Title: A Comparative Study on Maternal and Fetal Outcome in Cases of Placenta Previa with Previous Cesarean Section and Without Previous Cesarean Section
Authors: Dr Simi Jameela, Dr Bindu Policarp, Dr Uma Thankam, Dr Nirmala Chellamma
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.150
Abstract
Placenta previa is the major cause of antepartum haemorrhage that causes serious morbidity and mortality to both fetus and mother.
Objective[s]: To compare the antepartum, intrapartum, postpartum complications in placenta previa with previous cesarean section and without previous cesarean section.
To compare the fetal outcome in the two groups of cases of placenta previa.
Materials and Methods: This is a case control study conducted in Sree Avittom Thirunal Hospital Trivandrum over a period of one year with diagnosed case of placenta previa with previous cesarean and without previous cesarean During the study period out of 14164 deliveries 190 cases of placenta previa were reported. After excluding all primi and multiple pregnancies [to avoid bias] there were 58 cases in the case group and 72 cases in the control group.
We have excluded other causes of antepartum haemorrhage and those referred as P.P.H.
Results: Present study confirmed that APH before 37 weeks and recurrent bleeding were more in cases of placenta previa with previous cesarean than those without.
PPH 2.78 times more in case group than the control
All cases of adherent placenta were in cases of placenta with previous cesarean. The need for additional operative procedures is around 3.58 times more in case group. Cesarean hysterectomy was needed for 5.17% of case group and none in control group. Intraoperative complication [5.6 times] and postoperative complications [3 times] more in case group. The number of babies admitted to IBN was 2.5 times more in the cases than control which is due to prematurity and associated complications.
Conclusion: The study shows the need to reduce the primary cesarean rate to avoid future pregnancy complications like adherent placenta and cesarean hysterectomy. The occurrence of placenta previa in a patient with previous cesarean needs to be managed in a tertiary care centre with all facilities available, for a good maternal and neonatal outcome. Early referral of these patient to a tertiary care centre is always preferable.
Keywords: Placenta previa, previous cesarean, adherent placenta
References
1. Williams obstetrics, 24th edition, chapter 41 obstetrical haemorrhage, page 800
2. ACOG committee on obstetric practise. ACOG committee opinion number 266, Jan 2002 :placenta accrete obstet Gynecol 2002 99 : 169-70
3. Wong, HS, Cheung YK, Zuccolo J, et al: evaluation of sonographic diagnostic criteria for placenta accrete. J Clin Ultrasound 36[9]:551,2008
4. Salihu HM, Liq Rouse FJ et al Placenta previa: Neonatal death after live birth in US. Am J Obstet Gynaecol. 2003; 188: 1305.
5. Crane JMG, Vanden Hof MC, Dodds L. et al. Neonatal outcome with placenta previa. Obstet Gynecol. 1999; 93: 541
6. Esakoff TF,Handler S Granados JM, et al: PAMUS : placenta accrete management across the United States.J Mat Fet Neonatal Med 25;761,2012
7. Benirschke K, Burton, Baergen RN: Pathology of human placenta, 6th edition. New York, springer, 2012, p 204.
8. Morken N H,Henriksen H Placenta percreta two cases and review of literature.Eur J Obstet Gynecol Reprod Biol 2001;100;112-15
9. Mathuriya D, Lokhande P.Comparative study of obstetric outcome between scarred and unscarred uterus in placenta previa cases Indian journal of clinical practice.vol24, no6, Nov 2013.
10. Bencaiova G,Burkhardt T, Beinder; Abnormal placental invasion experience at1centre E J Reprod Med 2007 Aug52(8)709-14
11. Getahun D,Oyelese Y,Salihu H M,Ananth CV Previous caesarean delivery and risk of placenta previa and placental abruption
12. Ihab M ,Usha MD,Elie M et al placenta previa accrete risk factors and complications, American J Obtet Gynecol 2005 .193, 1045-9
13. Reddy R, Latha C. Placenta previa: an analysis of 4 year experience. J Obstet Gynaecol 2005:193: 1045-49.
14. Avan N, Benneth M J Walters WA Emergency peri partum hysterectomy; a 10 yrs. old review at Royal Hospital for women, Sydney, Aus NZ J O bstet Gynecol 51(3); 210, 2011
15. Jang DG,We JS, Shinn JU, Choi YJ, Ko HS, Park IY etal Maternal outcome according to placental position in placenta previa. Int j Med Sci 2011;8(5)439-44
16. Clark SL, Belfort MA, Carolan M, et al: Maternal death in the 21st century: causes, prevention and relationship to caesarean delivery.AM J Obstet Gynaecol- 199: 36. El,2008
17. Wong TY; Emergency peri partum hysterictomy; a 10 y review in a tertiary obstetric hospital, NZ Med J124(1345);34,2011
18. Knight M, UKOSS: Peri partum hysterectomy in UK; management and outcome of the associated haemorrhage, BJOG 114: 1380, 2007.