The Comprehensive Systematic Review of Association of Placenta Previa to the Incidence of Preeclampsia
Keywords:
Placenta previa, preeclampsia, hypertensive disorders of pregnancy, placental location, systematic reviewAbstract
Introduction: Placenta previa and preeclampsia are major causes of maternal and perinatal morbidity worldwide. While both conditions originate from placental abnormalities, the direct association between placenta previa and preeclampsia incidence remains poorly understood. This systematic review aims to synthesize available evidence on the relationship between placenta previa and the subsequent development of preeclampsia.
Methods: A comprehensive systematic review was conducted following standardized screening and data extraction protocols. We screened studies based on population (pregnant women with confirmed placenta previa), outcome (reported preeclampsia incidence), comparison groups, and study design. Eighty sources were retrieved and assessed for eligibility, with direct and indirect evidence analyzed separately.
Results: The sole meta-analysis directly addressing this association (Y. Xa et al., 2015) pooled seven cohort studies and reported an overall inverse association between placenta previa and hypertensive disorders (pooled RR 0.55, 95% CI 0.32–0.97). However, this protective effect was specific to pregnancy-induced hypertension (RR 0.36, 95% CI 0.23–0.57), with no significant association for preeclampsia specifically (RR 0.94, 95% CI 0.44–2.00). Placental laterality studies demonstrated that lateral placental location strongly predicted preeclampsia (pooled OR 3.48, 95% CI 3.03–3.99), while central/fundal locations were protective against hypertension (RR 0.47, 95% CI 0.31–0.71). Endometriosis meta-analyses consistently showed strong associations with placenta previa (OR range 2.84–3.92) but only modest, inconsistent links with preeclampsia.
Discussion: The available evidence suggests that placenta previa is not significantly associated with preeclampsia incidence. The apparent protective effect against hypertensive disorders is attributable to reduced gestational hypertension risk rather than preeclampsia. Distinct pathophysiological mechanisms may underlie different placental location abnormalities: lateral implantation may compromise uterine artery perfusion leading to preeclampsia, while low-lying implantation in placenta previa does not involve the same laterality-dependent hemodynamic deficit.
Conclusion: Current evidence does not support an association between placenta previa and increased preeclampsia risk. Future research should distinguish between hypertensive disorder subtypes and employ standardized definitions to clarify these relationships.
References
Y. Xa, Liu Ys (2015) Association between placenta previa and risk of hypertensive disorders of pregnancy: a meta-analysis based on 7 cohort studies.
M. L. Racher, Madison Morris, Amy P. Scott, et al (2021) Placental location site and adverse antepartum pregnancy complications: a meta-analysis and review of the literature. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-021-06253-x
S. Naik, A. Naik, S. Padhyegurjar (2022) Meta-analysis to Assess the Association of Lateral Location of Placenta on Ultrasound with Preeclampsia. Journal of Obstetrics and Gynecology of India. https://doi.org/10.1007/s13224-022-01657-4
Jianqing Wang, Jiamiao Zhang, B. Qian (2021) Adverse pregnancy outcomes for women with endometriosis: a systematic review and meta-analysis. Ginekologia Polska. https://doi.org/10.5603/GP.a2021.0081
Kjerstine Breintoft, Regitze Pinnerup, T. Henriksen, et al (2021) Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. https://doi.org/10.3390/jcm10040667
A. Busnelli, N. Di Simone, E. Somigliana, et al (2024) Untangling the independent effect of endometriosis, adenomyosis, and ART-related factors on maternal, placental, fetal, and neonatal adverse outcomes: results from a systematic review and meta-analysis. Human Reproduction Update. https://doi.org/10.1093/humupd/dmae024
F. Zullo, E. Spagnolo, G. Saccone, et al (2017) Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2017.07.019
