{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:41:50Z","timestamp":1793324510314,"version":"4.5.0"},"reference-count":41,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low\u2010lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Population\u2010based study in 176 maternity units in France.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All women with anterior low\u2010lying (0\u201319\u2009mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Severe PPH defined by a composite criterion either estimated blood loss of \u22651500\u2009ml, transfusion of \u22654 or more units of packed red blood cells, embolisation or surgical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 520\u2009114 women constituting the source population, 230 (0.44\/1000 women; 95% confidence interval [CI] 0.38\u20130.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2\u201330.4) overall, 27.5% (95% CI 21.8\u201333.3) in women with placenta praevia and 15.4% (95% CI 10.7\u201320.0) in women with low\u2010lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8\u201313.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4\u201322.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20\u201315.8).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Severe PPH is frequent among women with anterior low\u2010lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low\u2010lying placenta.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17554","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T03:54:20Z","timestamp":1684986860000},"page":"1653-1661","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Incidence and risk factors for severe postpartum haemorrhage in women with anterior low\u2010lying or praevia placenta and prior caesarean: Prospective population\u2010based study"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-0683","authenticated-orcid":false,"given":"Anne","family":"Pinton","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOP\u00e9) Research Team  Paris France"},{"name":"Department of Obstetrics and Gynaecology Trousseau Hospital, APHP, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Deneux\u2010Tharaux","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOP\u00e9) Research Team  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lien","family":"Seco","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOP\u00e9) Research Team  Paris France"},{"name":"Clinical Research Unit Necker Cochin APHP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lo\u00efc","family":"Sentilhes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Bordeaux University Hospital  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Kayem","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOP\u00e9) Research Team  Paris France"},{"name":"Department of Obstetrics and Gynaecology Trousseau Hospital, APHP, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PACCRETA Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31928-7"},{"key":"e_1_2_11_3_1","volume-title":"Caesarean sections [Internet]","author":"OECD","year":"2018"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16647"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12405"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.01.233"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15306"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.054"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gyobfe.2005.03.016"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2019.07.019"},{"key":"e_1_2_11_13_1","unstructured":"Placenta praevia and placenta accreta: diagnosis and management (Green\u2010top Guideline No. 27a) [Internet]. 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