Elimination of marginal and partial placenta previa from clinical perspective: is it rational?

Abstract Background We aimed to evaluate the difference between the effects of three categories of classifications of placenta previa (PP) on maternal and neonatal outcomes. Methods This study was conducted in the Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2009 and 2018. The three categories of PP were the four-classification (low-lying, marginal, partial, and complete PP), three-classification (low-lying, “marpartial,” and complete PP), and two-classification (low-lying PP and PP) methods. We performed multivariate analysis to determine the effects of these classifications on maternal and neonatal outcomes. Results There were 4490 singleton pregnancies complicated with PP, of which 466, 1233, 140, and 2651 were low-lying, marginal, partial, and complete PP, respectively. As per the four-classification method, compared with women with low-lying PP, women with complete PP had a risk of placenta accrete spectrum, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and perinatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and perinatal outcomes. Conclusions Complete and low-lying PP were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification method may be practical from the ultrasound and clinical perspective.