C. Jansen, C. E. van Dijk, C. Kleinrouweler, et al (2022) Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis. Frontiers in Endocrinology. https://doi.org/10.3389/fendo.2022.921220
Lu-ping Zhang, Ming Wang, X. Shang, et al (2020) The incidence of placenta related disease after the hysteroscopic adhesiolysis in patients with intrauterine adhesions. Taiwanese Journal of Obstetrics & Gynecology. https://doi.org/10.1016/j.tjog.2020.05.018
R. Illia (2017) Pregnancy Evolution, Associated Complications and Perinatal Outcome in Patients with Placenta Previa and Placental Abruption. https://doi.org/10.15406/MOJWH.2017.04.00096
E. Jauniaux, L. Grønbeck, C. Bunce, et al (2019) Epidemiology of placenta previa accreta: a systematic review and meta-analysis. BMJ Open. https://doi.org/10.1136/bmjopen-2019-031193
S. Matsuzaki, Y. Ueda, Y. Nagase, et al (2022) Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis. Biomedicines. https://doi.org/10.3390/biomedicines10020390
Santosh Khajotia (2020) A Prospective Observational Study to Know the Incidence of Placenta Previa and Comparing its Effect on Fetomaternal Outcome in Scarred and Unscarred Uterus at A Tertiary Care Centre. https://doi.org/10.36348/sijog.2020.v03i01.007
D. Fan, Dongxin Lin, J. Rao, et al (2024) Factors and outcomes for placental anomalies: An umbrella review of systematic reviews and meta-analyses. Journal of Global Health. https://doi.org/10.7189/jogh.14.04013
Shinya Matsuzaki, Y. Ueda, S. Matsuzaki, et al (2023) Relationship between Abnormal Placenta and Obstetric Outcomes: A Meta-Analysis. Biomedicines. https://doi.org/10.3390/biomedicines11061522
M. Karami, Jenabi, E. Jenabi (2019) Correction to: Karami et al., The association of placenta previa and assisted reproductive techniques: a meta-analysis. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2018.1469217
Giuliana Schindler Fogaça, Aline Cristina Costa (2026) INCREASED CESAREAN SECTION RATES AND THE SPECTRUM OF PLACENTAL ACCRETA: A SYSTEMATIC REVIEW. Lumen et Virtus. https://doi.org/10.56238/levv17n56-049
Ida Agersnap, P. Nissen, A. Hvas (2022) The Role of Plasminogen Activator Inhibitor Type 1 (PAI-1) in Placenta-Mediated Pregnancy Complications: A Systematic Review. Seminars in Thrombosis and Hemostasis. https://doi.org/10.1055/s-0041-1742082
Isabella Tan, M. Butlin, A. Avolio (2018) Does increase in arterial stiffness and wave reflection precede development of placental-mediated complications in pregnancy? Journal of Hypertension. https://doi.org/10.1097/HJH.0000000000001669
Isaac J Chamani, Lauren L. Taylor, Hailie Ciomperlik, et al (2025) Preimplantation genetic testing and disorders of placental implantation: a systematic review and meta-analysis. Journal of Assisted Reproduction and Genetics. https://doi.org/10.1007/s10815-025-03441-5
Dayna D. Whitcombe, Zhuopei Hu, S. Ounpraseuth, Everett F Magann (2025) Placental Location Site and Associated Intrapartum, Postpartum, and Neonatal Complications: A Comprehensive Review and Meta-Analysis. Journal of Clinical Medicine. https://doi.org/10.3390/jcm14051649
K. Suzuki, SD McDonald (2018) Screening and Intervention Practices for Alcohol Use By Pregnant Women and Women of Childbearing Age: Results of a Canadian Survey. https://doi.org/10.1111/jpc.13882_312
S. Matsuzaki, Y. Nagase, Y. Ueda, et al (2021) Placenta Previa Complicated with Endometriosis: Contemporary Clinical Management, Molecular Mechanisms, and Future Research Opportunities. Biomedicines. https://doi.org/10.3390/biomedicines9111536
M. Gasparri, K. Nirgianakis, K. Taghavi, et al (2018) Placenta previa and placental abruption after assisted reproductive technology in patients with endometriosis: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-018-4765-x
K. Hessami, B. Salmanian, B. Einerson, et al (2022) Clinical Correlates of Placenta Accreta Spectrum Disorder Depending on the Presence or Absence of Placenta Previa. Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0000000000004923
J. Cresswell, C. Ronsmans, C. Calvert, V. Filippi (2013) Prevalence of placenta praevia by world region: a systematic review and meta‐analysis. Tropical medicine & international health. https://doi.org/10.1111/tmi.12100
