Maternal and neonatal outcome in placenta praevia and adherent placenta: A retrospective study in a tertiary care center

Abstract

Objective: The study was conducted to see the maternal and neonatal outcomes of the women with placenta praevia. Methods: All women with the diagnosis of placenta praevia admitted in the hospital were included in the study. The maternal and fetal outcomes were recorded from January 2012 to August 2017, over a period of 5 years. Results: A total of 63 patients were included in the study, after radiological confirmation. The period of gestation for the first presentation was predominantly in 28 weeks of gestation, for central placenta praevia. The mean blood loss intraoperative was 3000 ml, ranging to as much as 5500 ml in central placenta praevia and more so in posterior than anterior placenta. The need of additional procedure like uterine artery ligation was needed in 26 (41.2%), internal iliac artery ligation 8 (12.6%), B lynch in 12 (19.04%) and peripartum hysterectomy was performed in 3 (4.7%). The mean requirement of blood transfusion was 500ml of packed cell. The need of ICU care was in 5 (7.9%) and serious morbidity was seen in 3 (4.7%). Maternal mortality was not seen in any case. Fetal outcomes were studied by recording the fetal weight, Apgar and need of NICU care which was for 23 (36.5%). Conclusion: The need for early diagnosis and multispecialty approach to a patient is greatly associated with reducing the blood loss, lesser need of additional procedure and lower maternal and fetal mortality and morbidity.Keywords: Placenta praevia, accreta, antepartum hemorrhage, maternal complication.Placenta praevia means the placenta located in the lower uterine segment which is less than 2.5 cms from the cervical os 1 . This condition is complicating about 0.3 to 0.8% of all pregnancy 2-5 . The risk factors for developing placenta praevia are previously scarred uterus, grand multiparty, maternal age of more than 35 years, recurrent abortion and intrauterine curettage 6-9 .Maternal morbidity in the form of abnormal placentation, increased risk of section and additional procedure, need for blood transfusion and ICU care and fetal morbidity in the form of preterm, low birth weight, low Apgar and need for NICU care makes it a must for care in a higher center and with available advanced resources [10][11][12][13] . The most frequent management in the form of section which is on the rise in today's era more so increases the risk of placenta praevia in the next RESEARCH ARTICLE

A retrospective analysis on placenta previa in a tertiary care center of Jharkhand

“…9,11 4.7% cases were managed by expectant management and all had better maternal and fetal outcome. In present study, only 31.6% patients were >37 weeks of gestational age, which was very less than the studies done by Ojha et al and Shivananjaiha et al 6,10 Thus, in present study most were preterm (68.4%), so the incidence of NICU admission of babies were more.…”

“…8,11 100% patient needed blood transfusion which is same as in Rangaswamy study. 11 Hysterectomy done in 7.2% cases which was almost double of the incidence reported by Rangaswamy et al and Shivananjaiha et al 10,11 Its incidence was very less in Ojha et al study and very high in Daskalakis et al study. 6,9 The incidence of hysterectomy was high due to atonic PPH cannot be managed by serial devascularization or due to morbidly adherent placenta.…”

“…In terms of parity 87% were multigravida which is supported by Shivananjaiah et al and Ojha et al in their studies. 6,10 37.9% cases were between 25-30 years which is comparable to study by Shivananjaiah et al 10 According to NIH and ACOG classification, almost half cases had true placenta previa which was similar with the study by Daskalakis et al 9 Scarred uterus was one of the independent cause of placenta previa and in present study, 60.2% cases had history of previous cesarean or previous D and E which was comparable to the study done by Shivananjaiha et al and slightly more than the study done by Ojha et al 6,10 Here 8.3% patients had adherent placenta. In present study 95.3% cases underwent cesarean section, results are comparable to studies conducted by Rangaswamy et al and Daskalakis et al being 95.2% and 93.9% respectively.…”

“…7,9 Expectant management is McAfee regimen indicated in cases with stable vitals, mild bleeding/ spotting p/v, preterm and with reassuring FHR, therefore, it can improve the outcome. 10 RCOG recommends cesarean delivery for women with placental edge within 2 cm circumference of internal os. 3 The likelihood of morbidly adherent placenta is more in prior uterine incision and if the placenta is implanted anteriorily, the need for hysterectomy increases.…”