Previous Caesarean Section, Subsequent Placenta Previa and its Outcome

Abstract

Background: Caesarean section rate is increasing in most countries. The relative risk for the placenta previa is higher in those having previous cesarean section as compared to those having an unscarred uterus. Objective: To observe the effects of placenta previa with previous Caesarean section on maternal and fetal outcome. Study Design: This was a prospective study. Settings: Obstetrics and Gynecology Department, Liaquat University Hospital, Hyderabad Pakistan. Duration: Six months from December 2016 to June 2017. Methodology: All pregnant having placenta previa and history of previous caesarean section at or >28 weeks of gestation irrespective of their parity and age were enrolled. Maternal and fetal outcome in terms of complications and mortality was observed. Data was collected via study proforma and analyzed by SPSS version 20. Results: Total 196 women were studied, their mean age was 29.19+2.66 years and their mean gestational age was 35.44+2.44 weeks. Morbidly adherent placenta was 5.10%. Out of all 95.9% patients seen with antepartum hemorrhage and 86.7% underwent multiple blood transfusions. Postpartum hemorrhage was in 41.3% patients, renal impairment was in 25.5% patients, caesarean hysterectomy was done in 7.1% cases and maternal mortality was 1.5%. Premature birth was 53.1% and 35.2% were admitted in NICU. Still birth rate was 27%, 17.9% cases were IUD, while fetal growth restriction rate was 14.3%. Premature birth, still born, antepartum hemorrhage, Caesarean Hysterectomy and maternal mortality were significantly linked to high grade of placenta previa, p-values were quite significant. Conclusion: Placenta previa with previous caesarean section remains risk factors for adverse maternal and fetal outcome. Efforts should be made to decrease this adverse outcome by spacing pregnancies, limitation of family size, proper antenatal care and early referral of high-risk patients.