Caesarian Section for Placenta Praevia: Does Booking Status Affect Maternofetal Outcome?

Abstract

Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1 st 2004 and December 31 st 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X 2 (4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X 2 (1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X 2 (1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X 2 (3) = 15.528, P = 0.001 and 5 minutes X 2 (3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.

An empirical study on maternal and perinatal outcome of placenta previa-risk factors, morbidity and mortality in JNIMS, Imphal, India

“…46 This is almost similar to finding of Sekiguchi A et al, who in their study found the incidence of incomplete placenta previa to be 56.2 % and that of complete placenta previa to be 43.8%. [47][48][49][50][51] Increasing maternal age was found to be an important risk factor the study conducted by Faiz AS et al 50 The mechanism by which advanced maternal age impairs normal placental development is not well understood. One of the possible explanations could be that the percentage of sclerotic change on the intra-myometrial arteries increases with increasing age thereby reducing the blood supply to the placenta.…”