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
