Abstract
Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1st 2004 and December 31st 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X2(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X2(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X2(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X2(3) = 15.528, P = 0.001 and 5 minutes X2(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.
Highlights
Placenta praevia is generally defined as the implantation of the placenta over or near the internal as of the cervix [1]
Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality [5]
Its aetiology remains speculative, several risk factors associated with this condition include advanced maternal age, multiparity, multiple gestation, smoking during pregnancy, a male fetus, previous history of placenta praevia, previous uterine scar following instrumentations, myomectomy and previous caesarian delivery [6] [7]
Summary
Placenta praevia is generally defined as the implantation of the placenta over or near the internal as of the cervix [1]. Its aetiology remains speculative, several risk factors associated with this condition include advanced maternal age, multiparity, multiple gestation, smoking during pregnancy, a male fetus, previous history of placenta praevia, previous uterine scar following instrumentations, myomectomy and previous caesarian delivery [6] [7]. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1st 2004 and December 31st 2008 with respect to maternal and fetal outcome. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate
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