Response to Baba et al

I read with interest a recent manuscript and letter to the editor by Baba et al.1 on a similar topic as our manuscript ‘Does previa location matter? Surgical morbidity associated with location of a placenta previa.’2 Baba et al. similarly found that anterior placenta previas are associated with massive hemorrhage (defined as >90th percentile of bleeding for the cohort) compared to posterior placenta previas. The primary end points in our manuscript (hysterectomy and blood transfusion) differ from the outcomes in Baba et al.’s manuscript of hemorrhage >2400 cc; however, both author groups tried to investigate the same question. We found that the majority of women requiring blood transfusion and hysterectomy were women with an anterior placenta who had a pathology-confirmed placenta accreta. Baba et al. noted that even when excluding placenta accretas women with an anterior placenta previa continued to have statistically higher blood loss compared to women with posterior placenta previas when controlling for select confounders. Although the exact cause of this finding remains speculative, taken in combination, the collective data indicate that placenta previa location in addition to cesarean delivery history is an important piece of information for clinicians preparing for a cesarean for placenta previa.