Open Access Highly Accessed Research article

Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis

Ipek Gurol-Urganci12*, David A Cromwell12, Leroy C Edozien3, Gordon CS Smith4, Chidimma Onwere2, Tahir A Mahmood2, Allan Templeton2 and Jan H van der Meulen1

Author affiliations

1 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

2 Office for Research and Clinical Audit, Lindsay Stewart R&D Centre, Royal College of Obstetricians and Gynaecologists, London, UK

3 Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, Manchester, UK

4 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge, UK

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Citation and License

BMC Pregnancy and Childbirth 2011, 11:95  doi:10.1186/1471-2393-11-95

Published: 21 November 2011



Objective: To compare the risk of placenta previa at second birth among women who had a cesarean section (CS) at first birth with women who delivered vaginally.


Retrospective cohort study of 399,674 women who gave birth to a singleton first and second baby between April 2000 and February 2009 in England. Multiple logistic regression was used to adjust the estimates for maternal age, ethnicity, deprivation, placenta previa at first birth, inter-birth interval and pregnancy complications. In addition, we conducted a meta-analysis of the reported results in peer-reviewed articles since 1980.


The rate of placenta previa at second birth for women with vaginal first births was 4.4 per 1000 births, compared to 8.7 per 1000 births for women with CS at first birth. After adjustment, CS at first birth remained associated with an increased risk of placenta previa (odds ratio = 1.60; 95% CI 1.44 to 1.76). In the meta-analysis of 37 previously published studies from 21 countries, the overall pooled random effects odds ratio was 2.20 (95% CI 1.96-2.46). Our results from the current study is consistent with those of the meta-analysis as the pooled odds ratio for the six population-based cohort studies that analyzed second births only was 1.51 (95% CI 1.39-1.65).


There is an increased risk of placenta previa in the subsequent pregnancy after CS delivery at first birth, but the risk is lower than previously estimated. Given the placenta previa rate in England and the adjusted effect of previous CS, 359 deliveries by CS at first birth would result in one additional case of placenta previa in the next pregnancy.