Maternal Complications With Placenta Previa

Abstract

The purpose of this study is to describe the maternal complications of placenta previa. A population-based retrospective cohort study including all women delivered in the province of Nova Scotia, Canada from 1988 to 1995 was performed. Patient information was obtained from the Nova Scotia Atlee Perinatal Database and maternal complications were described for all women undergoing cesarean delivery. Prognostic factors for the risk of hysterectomy in woman with placenta previa were analyzed by multiple logistic regression. During the 8-year period, 308 cases of placenta previa were identified in 93,996 deliveries (0.33%). Maternal complications included hysterectomy [relative risk (RR) = 33.26], antepartum bleeding (RR = 9.81), intrapartum (RR = 2.48), and postpartum (RR = 1.86) hemorrhages, as well as blood transfusion (RR = 10.05), septicemia (RR = 5.55), and thrombophlebitis (RR = 4.85). Risk factors for need of hysterectomy in women with placenta previa include the presence of placenta accreta and previous cesarean delivery.

Obstetric factors and pregnancy outcome in placenta previa

“…Various studies have shown the incidence of placenta previa ranging from 0.33 to 0.38% of deliveries. 2,6 In the meta analysis reviewing studies on placenta previa between 1950-1996, among 13,992 patients diagnosed with placenta previa the reported incidence of placenta previa ranged from 0.28-2.0% or approximately 1: 200 deliveries.4 This incidence is similar to this study.…”

“…The adverse maternal outcome like postpartum hemorrhage, cesarean hysterectomy, increased need for blood transfusion are dreaded complications. 2,6 Higher risk of preterm birth, low apgar score, congenital malformation increases the perinatal morbidity and mortality.2,7…”

A prospective study of maternal outcome in antepartum haemorrhage in tertiary care center in northern India

“…Crane et al also reported similar complications placenta previa like postpartum haemorrhage (20%), haemorrhagic shock (7%), scar dehiscence 5% and placenta accreta 5% in their study. 14 Surgical management of postpartum haemorrhage was done in 5 cases. In 3 cases bilateral uterine artery ligation and another 2 cases required bilateral internal iliac artery ligation to control postpartum haemorrhage.…”

Risk factors for hysterectomy among patients with placenta previa totalis

“…The need for hysterectomy is significantly increased in PP cases with approximately 30% relative risk. 9 A recent study suggested that a combined ultrasound and clinical scoring model may predict peripartum complication in patients with PP. However, there is a need for more comprehensive and extensive studies for its routine use.…”