DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203305

Maternal and fetal outcome in placenta previa: our experience

G. D. Maiti, M. Adhikary, P. R. Lele, Shilpa Gupta, M. Saha, Swagata Maiti

Abstract


Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.

Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.

Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.

Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta to mandatory exclude overdiagnosis or migration. All cases of placenta previa need to be managed in a higher centre facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.


Keywords


Caeserean, Feto-Maternal outcome, Placenta previa

Full Text:

PDF

References


Elsayes KM, Trout AT, Friedkin AM, Liu PS, Bude RO, Platt JF, et al Imaging of placenta: a multimodality pictorial review. Radiograph. 2009;29(5):1371-91.

Williams text book of obstetrics. 24th Edition, Obstetrical haemorrhage; 2014:780.

Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complication with placenta previa. Am J Perinatol. 2000;17(2):101-5.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong C. Williams Obstetrics. McGraw-Hill. New York; 2018: 755.

Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum haemorrhage today: ICM/FIGO initiative 2004-2006. Int J Obstet Gynaecol. 2006;94:243.

McCormick ML, Sanghvi HC and McIntosh N: Preventing postpartum haemorrhage in low-resource settings. Int J Gynaecol Obstet. 2002;77:267.

Weiner GM. Textbook of Neonatal Resuscitation. American Academy of Pediatrics, 7th Edition; 2016:17.

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. On behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJORG. 2016;124.

Biro MA, Davey MA, Carolan M, Kealy M. Advanced maternal age and obstetric morbidity for women giving birth in Victoria, Australia: a population-based study. Aust N Z J Obstet Gynaecol. 2012;52(3):229.

Babinski A, Kerenyi T, Torok O, Grazi V, Lapinski RH, Berkowitz RL. Perinatal outcome in grand and great grand multiparity: effects of parity on obstetric risk factors. Am J Obstet Gynecol, 1999; 81:669.

Gurol-Urganci I, Cromwell DA, Edozien LC, Smith GC, Onwere C, Mahmood TA. Risk of placenta previa in second birth after first birth cesarean section. BMC Preg Childbirth. 2011;11:95.

Dashe JS, McIntire DD, Ramus RM, Santos-Ramos R, Twickler DM. Persistence of placenta previa according to gestational age at ultrasound detection. Obstet Gynecol. 2002;99:692.

Laughon SK, Wolfe HM, Visco AG. Prior cesarean and the risk for placenta previa on second-trimester ultrasonography. Obstet Gynecol. 2005;105:962.

Robinson AJ, Muller PR, Allan R, Ross R, Baghurst PA, Keirse MJ. Precise mid-trimester placenta localisation: does it predict adverse outcomes? Aust N Z J Obstet Gynaecol. 2012;52(2):156.

Young B, Nadel A, Panda B, Kaimal A. Does placenta previa location matter? Surgical morbidity associated with previa location. Am J Obstet Gynecol. 2013;208(1):S57

Chervenak F, Lee Y, Hendler M. Role of attempted vaginal delivery-management of placenta praevia. Obstet Gynaecol. 1984;64(6):798-801.

Boyle RK, Waters BA, O’Rourke PK: Blood transfusion for caesarean delivery complicated by placenta praevia. Aust N Z J Obstet Gynaecol. 2009;49(6):627.

Sabourin JN, Lee T, Magee LA, von Dadelszen P, Demianczuk N. Indications for, the timing of, and modes of delivery in a national cohort of women admitted with antepartum haemorrhage at 22+0 to 28+6 weeks' gestation. J Obstet Gynaecol Can. 2012;34(11):1043.

Frederiksen MC, Glassenberg R, Stika CS. Placenta previa: a 22-year analysis. Am J Obstet Gynecol. 1999;180:1432.

Kayem G, Kurinczuk JJ, Alfirevic Z, Spark P, Brocklehurst P, Knight M. Uterine compression sutures for the management of severe postpartum haemorrhage. Obstet Gynecol. 2011;117(1):14.

Penotti M, Vercellini P, Bolis G. Compressive suture of the lower uterine segment for the treatment of postpartum haemorrhage due to complete placenta previa: a preliminary study. Gynecol Obstet Invest. 2012;73(4):314.

NØrgaard LN, Pinborg A, Lidegaard Ø, Bergholt T. A Danish national cohort study on neonatal outcome in singleton pregnancies with placenta previa. Acta Obstet Gynecol Scand. 2012;91(5):546.

Salihu HM, Li Q, Rouse DJ, Alexander GR. Placenta previa: neonatal death after live births in the United States. Am J Obstet Gynecol. 2003;188:1305.