Clinical characteristics of pregnancies complicated by both fetal growth restriction and placenta previa or low-lying placenta

Aim: This study aimed to examine the clinical characteristics of pregnancies complicated by both fetal growth restriction (FGR) and placenta previa or low-lying placenta (PPLLP). Methods: A retrospective cohort study was performed to compare clinical characteristics of pregnancies complicated by FGR and/or PPLLP in women who do not habitually smoke or consume alcohol and who underwent delivery of singletons at 22 weeks' gestation at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2015. Assessed factors related to patients and perinatal outcomes included maternal age, parity, history of in vitro fertilization, hypertensive disorders, delivery mode, fetal ultrasonographic findings, delivery mode, gestational age at delivery, neonatal asphyxia, and postpartum hemorrhage. Results: There were 24,118 singleton deliveries assessed for eligibility. Of these, 7 were complicated by both FGR and PPLLP. The development of FGR was not associated with the presence of PPLLP (odds ratio 1.12, 95% confidence interval 0.54-2.4, P = 0.69). Multivariate logistic regression analysis revealed that the incidence of preterm cesarean delivery due to massive bleeding in pregnancies complicated by both FGR and PPLLP was higher than that in pregnancies complicated by PPLLP or FGR alone (vs. PPLLP alone: adjusted OR 7.11, P= 0.03; vs. FGR alone: adjusted OR 195, P<0.01). Conclusion: Obstetricians should be aware of the increased risk of preterm delivery related to antepartum massive bleeding in pregnancies complicated by both FGR and PPLLP.