Strength and limitations of the study
A major strength of this retrospective population-based study was that we were able to analyse a rare condition over a period of ten years and therefore we were able to provide a true representation of placenta praevia outcomes.
The present study has been conducted within a major referral and tertiary hospital and thus we were able to recruit over 350 patients. Additionally, our hospital is well resourced both medically and surgically, with maternal-fetal-medicine obstetricians, gynae-oncology specialists and interventional radiologists on standby to optimise maternal care. Our results are widely generalisable because the study hospital is representative of the type of tertiary centres where the majority of these rare high-risk placenta praevia cases are referred.
The perinatal database utilised in this study is obtained from obstetrician documentation and routinely undergoes large institution-based rigorous examination for accuracy to mitigate risk of misclassification and recall bias, which are intrinsic limitations associated with retrospective studies.
The authors acknowledge that though clinical practices may change over the years with new clinical insights, it is unlikely to substantially influence the results as effects would be equally distributed between the comparison cohorts.