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Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo

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Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo Open Access Austin Journal of Pregnancy & Child Birth Research Article Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo Ndomba MM1, Mukuku O2*, Tamubango HK2, Biayi JM1, Kinenkinda X1, Kakudji PL1 and Abstract 1 Kakoma JB Introduction: Placenta Praevia (PP) is frequently associated with severe 1Department of Gynecology and Obstetrics, University of maternal bleeding leading to an increased risk for adverse outcome of mother Lubumbashi, Democratic Republic of Congo and infant. This study aims to determine the prevalence, and to evaluate potential 2Higher Institute of Medical Techniques, Democratic risk factors and respective outcomes of pregnancies with PP in Lubumbashi, Republic of Congo Democratic Republic of Congo. *Corresponding author: Olivier Mukuku, Higher Methods: Data were retrospectively collected from patients diagnosed Institute of Medical Techniques, Lubumbashi, with PP at 4 hospitals in Lubumbashi between January 2013 and December Democratic Republic of Congo 2016. All women who gave birth to singleton infants were studied. Differences Received: January 11, 2021; Accepted: February 02, between women with PP and without PP were evaluated. Adjusted Odds Ratios 2021; Published: February 09, 2021 (aOR) with 95% confidence intervals for risk factors, and adverse maternal and perinatal outcomes associated with PP were estimated in multivariable logistic regression. Results: The overall prevalence of PP was 1.49% (227/15,292). The following risk factors were independently associated with PP: multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous cesarean section (aOR=6.74; 95% CI: 2.99-15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). PP was significantly associated with adverse maternal outcomes such as delivery by cesarean section (aOR=3.09; 95% CI: 1.89- 5.06), maternal anemia (aOR=11.43; 95% CI: 6.20-21.06); and hospital stay of >4 days (aOR=2.02; 95% CI: 1.24-3.29). PP was also significantly associated with adverse perinatal outcomes such as Apgar scores of <7 at the 5th minute after birth (aOR=4.39; 95% CI: 2.62-7.36), low birth weight (aOR=4.10; 95% CI: 2.26-7.44), stillbirth (aOR=4.16; 95% CI: 1.39-12.46), and early neonatal death (aOR=5.72; 95% CI: 1.60-20.42). Conclusion: PP is associated with adverse maternal and perinatal outcomes, and multiple independent risk factors were identified. Therefore, detection and careful surveillance of these risk factors are important to ultimately improve maternal and perinatal outcomes. Keywords: Placenta praevia; Prevalence; Risk factors; Adverse maternal outcome; Perinatal outcome Introduction problems [9]. Perinatal mortality in pregnancies complicated by PP is around 4-8 % [2]. Placenta Praevia (PP) is a potentially severe obstetric complication where the placenta lies within the lower segment Maternal and perinatal outcomes of PP occupy an important of the uterus, presenting an obstruction to the cervix and thus to place in the literature. But we realized that there is no work devoted delivery [1-4]. PP occurs in 1/200 births, complicates about 0.3% of to this entity in the Democratic Republic of Congo (DRC) in general pregnancies and contributes to about 5% of all preterm deliveries and in Lubumbashi in particular. [2,5,6]. The recurrence rate is 4 to 8% of subsequent pregnancies [7]. So the present study aims to determine the prevalence, and to The etiology of this condition remains unclear. The incidence of low evaluate potential risk factors and respective outcomes of pregnancies placenta insertion increases with advanced maternal age, multiple with PP in Lubumbashi, DRC. gestations, multiparity, smoking, previous caesarean sections and history of curettage, voluntary termination of pregnancy [8-11]. This Materials and Methods catastrophic complication not only poses a risk to the fetus, but also A case-control study comparing women with and without PP endangers the life of the mother [12]. On the one hand, main maternal was conducted. We conducted a retrospective study using maternally complications of PP are postpartum hemorrhage requiring blood linked data from maternities of 4 hospitals at level 3 on the public transfusion and hysterectomy [13,14] which can also cause bladder health scale (University Clinics, Jason Sendwe Hospital, Gécamines- damage during surgery [15]. On