Clinical study of placenta previa in scarred and unscarred uterus

Abstract

Background: Placenta previa complicates 0.3–0.5% of all pregnancies and is a major cause of third-trimester hemorrhage which is on the rise due to rise in incidence of cesarean sections. Significant maternal morbidity in form of increased incidence of fetal malpresentation, cesarean delivery, increased blood loss, and peripartum hysterectomy have been noted in cases of placenta previa and can lead to prolonged hospitalization in these women. Premature deliveries can occur which lead to higher admission to neonatal intensive care unit and stillbirths. Aim: To study all cases of placenta previa in scarred and unscarred uterus clinically. Materials and Methods: A retrospective study of 80 cases derived from case records, divided into two groups — A (scarred uterus) and B (unscarred uterus), was conducted in Department of Obstetrics and Gynecology at Mamata General Hospital, Khammam, over a period of 5 years from June 2011 to May 2016. Results: Incidence of placenta previa in scarred uterus (A) was 2.75% which was much higher than in unscarred uterus (B) - 1.4% [P value 0.001]. Anterior placenta was seen in 63.8% in group-A and 47.7% in group-B. P value for Type IIIA placenta previa was statistically significant [0.02]. Placenta was adherent in 13.9% of group-A and 4.5% of group-B. Obstetric hysterectomy was performed in 19.4% of group-A and 4.5% of group-B [P-value 0.01]. Conclusions: Incidence of placenta previa and its associated complications is definitely more in scarred group when compared to unscarred group although statistically significant values were obtained only in incidence of placenta previa, especially type III anterior and rate of hysterectomy.