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OBSTETRICS
330.e1
2010
OCTOBER
330.e1
We therefore sought to estimate the relationship between placenta previa and fetal growth restriction in an effort to assist
physicians with clinical management.
330.e2
2010
OCTOBER
330.e2
Research
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across groups. The statistical analysis
was performed using STATA, version
10
Special Edition (StataCorp, College Station, TX).
TABLE 1
Demographic data
Demographic
No previa
(n 57,015)
Previa
(n 724)
Age, y
30.2 6.3
32.5 5.8
.
01
..............................................................................................................................................................................................................................................
Gravidity
2.7 1.6
3.1 1.7
.
01
..............................................................................................................................................................................................................................................
Parity
1.1 1.2
1.2 1.2
.
01
..............................................................................................................................................................................................................................................
Race.....................................................................................................................................................................................................................................
White
36,337 (63.7%)
479 (66.2%)
.18
.....................................................................................................................................................................................................................................
Black
11,716 (20.5%)
124 (17.1%)
.
02
..............................................................................................................................................................................................................................................
Tobacco
use
6308 (11.1%)
94 (13.0%)
.11
..............................................................................................................................................................................................................................................
Diabetes
2998 (5.4%)
38 (5.3%)
.95
..............................................................................................................................................................................................................................................
Preeclampsia
4244 (7.6%)
38 (5.3%)
.02
R ESULTS
type of previa on routine second-trimester ultrasound: 392 complete, 332 partial, and 941 marginal. The 724 patients
who received a diagnosis of either complete or partial previa were included in
the primary analysis. Patients with and
without placenta previa differed slightly
(Table 1). Patients with placenta previa
tended to be slightly older, had more
The incidence of placenta previa by
previa type was described, and their association with IUGR was estimated. Patients with and without placenta previa
were compared with descriptive and bivariate statistics using unpaired Student t
2
tests for continuous variables and
tests for categorical variables. Potentially
confounding variables of the exposureoutcome association were identified in
the stratified analyses. Multivariable logistic regression models for IUGR less
than the 10th and fifth percentiles were
then developed to better estimate the effect of placenta previa on fetal growth
while adjusting for potentially confounding effects. Clinically relevant covariates for initial inclusion in multivariable statistical models were selected
using results of the stratified analyses,
and factors were removed in a backward
stepwise fashion, based on significant
changes in the exposure adjusted odds
ratio (AOR) or significant differences
between hierarchical models using likelihood ratio test. In patients with a repeat
ultrasound, the rate of previa at the first
and the last ultrasound were described.
McNemar 2 analysis was used to com-
..............................................................................................................................................................................................................................................
1311 (2.3%)
27 (3.8%)
.01
..............................................................................................................................................................................................................................................
Single
umbilical artery
260 (0.5%)
2 (0.3%)
.47
..............................................................................................................................................................................................................................................
Intrauterine fetal demise
415 (0.7%)
13 (1.8%)
.
01
..............................................................................................................................................................................................................................................
Bleeding (any time)
01
3286 (5.8%)
123 (17.0%)
..............................................................................................................................................................................................................................................
Research
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pare the rate of resolution between types
2
of previa, and Pearson
test for trend
Obstetrics Research
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pregnancies, had less preeclampsia,
and had higher rates of preterm
premature rupture of membranes,
bleeding during pregnancy,
and
intrauterine fetal de- mise. The 2
groups were similar with re- spect to
tobacco use, diabetes, and single
umbilical artery.
Of the 724 women with placenta
previa
on
second-trimester
ultrasound, 51 (7.2%) had an infant
with a birthweight less than the 10th
percentile, compared with 4026
(7.2%) in patients without placenta
previa (risk ratio [RR], 1.0; 95%
confidence interval [CI], 0.771.3)
(Ta- ble 2). After adjusting for black
race, di- abetes, preeclampsia, and
TABLE 2
Complete or
Partial previa
(n 724)
No previa
(n 57,015)
RR
(95% CI)
AOR
(95% CI)
Birthweight
10th percentile
4026 (7.2%)
51 (7.2%)
1.0 (0.81.3)
1.1 (0.91.5)
.70
................................................................................................................................................................................................................................................................................................................................................................................
Birthweight 5th percentile
1705 (3.1%)
21 (3.0%)
0.98 (0.61.5)
1.1 (0.81.7)
.93
................................................................................................................................................................................................................................................................................................................................................................................
AOR, adjusted odds ratio; CI, confidence interval; IUGR, intrauterine growth restriction; RR, relative risk.
a
Adjusted for black race, diabetes, preeclampsia, and single umbilical artery.
11.3%; P
.01), but they were less
likely to have a single umbilical artery
(0.3% vs
0.6%; P
.01). They were statistically
similar on all other measured covariates
and baseline characteristics.
C OMMENT
We found no association between placenta previa diagnosed at routine second-trimester ultrasound and a birthweight less than the 10th percentile, or
5th percentile, on the Alexander growth
standard. In addition, we found that the
risk of IUGR is not increased in
patients with persistent placenta previa
through the third trimester.
In an era when the majority of
patients will undergo a secondtrimester ultra- sound,11
clinicians
must be capable of counseling patients
on the implications of the findings of
that ultrasound. Prior large studies
examining the relationship between
placenta previa and neonatal
TABLE 3
Variable
IUGR,
n (%)
AOR
(95% CI)
Resolved
previa,
n (%)
Persistent
previa,
n (%)
IUGR in
persistent
previa,
n (%)
AOR
(95% CI)
32 (8.7)
19 (5.9)
52 (5.8)
1.4 (0.92.0)
.23
135 (59.0)
94 (41.0)
15 (20.2)
1.6c (0.73.5)
.23
................................................................................................................................................................................................................................................................................................................................................................................
0.9 (0.61.4)
.43
168 (80.8)
40 (19.2)
.23
................................................................................................................................................................................................................................................................................................................................................................................
d
0.8 (0.61.1)
.11
534 (94.5)
31 (5.5)
1 (4.3)
0.5 (0.14.2)
.56
................................................................................................................................................................................................................................................................................................................................................................................
AOR, adjusted odds ratio; CI, confidence interval; IUGR, intrauterine growth restriction.
a
Reference group: patients with no previa, n 57,015, rate of IUGR, 7.2% (Table 2). Adjusted for black race, diabetes, preeclampsia, and single umbilical artery; b Reference group: patients with
resolved previa; c Adjusted for single umbilical artery; d Adjusted for preeclampsia.
REFERENCES