F. D’Antonio, C. Iacovella, A. Bhide (2013) Prenatal identification of invasive placentation using ultrasound: systematic review and meta‐analysis. Ultrasound in Obstetrics and Gynecology. https://doi.org/10.1002/uog.13194
A. Iacovelli, M. Liberati, A. Khalil, et al (2018) Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2018.1493453
B. Vermey, A. Buchanan, G. Chambers, et al (2019) Are singleton pregnancies after assisted reproduction technology (ART) associated with a higher risk of placental anomalies compared with non‐ART singleton pregnancies? A systematic review and meta‐analysis. BJOG: an International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.15227
Ivandra Septiadi, T. Putra, Penri Fransiskus Manulang, et al (2025) The Association of High Body Mass Index with the Risk of Placenta Previa: A Systematic Review. The Indonesian Journal of General Medicine. https://doi.org/10.70070/m9ek0y69
Puja Patel, Abdullah Al Khan, M. Figueroa, et al (2025) Placenta Previa During Second-Trimester Abortion and the Risk of Adverse Outcomes: A Systematic Review and Meta-analysis [ID 1352]. Obstetrics & Gynecology. https://doi.org/10.1097/AOG.0000000000005917.074
A. Ayaz, M. Farooq (2012) Risk of adverse maternal and peri-natal outcome in subjects with placenta previa with previous cesarean section. The Kurume Medical Journal. https://doi.org/10.2739/KURUMEMEDJ.59.1
K. G. Martinelli, Érica Marvila Garcia, Edson Theodoro dos Santos Neto, S. Gama (2018) Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis. Cadernos de Saúde Pública. https://doi.org/10.1590/0102-311X00206116
K. Hessami, M. Mitts, Nikan Zargarzadeh, et al (2023) Ultrasonographic cervical length assessment in pregnancies with placenta previa and risk of perinatal adverse outcomes: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2023.101172
A. Shub (2023) Gestation of delivery in people with preterm antepartum haemorrhage and placenta previa. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2023.101191
M. Rodger (2011) Anticoagulant prophylaxis for placenta mediated pregnancy complications. Thrombosis Research. https://doi.org/10.1016/S0049-3848(11)70021-4
Shun Sugai, Kaoru Yamawaki, Tomoyuki Sekizuka, et al (2023) Comparison of maternal outcomes and clinical characteristics of prenatally- versus non-prenatally-diagnosed placenta accreta spectrum: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM. https://doi.org/10.1016/j.ajogmf.2023.101197
Niève Seguin, S. Visintini, K. Muldoon, M. Walker (2023) Use of tranexamic acid (TXA) to reduce preterm birth and other adverse obstetrical outcomes among pregnant individuals with placenta previa: a systematic review protocol. BMJ Open. https://doi.org/10.1136/bmjopen-2022-068892
H. Soliman (2019) Placenta previa : An ultimate everlasting obstetric emergency. Evidence Based Womenʼs Health Journal. https://doi.org/10.21608/ebwhj.2019.64359
Chang-kun Zhu, Fei Wang, Yumei Zhou, et al (2015) [Maternal outcomes in pregnant women with pernicious placenta previa]. Zhejiang da xue xue bao Yi xue ban = Journal of Zhejiang University Medical sciences
M. W. Osman, M. Nath, E. Breslin, et al (2018) Association between arterial stiffness and wave reflection with subsequent development of placental-mediated diseases during pregnancy: findings of a systematic review and meta-analysis. Journal of Hypertension. https://doi.org/10.1097/HJH.0000000000001664
S. Barinov, I. Shamina, G. D. Di Renzo, et al (2020) The role of cervical pessary and progesterone therapy in the phenomenon of placenta previa migration. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2018.1509068
Ying Peng, Lai Jiang, Cheng Peng, et al (2020) The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-020-03041-4
F. M. Fındık, M. Icen (2023) Clinical Comparison of Anterior or Posterior Placental Location with Placenta Previa and History of Previous Cesarean Section Delivery. Medical Science Monitor. https://doi.org/10.12659/MSM.939326
