Abstract
Objectives:To assess maternal and fetal morbidity associated with placenta previa and morbidly adherent placenta (MAP).Methods:All patients with placenta previa who delivered in services hospital from April 1, 2017 to March 31, 2019 were included. Maternal and fetal outcomes were compared amongst patients with placenta previa and MAP.Results:Total of 8002 patients delivered with 152 (1.9%) diagnosed as placenta previa and 56 (36.8%) amongst them had MAP. One hundred thirty-one out of One hundred fifty-two (86.1%) of our patients were booked. Increased number of caesarean section, multi parity and anterior placenta had significant association with MAP (p<0.0001). Maternal morbidity in terms of postpartum hemorrhage >2000ml, caesarean hysterectomy, number of blood transfusions, bladder injury, need for ICU admission was significantly more in patients with MAP (p<0.0001). Case fatality was 3% with two maternal deaths in MAP and none in placenta previa. Fetal outcome was good in both groups as gestational age at delivery was 36 weeks or more, birth weight was ≥ 2.5 kg and >6 APGAR score (p<0.05). Two neonatal deaths occurred in MAP and one in placenta previa owing to prematurity.Conclusion:MAP is a dreadful complication of placenta previa with increased maternal morbidity. Regular antenatal care with adequate arrangement of blood transfusion and multidisciplinary approach can reduce maternal mortality.
Highlights
Placenta previa complicates 0.3-1.5% of the pregnancies and it may lead to significant maternal morbidity and even death
Total number of 8002 patients delivered with 152 patients having placenta previa during the study period, giving a frequency of 1.9%
The patients having morbidly adherent placenta (MAP) were older and had high parity than those with placenta previa. 66.07% of patients were in age group 31-40 years while 52.08% of patients with placenta previa were less than 30 years (p
Summary
Placenta previa complicates 0.3-1.5% of the pregnancies and it may lead to significant maternal morbidity and even death. It is associated with poor neonatal outcome includes preterm delivery, low birth weight and perinatal death.[1] Placenta previa invading the uterine wall becomes morbidly adherent placenta (MAP) in form of placenta accrete, increta and percreta. MAP can result in life threatening hemorrhage, disseminated intravascular coagulation and death.[2,3]. The rising trend of caesarean section has led to dramatic increase in incidence of placenta Previa and MAP in last few decades.[4,5] Ultrasound has
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