Neonatal and Maternal Complications of Placenta Praevia and Its Risk Factors in Tikur Anbessa Specialized and Gandhi Memorial Hospitals: Unmatched Case-Control Study

Abstract

Background. Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective. To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results. Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion. Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.

Risk factors of placenta previa with maternal and neonatal outcome at Dongola/Sudan

“…The highest maternal complication in this study was hemorrhage, which required blood transfusion (40.38%) as in Adere study. [ 15 ] In our study, (21.15%) of patients had hysterectomy to control bleeding, interestingly this is similar to what has concluded in previous studies. [ 16 ]…”

To study the maternal and perinatal outcomes in patients suffering from placenta previa

“…In current study, the mean age of the study population was 31.69±4.04 years (20-35) with 41.0% ≤ 30 years and 59.0% were more than 30 years. This finding was similar to Adere et al [13] advanced maternal age ≥ 35 connoted 6-fold increase in risk of placenta previa, Sorakayalapeta MR et al, [13] major number of cases fell into the age group 25-29years with mean age being 25.6 years Prasanth et al [14] found that the incidence of Placenta previa was highest in the age group of 20-29 years i.e., 72.9%, followed by 30-35 year age group, above 35 year age group and less than 19 year age group, i.e., 20.3%, 5.1%, 1.7% respectively. This is thought to be due to atherosclerotic changes in the uterus resulting in under perfusion and infraction of the placenta, thereby increasing the size of the placenta.…”

Placenta previa and its effect on maternal and fetal outcome: retrospective observational study

“…PPH was most common post-partum complication. This finding is supported by the work of Adere et al 19 Regarding neonatal outcome most of the neonate were normal without complications, 6% neonate were preterm, 2 neonate have IUD, Meconium aspiration syndrome was present in 2 patients and 1 neonate was still born. This finding is supported by the work of Crane et al 20…”