F. Akkuş, Yusuf Dal, Sıtkı Özbilgeç, Dilay Gök Korucu (2025) Effects of the number of antenatal hemorrhage episodes on complete placenta previa neonatal outcomes. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1002/ijgo.70368
A. Urfalıoğlu, G. Öksüz, B. Bilal, et al (2020) Retrospective Evaluation of Anesthetic Management in Cesarean Sections of Pregnant Women with Placental Anomaly. Anesthesiology Research and Practice. https://doi.org/10.1155/2020/1358258
F. Huo, Han-sheng Liang, Yi Feng (2021) Prophylactic temporary abdominal aortic balloon occlusion for patients with pernicious placenta previa: a retrospective study. BMC Anesthesiology. https://doi.org/10.1186/s12871-021-01354-1
A. Shaamash, M. Ali, Khalid M Attyia (2020) Intramuscular 17α-hydroxyprogesterone caproate to decrease preterm delivery in women with placenta praevia: a randomised controlled trial. Journal of Obstetrics and Gynaecology Research. https://doi.org/10.1080/01443615.2019.1645099
Dexin Chen, Xuelin Gao, Tingyue Yang, et al (2025) Independent risk factors for placental abruption: a systematic review and meta-analysis. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-025-07482-7
M. Rodger, M. Rodger, M. Carrier, et al (2014) Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood. https://doi.org/10.1182/blood-2013-01-478958
L. Skeith, M. Rodger (2017) Anticoagulants to prevent recurrent placenta-mediated pregnancy complications: Is it time to put the needles away? Thrombosis Research. https://doi.org/10.1016/S0049-3848(17)30065-8
Johannes Skogler, Tilda Moberg, Luca Tancredi, et al (2023) Association between human chorionic gonadotropin (hCG) levels and adverse pregnancy outcomes: A systematic review and meta-analysis. Pregnancy Hypertension. https://doi.org/10.1016/j.preghy.2023.11.003
A. Schaub, M. Pisarska, J. Chan (2022) Getting to the root of the risk-the underpinnings of a novel set of risk factors for pregnancies conceived with assisted reproductive technology. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2022.09.009
T. Radaelli, M. M. Ferrari, S. Duiella, et al (2020) Prophylactic intraoperative uterine artery embolization for the management of major placenta previa. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2020.1818218
E. Mery, E. Clark-Campbell, H. Poisson, et al (2023) The Association Between Placenta-Mediated Diseases of Pregnancy and Postpartum Maternal Cardiovascular Disease Risk Factors: A Systematic Review. Canadian Journal of Cardiology. https://doi.org/10.1016/j.cjca.2023.02.063
C. Gyamfi‐Bannerman, S. Gilbert, M. Landon, et al (2012) Risk of Uterine Rupture and Placenta Accreta With Prior Uterine Surgery Outside of the Lower Segment. Obstetrics and Gynecology. https://doi.org/10.1097/AOG.0b013e318273695b
A. Javinani, S. Conyers, M. Jamali, et al (2023) OP08.09: Causes of death and perinatal mortality rate in patients with prenatally diagnosed vasa previa: a systematic review and meta‐analysis. Ultrasound in Obstetrics & Gynecology. https://doi.org/10.1002/uog.26518
K-H Chen, L-R Chen (2012) PP096. The effect of preterm placental calcification on uteroplacental blood flow, fetal growth and perinatal outcome in hypertension complicating pregnancy. Pregnancy Hypertension. https://doi.org/10.1016/j.preghy.2012.04.207
M. Sarkar, Jaydeb Mandal, Dibyendu Roy, S. Sarkar (2020) A Prospective Study on Placental Lateralisation in an Indian Rural Medical College. Journal of Evidence Based Medicine and Healthcare. https://doi.org/10.18410/jebmh/2020/224
H. Soyama, M. Miyamoto, H. Sasa, et al (2017) Effect of routine rapid insertion of Bakri balloon tamponade on reducing hemorrhage from placenta previa during and after cesarean section. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-017-4446-1
Lauren H. Theilen, H. Campbell, S. Mumford, et al (2020) Platelet activation and placenta-mediated adverse pregnancy outcomes: an ancillary study to the EAGeR trial. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2020.05.026
Mayo Miura, T. Ushida, K. Imai, et al (2019) Adverse effects of endometriosis on pregnancy: a case-control study. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-019-2514-1
