Maternal and Foetal Outcome in Cases of Placenta Previa, Accreta and Increta

Fauzia Anjum,Arooba Rahim,Rabia Bashir

doi:10.21649/akemu.v22i4.1469

Abstract

AbstractObjective: To evaluate the maternal and foetal outcome in cases of placenta previa, placenta accrete and placenta increta.Methods: Medical records of patients from 1 Feb 2014 to 28 Feb 2015 were checked and patients who underwent caesarean section with a diagnosis of placenta previa types III and IV (and placenta accreta, increta and percreta) were identified. Their medical record files were retrieved and data collected regarding patients age, parity, previous LSCS, D&amp;C, blood loss, bladder injury, hysterectomy and use of B-lynch technique were recorded. Neonatal statistics were also recorded regarding birth weight, gender, APGAR score and need for admission in NICU.Results: In total 37 cases of major placenta previa were identified. These included 8 cases with placenta accrete including 2 cases of placenta increta. No maternal death occurred amongst the studied cases. Only one case of IUFD was identified. The incidence of placenta previa (major) was 29.95/1000 births. Average parity of patients with placenta accreta (PA) was signi-ficantly higher than cases of placenta previa (PP) (2.75 vs. 1.55, p = 0.04). Similarly average number of LSCS in cases of PA was significantly higher than cases of PP (2.25 vs. 0.86, p = 0.02). PA cases were delivered at a significantly earlier gestational age as compared to cases with PP (34.5 weeks vs. 37 weeks, p = 0.01). Hysterectomy was done in 6 (75%) cases of PA but in none with PP. Bladder injury occurred in 2(25%) cases of PA but in none with PP. Blood loss was also signi-ficantly higher in PA cases than PP cases (3975 ml vs. 1196 ml, p = 0.006). Conclusion: At tertiary care hospitals, maternal and foetal outcomes for placenta previa and placenta accreta have improved owing to improved surgical techniques and better understanding of these conditions.

Highlights

Placentaprevia (PP) is the presence of placental tissue which extends over or lies very close to the internal cervical os
Total number of patients delivered during the study period was 1235 which gives us the incidence of placenta previa major as 29.95/1000 births
Eighty seven percent patients with placenta accreta (PA) had had one or more LSCS and mean number of LSCS that these patients had was 2.25. This is in contrast with corresponding figures for placenta previa (PP) without PA where 48% patients had had LSCS before

Summary

Introduction

Placentaprevia (PP) is the presence of placental tissue which extends over or lies very close to the internal cervical os. Prevalence of placenta previa has been reported in the range of 3.5 to 4.6 per 1000 births.[1] Prevalence of PP is rising as a result of increasing rates of LSCS.[2] New research on abnormal placentation suggests individualised approach to improve delivery timing.[3] Risk factors for PP include previous PP, previous LSCS, multiple gestation, multiparity, advanced maternal age, previous abortion, previous intrauterine surgical procedure, male foetus and non-white race. Placenta previa has historically been associated with severe complications like ante partum, intra-partum and postpartum haemorrhages, which often nece-

Methods

Results

Conclusion