Risk factors and complications in pregnancies associated with placenta previa among admitted cases in FMCH
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20230774Keywords:
Complications, Pregnancies, Placenta previa, Risk factorAbstract
Background: Placenta previa is a leading cause of antepartum haemorrhage. Placenta previa present a significant clinical problem and patients are at risk for significant haemorrhage, needing blood transfusion. The risks are increased in women with previous placenta previa, endometrial damage caused by DE and C, caesarean delivery, myomectomy, multiparity, alcohol cocaine use during pregnancy, smoking during pregnancy.
Methods: Admitted patients were selected with convenience sampling type of non-probability sampling type of non-probability sampling technique. The primary end point was to determine the risk factors of placenta previa and its complications. The secondary end point was to determine maternal morbidity and mortality of placenta previa.
Results: Incidence of placenta previa was 2.03% out of 2459 patients, 70% were associated with risk factors. Among them 42% had history of caesarean section, 14% had history of abortion, 10% had history of manual removal, 48% patients were more than 25% years old, 36% were more than 30 years. Placenta previa occurred in gravida 3rd or more. Forty two percent patients belonged to lower socioeconomics group. Only 12% patients had regular antenatal checkup. Malpresentations were present in 24% cases. In this study 50% patients were associated with central placenta previa. Eighty percent patients were in shock, only 2% patients were asymptomatic. Regarding management 76.34% patients were managed actively, 12% patients had expectant management. Only 2% patients delivered vaginally, 82% patients delivered by caesarean section. Maternal mortality rate was 02%. Regarding fetal outcome, 76% babies were alive and there were 20% perinatal deaths.
Conclusions: Although etiology of placenta previa largely remain obscure and speculative. There is a strong association between advanced maternal age, multiparity, history of caesarean section and abortion with subsequent development of placenta previa. Women aged >30 years, grand multipara, previa and must be monitored carefully. Hence the study advocates proper antenatal care early referral to hospital and prompt management of patients after proper selection can reduce maternal morbidity and mortality.
References
Elias S, Amano A, Wakgari N. Placenta previa and its associated factors among women admitted with antepartum haemorrhage in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. East Afr J Health Biomed Sci. 2020;4(2):39-46.
Simon C, Everitt H, Van Dorp F, Hussain N, Nash E, Peet D. Oxford handbook of general practice. Oxford University Press; 2020.
Collier JA, Collier J, Longmore M, Longmore JM, Amarakone K. Oxford handbook of clinical specialties. Oxford university press; 2013.
Aliyu MH, Lynch ON, Nana PN, Alio AP, Wilson RE, Marty PJ, et al. Alcohol consumption during pregnancy and risk of placental abruption and placenta previa. Matern Child Health J. 2011;15:670-6.
Kistin N, Handler A, Davis F, Ferre C. Cocaine and cigarettes: a comparison of risks. Paediatr Perinat Epidemiol. 1996;10(3):269-78.
Kollmann M, Gaulhofer J, Lang U, Klaritsch P. Placenta praevia: incidence, risk factors and outcome. J Matern Fet Neonat Med. 2016;29(9):1395-8.
Vergnes JN, Sixou M. Cruz Lemini MC, Ochoa FI, Gonzalez MA. Department of Obstetrics, National Institute of Perinatology, Mexico City, Mexico. Int J Gynecol Obstet. 2007;96(2):76-9. Obstet Anesth Digest. 2007:155.
Kiondo P, Wandabwa J, Doyle P. Risk factors for placenta praevia presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda. Afr Health Sci. 2008;8(1):44-9.
Sheiner E, Shoham-Vardi I, Hallak M, Hershkowitz R, Katz M, Mazor M. Placenta previa: obstetric risk factors and pregnancy outcome. J Matern Fet Med. 2001;10(6):414-9.
Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005;193(3):1045-9.
Wing DA, Paul RH, Millar LK. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. Am J Obstet Gynecol. 1996;175(4):806-11.
Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol. 1997;177(5):1071-8.
Purohit A, Desai R, Jodha BS, Babulal G. Maternal and fetal outcome in third trimesters bleeding. IOSR J Dent Med Sci. 2014;5(3):13.
Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5(12):e1192-207.
Ananth CV, Savitz DA, Williams MA. Pracental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol. 1996;88(2):309-18.
Bose DA, Assel BG, Hill JB, Chauhan SP. Maintenance tocolytics for preterm symptomatic placenta previa: a review. Am J Perinatol. 2011;28(01):045-50.
Anzaku AS, Musa J. Transabdominal sonographic diagnosis of placenta praevia in a tertiary maternity unit in Jos, Nigeria: How accurate? Trop J Obstet Gynaecol. 2012;29(1):45-9.
Tuzovic L, Djelmis J, Ilijic M. Obstetric risk factors associated with placenta previa development: case-control study. Croat Med J. 2003;44(6):728-33.
Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005;193(3):1045-9.
McGee WB, O’Sullivan TA. Modern treatment of placenta previa- a study of 234 cases. California Med. 1957;87(4):221.
Wing DA, Paul RH. A comparison of differing dosing regimens of vaginally administered misoprostol for preinduction cervical ripening and labor induction. Am J Obstet Gynecol. 1996;175(1):158-64.
Rahman D, Adhikary A, Hussein S. Aetiologies of vaginal discharge among women presented with cervical abnormalities: experiences at a tertiary care hospital. J Shaheed Suhrawardy Med Coll. 2013;5(1):31-4.
Wing DA, Paul RH, Millar LK. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. Am J Obstet Gynecol. 1996;175(4):806-11.
Ezechi OC, Kalu BK, Nwokoro CA, Njokanma FO, Loto OM, Okeke GC. Placenta praevia: a study of risk factors, maternal and fetal outcome. Trop J Obstet Gynaecol. 2004;21(2):131-4.
Raees M, Parveen Z, Kamal M. Fetal and maternal outcome in major degree placenta previa. Gomal J Med Sci. 2015;13(3).
Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107(4):927-41.
Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. Int J Gynecol Obstet. 2006;93(2):110-7.
Ikechebelu JI, Onwusulu DN. Placenta previa: review of clinical presentation and management in a Nigerian teaching hospital. Niger J Med. 2007;16(1):61-4.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-4.
Ahmed SR, Aitallah A, Abdelghafar HM, Alsammani MA. Major placenta previa: rate, maternal and neonatal outcomes experience at a tertiary maternity hospital, Sohag, Egypt: a prospective study. J Clin Diagn Res. 2015;9(11):QC17.
Daskalakis G, Simou M, Zacharakis D, Detorakis S, Akrivos N, Papantoniou N, et al. Impact of placenta previa on obstetric outcome. Int J Gynecol Obstet. 2011;114(3):238-41.
Kollmann M, Gaulhofer J, Lang U, Klaritsch P. Placenta praevia: incidence, risk factors and outcome. J Matern Fet Neonat Med. 2016;29(9):1395-8.
Senkoro EE, Mwanamsangu AH, Chuwa FS, Msuya SE, Mnali OP, Brown BG, et al. Frequency, risk factors, and adverse fetomaternal outcomes of placenta previa in Northern Tanzania. J Pregnancy. 2017;2017.