Daijuan Chen, Jinfeng Xu, Yuan Tian, et al (2021) Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta. BMC Pregnancy and Childbirth. https://doi.org/10.1186/s12884-021-04103-x
A. Picel, B. Wolford, R. Cochran, et al (2017) Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta. Journal of Vascular and Interventional Radiology. https://doi.org/10.1016/j.jvir.2017.08.015
Toshitaka Tanaka, S. Makino, T. Yorifuji, et al (2014) Vertical compression sutures for control of postpartum hemorrhage from a placenta previa in cesarean section — To evaluate the usefulness of this technique. https://doi.org/10.14390/JSSHP.2.21
F. Borella, L. Marozio, Gianluca Bertschy, et al (2023) Placenta-mediated pregnancy complications in women with a history of late fetal loss and placental infarction without thrombophilia: risk of recurrence and efficacy of pharmacological prophylactic interventions. A 10-year retrospective study. Journal of Maternal-Fetal & Neonatal Medicine. https://doi.org/10.1080/14767058.2023.2183748
Yao Fan, X. Gong, Nan Wang, et al (2017) A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa–accreta. Medicine. https://doi.org/10.1097/MD.0000000000008276
Yushan Ma, Xi Luo, Xuemei Lin, et al (2019) Perioperative patient blood management during parallel transverse uterine incision cesarean section in patient with pernicious placenta previa. Medicine. https://doi.org/10.1097/MD.0000000000021916
U. Akpan, U. Asibong, K. Arogundade, et al (2021) Effectiveness of Pre-operative Rectal Misoprostol in Reducing Blood Loss during Cesarean Section for Placenta Previa and Manual Removal of Retained Placenta: A Parallel Placebo-Controlled Study. https://doi.org/10.3889/OAMJMS.2021.4690
O. Golyanovskiy, N.Ye. Heints, I.V. Klyuzko, et al (2025) Effectiveness of modern methods of delivery of pregnant women with placenta previa/percreta 3b and 3c. Reproductive health of woman. https://doi.org/10.30841/2708-8731.1.2025.323711
Aarti Chitkara, S. Siwatch, R. Bagga, et al (2020) Cervical Length Monitoring in Placenta Previa to Predict Emergency Cesarean Section for Antepartum Hemorrhage [06M]. https://doi.org/10.1097/01.aog.0000664732.00043.b9
Nahid Sultana, Shahnaj Jahan Chawdhury, Fahmida Shirin, Munawar Sultana (2026) Fetomaternal Outcomes in Placenta Previa with and without Coverage of a Uterine Scar in a Tertiary Hospital in Chattogram, Bangladesh. Chattagram Maa-O-Shishu Hospital Medical College Journal. https://doi.org/10.3329/cmoshmcj.v24i1.82449
Dong Hyun Lee, Won Ku Choi, D. Park, et al (2020) Effect of a Combined Hemostatic Technique during Cesarean Section in Placenta Previa. https://doi.org/10.14734/pn.2020.31.1.20
B. Köstü, Ö. Ercan, A. Özer, et al (2015) Male fetus domination in total placenta previa cases. https://doi.org/10.2399/PRN.15.0232006
I. Chamani, Lauren L. Taylor, Timothy N. Dunn, et al (2023) PREIMPLANTATION GENETIC TESTING AND PLACENTAL ABNORMALITIES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2023.08.108
KY Eichelberger (2018) The association between assisted reproduction technology (ART) and abnormal placentation. BJOG: an International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.15262
S. Pecheriaha, I. Marynchyna (2021) Prevention of pregnancy complications and delivery at low placentation. Bukovinian Medical Herald. https://doi.org/10.24061/2413-0737.xxv.3.99.2021.13
Juan Wang, Xiu Shi, Yan Li, et al (2019) Prophylactic intraoperative uterine or internal iliac artery embolization in planned cesarean for pernicious placenta previa in the third trimester of pregnancy. Medicine. https://doi.org/10.1097/MD.0000000000017767
Qiaozhen Peng, Weishe Zhang (2015) Uterine arterial embolization to assist induction of labor among patients with complete placenta previa. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. https://doi.org/10.1016/j.ijgo.2015.02.033
Lijuan Bai, Jie Lin, Qiuni Shen, Xiaodong Fu (2023) Application of Ligation of Internal Iliac Artery and Uterine Artery in Pernicious Placenta Previa. Clinical and Experimental Obstetrics & Gynecology. https://doi.org/10.31083/j.ceog5009190
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