解释不良产妇结局.
