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. This is likely due to the abnormal placental implantation and potential for placental accreta spectrum, which can lead to increased bleeding during delivery.
Risk Factors
- Previous cesarean delivery: The risk of placenta accreta spectrum, and subsequently PPH, increases with the number of prior cesarean deliveries 1.
- Placenta previa: The risk of placenta accreta spectrum is significantly increased in women with placenta previa, especially those with prior cesarean deliveries 1.
- Advanced maternal age and multiparity: These factors also increase the risk of placenta accreta spectrum and PPH 1.
Management
- Active management of the third stage of labor: This can help reduce the risk of PPH in women with a history of low-lying placentation 1.
- Availability of uterotonic medications: Medications like oxytocin (20-30 units) or carboprost tromethamine (0.25mg) can be used to manage PPH 1.
- Tranexamic acid: This antifibrinolytic agent can be used to reduce bleeding complications and mortality in cases of PPH 1.
It is essential to note that the evidence is based on studies of placenta accreta spectrum and PPH, and the specific association between resolved low-lying placentation and PPH risk may require further investigation. However, based on the available evidence, it is reasonable to conclude that women with a history of low-lying placentation are at a higher risk of PPH and should be managed accordingly 1.