A prospective observational study on maternal and perinatal outcomes in patients with placenta previa at a tertiary care centre

Prajakta Sunil Gulhane; Sandeep Suhas Pophale

doi:10.18203/2320-1770.ijrcog20263422

Authors

Prajakta Sunil Gulhane Department of Obstetrics and Gynecology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India
Sandeep Suhas Pophale Department of Obstetrics and Gynecology, GGMC and Sir JJ Hospital, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263422

Keywords:

Antepartum hemorrhage, Maternal morbidity, Neonatal mortality perinatal outcomes, Placenta accreta spectrum, Placenta previa, Tertiary care

Abstract

Background: Placenta previa is a leading cause of antepartum hemorrhage associated with significant maternal and perinatal morbidity. Rising rates of cesarean sections have contributed to increasing prevalence. This study evaluates maternal and perinatal outcomes in placenta previa patients managed at a tertiary care centre. This study aimed to assess maternal complications (hemorrhage, anemia, blood transfusion, surgical interventions) and perinatal outcomes (preterm birth, low birth weight, NICU admission, neonatal mortality) in patients with placenta previa.

Methods: A prospective observational study of 90 pregnant women diagnosed with placenta previa at GGMC and Sir JJ Hospital, Mumbai over a 14-month period (January 2022 to February 2023). Data on demographics, risk factors, comorbidities, maternal interventions, and neonatal outcomes were systematically collected and analyzed using descriptive statistics and chi-square tests.

Results: The mean maternal age was 30.44±6.25 years. Previous uterine surgery was the predominant risk factor, present in 88.9% of patients. Antenatal hemorrhage occurred in 37.8% of cases. Maternal morbidity was substantial: 75.6% required blood transfusion, 48.9% required ICU admission, and 11.1% underwent obstetric hysterectomy. Placenta accreta spectrum (PAS) was identified in 13.3% of patients. Perinatal outcomes were significantly compromised: 53.3% of neonates were delivered early preterm (<34 weeks), 63.3% had low birth weight (<2.5 kg), 32.2% required NICU admission, and neonatal mortality was 11.1%. A statistically significant association was found between antenatal registration status and gestational age at delivery (χ²=19.437, p<0.001), with unregistered patients demonstrating markedly higher rates of early preterm delivery.

Conclusions: Placenta previa remains a high-risk obstetric condition with considerable maternal and perinatal morbidity. Previous cesarean delivery is the most important risk factor. Early antenatal registration significantly improves gestational age at delivery and is associated with better perinatal outcomes. Multidisciplinary management in well-equipped tertiary centres, including blood bank preparedness, skilled surgical interventions, and NICU support, is essential for improving outcomes.

References

American College of Obstetricians and Gynecologists. Placenta accreta spectrum. Obstet Gynecol. 2018;132(5):e207-24.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107(6):1226-1232.

Oppenheimer L. Diagnosis and management of placenta previa. J Obstet Gynaecol Can. 2007;29(3):261-73.

Khanna P, Bedi N, Matta S. Early diagnosis of placenta previa using first trimester ultrasound: implications for management. Curr Obstet Gynecol Rep. 2018;7(4):234-41.

Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Factors predicting obstetric complications after placenta previa. J Obstet Gynaecol Can. 2003;25(2):99-105.

Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006;107(4):771-8.

Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. Am J Obstet Gynecol. 2003;189(1):175-83.

Ananth CV, Vintzileos AM. Maternal-fetal conditions necessitating cesarean delivery resulting in prematurity. Obstet Gynecol. 2006;108(6):1557-63.

Usta IM, Hobeika EM, Abu Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: Risk factors and complications. Am J Obstet Gynecol. 2005;193(3):1045-9.

Bailit JL, Grobman WA, Rice MM, Reddy UM, Wapner RJ, Varner MW, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 2015;125(3):556-62.

Jauniaux E, Bhide A. Prenatal diagnosis and outcome of placenta previa accreta after cesarean delivery: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(5):546-54.

Crane JM, van den Hof MC, Dodds L, Armson BA, Liston R. Neonatal outcomes with placenta previa. Obstet Gynecol. 1999;93(4):541-4.

Zlatnik MG, Cheng YW, Norton ME, Thiet MP, Caughey AB. Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med. 2007;20(10):719-23.

Yang W-C, Sabwa S, Mebratie AD, Amboko B, Mugenya I, Kim S, et al. Quality of first antenatal care visits and perinatal outcomes: Evidence from a cohort study in Ethiopia, Kenya, South Africa, and India. PLOS Glob Public Health. 2026;6(4):e0006248.

Gaikwad V, Bhadoriya A, Gaikwad S. A comparative study of fetal and maternal outcomes in registered and unregistered antenatal cases in a tertiary care center. Cureus. 2024;16(8):e66066.

Lewis PF, Bijapur ST, Gurnani D. The bleeding mother and her baby: a study to determine the fetomaternal outcome in cases of placenta previa. Int J Reprod Contracept Obstet Gynecol. 2020;9(9):3775-9.

Sidhiq MC. Maternal and fetal outcome of placenta previa at a tertiary centre in North Kerala, India. Int J Reprod Contracept Obstet Gynecol. 2018;7(5):1723-9.

Sorakayalapeta MR, Manoli NS. Maternal and perinatal outcome in placenta previa: an observational study at a tertiary care hospital in Mysore, Karnataka, India. Int J Reprod Contracept Obstet Gynecol. 2019;8(4):1322-6.

Gurol-Urganci I, Cromwell DA, Edozien LC, Smith GCS, Onwere C, Mahmood TA, et al. Risk of placenta previa in second birth after first birth cesarean section: a population-based study and meta-analysis. BMC Pregnancy Childbirth. 2011;11:95.

Lad SU, Shinde MA. Maternal and Perinatal Outcomes in Placenta Previa: A Retrospective Study at a Tertiary Care Centre of Western India. J Clin Diagn Res. 2022;16(2):23-6.

Sorakayalapeta MR, Manoli NS. Maternal and perinatal outcome in placenta previa: an observational study at a tertiary care hospital in Mysore, Karnataka, India. Int J Reprod Contracept Obstet Gynecol. 2019;8(4):1322-6.

Raja RR, Rubini M. Maternal and perinatal outcome in placenta previa - one year study in tertiary care center in Tamil Nadu, India. Int J Reprod Contracept Obstet Gynecol. 2016;5(8):2819-22.

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):17-9.

Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-74.

Jauniaux E, Ayres-de-Campos D; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: introduction. Int J Gynaecol Obstet. 2018;140(3):261-4.

Birendra R, Singh J. A retrospective study of maternal and neonatal outcome in placenta accreta spectrum after planned or emergency delivery from a tertiary care centre in north India. Cureus. 2023;15(9):e44725.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-214.

Zia S. Placental location and pregnancy outcome. J Turk Ger Gynecol Assoc. 2013;14(4):190-3.

Gaikwad V, Bhadoriya A, Gaikwad S. A comparative study of fetal and maternal outcomes in registered and unregistered antenatal cases in a tertiary care center. Cureus. 2024;16(8):e66066.

Patel PB, Rupani MP, Patel SP. Antenatal care registration and predicting factors of late registration among pregnant women. Trop Doct. 2013;43(1):9-12.