From the Guidelines
Resolved low-lying placentation is associated with an increased risk of postpartum hemorrhage (PPH). The evidence suggests that women with a history of low-lying placentation, including placenta previa, are at a higher risk of developing PPH 1.
Key Risk Factors
- Previous cesarean delivery: The incidence of placenta accreta spectrum, which is a significant risk factor for PPH, increases with the number of prior cesarean deliveries 1.
- Placenta previa: The risk of placenta accreta spectrum is dramatically increased in women with placenta previa and one or more previous cesarean deliveries 1.
- Advanced maternal age and multiparity: These factors also increase the risk of placenta accreta spectrum and subsequent PPH 1.
Management Implications
- Increased vigilance: Women with a history of low-lying placentation should be closely monitored for signs of PPH during the postpartum period 1.
- Prophylactic oxytocin administration: Consider administering oxytocin (10-20 units) during the third stage of labor to reduce the risk of PPH in these women 1.
- Availability of blood transfusion protocols: Ensure that women with a history of low-lying placentation have access to a blood bank capable of employing massive transfusion protocols in case of severe PPH 1.