When should women with placenta previa be delivered? A decision analysis

Marya G. Zlatnik, Sarah E. Little, Puja Kohli, Anjali J. Kaimal, Naomi E. Stotland, Aaron B. Caughey

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

OBJECTIVE: To determine the optimal gestational age of delivery for women with placenta previa by accounting for both neonatal and maternal outcomes. STUDY DESIGN: A decision-analytic model was designed comparing total maternal and neonatal qualityadjusted life years for delivery of women with previa at gestational ages from 34 to 38 weeks. At each week, we allowed for four different delivery strategies: (1) immediate delivery, without amniocentesis or steroids; (2) delivery 48 hours after steroid administration (without amniocentesis); (3) amniocentesis with delivery if fetal lung maturity (FLM) positive or retesting in one week if FLM negative; (4) amniocentesis with delivery if FLM testing is positive or administration of steroids if FLM negative. RESULTS: Delivery at 36 weeks, 48 hours after steroids, for women with previa optimizes maternal and neonatal outcomes. In sensitivity analyses, these results were robust to a wide range of variation in input assumptions. If it is assumed that steroids offer no neonatal benefit at this gestational age, outright delivery at 36 weeks' gestation is the best strategy. CONCLUSION: Steroid administration at 35 weeks and 5 days followed by delivery at 36 weeks for women with placenta previa optimizes maternal and neonatal outcomes.

Original languageEnglish (US)
Pages (from-to)373-381
Number of pages9
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume55
Issue number10
StatePublished - Oct 2010
Externally publishedYes

Keywords

  • Decision analysis
  • Placenta previa
  • Pregnancy complications
  • Preterm delivery

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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