Obstetrics
Placenta previa: Neonatal death after live births in the United States☆

https://doi.org/10.1067/mob.2003.303Get rights and content

Abstract

Objective: The purpose of this study was to describe neonatal mortality rates among live births that were complicated by placenta previa in the United States. Study Design: This was a population-based retrospective cohort study of 1997 United States singleton live births. Neonatal deaths among pregnancies that were complicated by placenta previa were compared with deaths among pregnancies with no placenta previa. Adjusted and unadjusted hazard ratios were generated from a proportional hazards regression model. Results: Of 3,773,369 live births, 9656 were complicated by placenta previa (2.6 cases per 1000). Among cases of placenta previa, 114 neonatal deaths occurred (11.8 per 1000) versus 14951 (4 per 1000) among non-placenta previa neonates (P <.0001). The adjusted relative risk of death was three times higher among placenta previa neonates (hazard ratio, 3.06; 95% CI, 2.40-3.94). Placenta previa-related death was mediated through preterm delivery rather than small for gestational age. Conclusion: Placenta previa triples the rate of neonatal mortality, which is mediated mainly through preterm birth. (Am J Obstet Gynecol 2003;188:1305-9.)

Section snippets

Material and methods

This was a retrospective cohort study that was based on live births that occurred throughout the United States in 1997. We used the national linked birth/infant death data set that contains the 1997 live birth cohort for our analysis. These data source are available to the public on CD-ROMS and cover 99% of all births that occurred in the United States and its territories in 1997. Complete linkage was successful for approximately 98% of live births. The details of the linkage process and

Results

In 1997, 3,773,369 women were delivered of singleton live infants in the United States, of which 9656 births were identified as cases of placenta previa, which was a prevalence of 2.6 cases per 1000 live births. White mothers had a higher likelihood for placenta previa compared with black mothers (P =.01, Table I).However, other minority mothers had a much higher rate of placenta previa than white mothers (P <.0001). The overwhelming majority (82%) of this racial minority group were Asian or

Comment

The incidence of placenta previa has been reported to range between 3.0 and 7.0 per 1000 singleton pregnancies.2, 9, 15, 16, 17, 18 We observed 2.6 cases per 1000 in this population-based study that included only cases of placenta previa that underwent a cesarean delivery; despite this restriction, this figure falls within the confidence limits of the quoted incidence estimates. Although the cause of placenta previa remains poorly understood, several risk factors that are related to this

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    ☆

    Reprint requests: Hamisu M. Salihu, MD, PhD, Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 320 Ryals Bldg, 1665 University Boulevard, Birmingham, AL 35294-0022. E-mail: [email protected]

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