Maternal Outcome of Cases of Placenta Previa with and without Morbidly Adherent Placenta at King Abdul-Aziz University Hospital, Saudi Arabia

Abstract

Introduction: Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups; Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant

Incidence, risk factors, and maternal outcomes of major degree placenta previa

“…Generally, the incidence of PP among other Saudi studies ranged from 0.41-1.6%. [18][19][20][21][22][23] In a previous report from AMCH, Saudi Arabia, by Bahar et al 21 the total incidence of PP was 0.73% which is comparable to our study )0.69%(. An earlier study from AMCH by Zaki et al 23 reported an incidence of PP patients delivered by C-sections )meaning major degree( to be 0.48%, which is marginally less than our study )0.55%(.…”

“…The percentage of patients with PP and a previous cesarean delivery is up to 75-96% among PP/PAS patients. [18][19][20][21][22][23] In AMCH, over the last 2 decades )2000-2021(, the percentage of PP patients with one previous C-section had increased from approximately 57% )in a previous study by Bahar et al 21 ( to ~61% in the current study. It is recommended that every pregnant woman with a previous cesarean delivery should have a placental localization during a mid-pregnancy routine fetal anomaly scan.…”

“…21,23 Moreover, the recent Saudi studies )Table 6( fully agreed with our findings which represent national trends. [18][19][20][21][22][23] According to the most recent recommendations, the incidence of PP/PAS is increasing as a result of changing trends in risk factors, particularly increasing maternal age, high parity, and multiple prior C-sections. 1,7 Among our PP patients, previous/repeated cesarean deliveries are leading risk factors, where 61.5% )n=184( of patients had a previous cesarean delivery and 28.1% )n=84( had ≥3 repeated C-sections.…”

“…This feature is seen in similar Saudi studies, which reported incidences ranging from 26-67%. [18][19][20][21][22][23] However, other risk factors for PP such as older age, grand multiparity, and previous uterine surgery were present.…”

Nursing‐sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions

“…PPP leads to insufficient blood supply to the placenta, inducing placental adhesion or implantation, making it difficult for the placenta to be separated from the mother during delivery. It increases the risk of postpartum bleeding and endangering the life of the mother and child (Chitkara et al., 2020 ; Radwan et al., 2018 ; Ryu et al., 2019 ; Shah et al., 2020 ). According to the report, the incidence of placenta previa with placental implantation was 25% and 40% in women with a history of first and second caesarean sections, respectively.…”