Prevalence of Placenta Previa in Developing Countries and Its Association with Scarred and Unscarred Uterus

Sadia Asghar,Najaf Asghar Cheema,Samra Asghar Cheema

doi:10.11648/j.jgo.20200804.15

Abstract

Placenta previa is an obstetric complication that occurs in the second and third trimester of pregnancy. It may cause severe feto-maternal morbidities and mortalities to mother and fetus. The risk of placenta previa increases with the history of cesarean section. In the presence of these two risk factors (placenta previa and previous cesarean section) incidence of placenta accrete spectrum is also increased. The value of making the diagnosis of placenta previa before delivery is important to involve for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality so the feto-maternal outcome can be optimized. The aim of the study is to determine the prevalence of placenta previa in developing countries like Pakistan and find out its association with scarred and unscarred uterus. It is a descriptive cross sectional study. 207 cases of placenta previa were found in six month of period, among them 138 patients were having previously scared uterus, and 69 were having previously unscarred uterus. Most patients 35.74% were between 36-40 years age group, and presented with gestational age between 32-35 weeks were 53.62%. Mostly found between G5-G7 i.e. 52.65%. While frequency of placenta previa in scarred uterus was 66.66% and in unscarred uterus was 32.45%. Association of placenta previa with previous four LSCS was found 33.33%. Occurrence of major degree placenta previa was found 18.84% and minor was 81.15%. Prevalence of placenta previa was found 5.78%. Strong association was found between placenta previa and scared uterus which is highest with previous four. Our objective is to determine the frequency of placenta previa in scared and un-scared uterus. To minimize the rate of cesarean section we can reduce the feto-maternal morbidity and mortality, rising trend of cesarean section in turn increases the rate of placenta previa.

Highlights

Placenta previa complicates 0.3% - 0.5% of all pregnancies and is a major cause of third-trimester hemorrhage [1].Almost 30% maternal deaths in the Asian population are due to major obstetrical haemorrhage in placenta previa, especially due to rise in the incidence of caesarean sections [2].Significant maternal morbidity in the 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
It is concluded from the study that there is strong association between scarred uterus and incidence of placenta previa, and as the number of cesarean section increases the frequency of placenta previa is increased
This study concludes that efforts should be made to reduce the rates of cesarean section because there is greater likelihood of placenta previa in scarred uterus in subsequent pregnancies

Summary

Introduction

Placenta previa complicates 0.3% - 0.5% of all pregnancies and is a major cause of third-trimester hemorrhage [1].Almost 30% maternal deaths in the Asian population are due to major obstetrical haemorrhage in placenta previa, especially due to rise in the incidence of caesarean sections [2].Significant maternal morbidity in the 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. Placenta previa complicates 0.3% - 0.5% of all pregnancies and is a major cause of third-trimester hemorrhage [1]. Almost 30% maternal deaths in the Asian population are due to major obstetrical haemorrhage in placenta previa, especially due to rise in the incidence of caesarean sections [2]. Significant maternal morbidity in the 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. Clinical examination and ultrasound (transabdominal and transvaginal), MRI (magnetic resonance imaging) has been used in patients with placenta previa, especially to diagnose adherent placenta. It has been speculated that uterine scarring due to trauma, infection or surgery lead to endo-myometrial junction abnormality causing abnormal vascularization which

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Conclusion