The authors have declared that no competing interests exist.
The nature of placenta previa can be unpredictable and harsh on the mother and baby. These complications are often unpredictable, unpreventable and often leave the labour ward team in a dilemma. This Obstetricians' nightmare is fortunately a rare complication. The frequency of placenta previa at the time of delivery average 1/200 births i.e. 0.5%. Placenta previa is still an important cause of maternal and fetal death in our country. The risk factors are Advanced Maternal age, Multi parity, Previous Cesarean Section, Multiple gestation, Previous Abortions, Previous intrauterine surgery, placenta previa in previous pregnancy, Smoking.
Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa with previous caesarean section.
This cross sectional study was conducted from July 2012 to June 2015 in Obstetrics and Gynaecology department, Dhaka Medical College hospital. 100 patients of placenta previa were included in this study. Non-probability purposive sampling method was used for selection of patients.
There is significant association of placenta previa with previous cesarean delivery. So, Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the Obstetricians' nightmare.
The nature of placenta previa can be unpredictable and harsh on the mother and baby. These complications are often unpredictable, unpreventable and often leave the labour ward team in a dilemma. Nobody likes to be in the 'red' whether it is the bank account or in exam result. Similarly in obstetrics, doctors do not enjoy seeing abnormal vaginal bleeding in the antenatal period. Nerve wrecking decisions have to be taken depending on the severity. This Obstetricians' nightmare is fortunately a rare complication. 2 -5% of all pregnancies, approximately one-third are due to placenta previa. The frequency of placenta previa at the time of delivery average 1/200 births i.e. 0.5%. Placenta previa is still an important cause of maternal and fetal death in our country. The risk factors are Advanced Maternal age, Multiparity, Previous Cesarean Section, Multiple gestation, Previous Abortions, Previous intrauterine surgery, PP (placenta previa) in previous pregnancy, Smoking.
Identification of risk factors, the feto-maternal outcome and complications of patients having placenta previa with previous caesarean section.
This cross sectional study was conducted from July 2012 to June 2015 in Obstetrics and Gynaecology department, Dhaka Medical College hospital. 100 patients of placenta previa were included in this study. It was non-probability purposive sampling method.
The diagnosis of placenta previa for this study was based on sonographic diagnosis during the third trimester at 28 wks gestation or more. Furthermore the diagnosis was confirmed by direct inspection of placental location at the time of caesarean section. The exclusion criteria were incomplete medical records, uncertain gestational age, and placental abruption.
After selection of patients, two groups were made.
Group A - Patients of placenta previa with history of previous caesarean delivery (Scarred Uterus)
Group B (Control)-Patients of placenta previa without history of previous caesarean delivery (Unscarred Uterus)-
Placenta praevia is a major cause of morbidity and mortality in both the developed and developing countries like Bangladesh. The present study showed a strong association of placenta praevia with cesarean section. The frequency of placenta praevia with previous cesarean section came out 61% which is very high (
Similar results were also obtained in a study during the period of 1977-1983 in Loss Angeles hospital series
| Stages | Frequency | Percentage | P Value |
| Group A(Scarred Uterus) | 61 | 61% | <0.05 |
| Group B(Unscarred Uterus) | 39 | 39% | |
| Total | 100 |
| Parameters | Group A scarred Uterus(n=61) No.(%) | Group B Unscarred Uterus(n=39) No.(%) | P value |
| Age Group(years) | |||
| 16-25 | 11(18.0%) | 11(28.2%) | |
| 26-35 | 48(78.7%) | 27(69.2%) | 0.992ns |
| 36-45 | 02(3.3%) | 01(2.6%) | |
| Mean±SD | 28.16±3.96 | 28.15±6.12 | |
| Parity | |||
| Nulliparous | 00(00%) | 07(17.9%) | |
| 1-4 para | 39(63.9%) | 22(56.4%) | 0.164ns |
| >5 para | 22(36.1%) | 10(25.6%) | |
| Socio economic status | |||
| Low | 28(45.9%) | 17(17.9%) | |
| Middle | 22(36.1%) | 12(25.6%) | 0.463ns |
| Upper Middle | 11(57.4%) | 10(56.4%) | |
| Educational Status | |||
| Illiteracy | 5(8.2%) | 2(5.1%) | |
| Primary | 17(27.9%) | 14(35.9%) | |
| SSC | 21(34.4%) | 14(35.9%) | 0.597ns |
| HSC | 17(27.9%) | 7(17.9%) | |
| Graduate | 1(1.6%) | 2(5.1%) | |
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32 (52.5%) | 22 (56.4%) | 0.699NS | |
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29 (47.5%) | 17 (43.6%) | ||
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3(4.9%) | 5(12.8%) | ||
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11(18.0%) | 5(12.8%) | 0.313ns | |
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28(45.9%) | 21(53.8%) | ||
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19(31.1%) | 8(20.5%) | ||
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35.87±2.55 | 35.21±3.08 | ||
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32 (52.5%) | 22 (56.4%) | 0.699NS | |
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29 (47.5%) | 17 (43.6%) | ||
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61 (100%) | 39 (100%) | ||
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12 | 19.70% | <0.05 |
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33 | 54.10% | |
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16 | 26.20% |
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NS | ||
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12 | 19 | |
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33 | 5 | |
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NS | ||
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12 | 19 | |
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33 | 5 |
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42(68.9%) | 23(59.0%) | 0.312ns |
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27(44.3%) | 14(35.9%) | 0.407ns |
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3(4.9%) | 1(2.6%) | 0.558ns |
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12 | 19.70% | <0.05 |
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33 | 54.10% | |
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16 | 26.20% | |
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61 | 100% |
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23(37.7%) | 20(51.3%) | 0.181ns |
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24(39.3%) | 19(48.7%) | 0.256ns |
If we look at the demographic profiles of the patients in this study - with a history of previous caesarean section, 78.7% patients were in the age group 26-35. Similar results were found by Tuzović et al.
Multiparity was predominant on scarred uterus group (63.9%). It has been mentioned as a risk factor by previous studies
In addition our study has also demonstrated that previous history of abortions was associated with placenta previa. 54.1% cases of the scarred group & 48.7% of the unscarred group had history of abortion previously. Johnson et al
Regarding maternal outcome, complications like massive haemorrhage, ureteral injury, bladder injury were more in the scarred patients than in the unscarred patients. In our study, 54.1% were P. accreta type. Another study carried out in Jordan University of science and technology shows that placenta praevia is higher among gravida >4, para >3 and previous caesarean section and no increased in incidence of placenta praevia with increasing maternal age and previous abortion
The nature of placenta previa can be unpredictable and harsh on the mother and baby. It is concluded that there is significant association of placenta previa with previous cesarean delivery. Also It demonstrates the feto-maternal outcome and complications associated with placeta previa.
So, Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the Obstetricians' nightmare.