the other hand, premature birth, low Sud Hospital and SNCC Hospital) in Lubumbashi (in Haut-Katanga birth weight, respiratory distress syndrome, admission to neonatal province, DRC) for the period from January 1, 2013 to December 31, intensive care unit as well as perinatal death are significant neonatal Austin J Pregnancy Child Birth - Volume 2 Issue 1 - 2021 Citation: Ndomba MM, Mukuku O, Tamubango HK, Biayi JM, Kinenkinda X, Kakudji PL, et al. Risk Factors and Submit your Manuscript | www.austinpublishinggroup.com Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo. Austin J Pregnancy Child Birth. Mukuku et al. © All rights are reserved 2021; 2(1): 1002. Mukuku O Austin Publishing Group Table 1: Logistic regression of risk factors for placenta praevia in Lubumbashi (DRC). Variable Placenta praevia No placenta praevia cOR [95% CI] aOR [95% CI] Maternal age <20 years 5 (2.20%) 18 (4.32%) 0.54 [0.19-1.48] 0.91 [0.29-2.91] 20-34 years 159 (70.04%) 308 (73.86%) 1 1 ≥35 years 63 (27.75%) 91 (21.82%) 1.34 [0.93-1.95] 1.26 [0.79-2.02] Parity 0 29 (12.78%) 95 (22.78%) 1 1 1-5 154 (67.84%) 274 (65.71%) 1.84 [1.16-2.92] 1.50 [0.87-2.57] ≥6 44 (19.38%) 48 (11.51%) 3.00 [1.67-5.38] 2.36 [1.13-4.91] History of abortion No 159 (70.04%) 324 (77.70%) 1 1 Yes 68 (29.96%) 93 (22.30%) 1.49 [1.03-2.14] 1.43 [0.94-2.17] History of myomectomy No 225 (99.12%) 413 (99.04%) 1 1 Yes 2 (0.88%) 4 (0.96%) 0.92 [0.08-6.46] 0.43 [0.07-2.57] Previous CS No 205 (90.31%) 407 (97.60%) 1 1 Yes 22 (9.69%) 10 (2.40%) 4.37 [2.03-9.40] 6.74 [2.99-15.18] Antenatal care in this pregnancy Yes 101 (44.49%) 345 (82.73%) 1 1 No 126 (55.51%) 72 (17.27%) 5.98 [4.15-8.61] 7.15 [4.86-10.53] CS=Caesarean Section, cOR=Crude Odds Ratio and aOR=Adjusted Odds Ratio 2016. death. The following neonatal complications and birth outcomes were assessed: preterm birth, fetal malpresentation, Apgar score at the 5th All deliveries that took place in these 4 maternities from January minute after birth less than 7, stillbirth, low birth weight, admission 2013 to December 2016 with complete birth registry records were to neonatal intensive care unit, and early neonatal death. considered for analysis. Women diagnosed with placenta abruption were excluded to avoid misdiagnosis of PP. In addition, women Placenta praevia was defined as an obstetric complication with multiple gestation pregnancies were also excluded to avoid characterized by placental implantation into the lower uterine overrepresentation of studying high risk women. The study included segment, covering part of or the entire cervix in the second and third any parturient having a PP on a single pregnancy. The control group trimester [9]. consisted of parturients without PP during the study period, two Maternal anemia was established on the basis of clinical signs controls for one case. and/or on a hemoglobin level of less than 11 g/L when it was available The minimum sample size was 58 cases with PP and was calculated and/or receiving a blood transfusion (during or after delivery). z2. p (1− p ) using the following formula: n= 2 where: n= sample size; z= d Apgar score was defined as a measure of the physical condition of confidence level according to the reduced normal centered law (for a newborn infant. The Apgar score has a maximum ten points, with a confidence level of 95%, z=1.96); p= estimated prevalence reported two possible for each of heart rate, muscle tone, breathing, response by Senkoro et al. [9] who had reported a PP prevalence of 0.6% in to stimulation, and skin coloration. northern Tanzania; d= margin of error at 2% (typical value of 0.02). Data analysis was performed using Stata version 15. Frequencies We took into account all the parturient women who presented with respective percentages were used to summarize categorical themselves during the study period in the abovementioned variables. Both bivariate and multivariable analysis were performed maternities for childbirth. In all, we collected 227 cases of PP; as for using logistic regression and adjusted Odd Ratios (aOR) with 95% the control group, it was represented by 454 parturients without PP. confidence intervals for risk factors, and maternal and perinatal Thus, our total study sample was 682 parturients. outcomes associated with PP were estimated. A p-value of less than A standardized questionnaire was used to collect information 0.05 was considered statistically significant. Our study was approved by from the medical birth registry. Maternal age, and obstetric history the Medical Ethics Committee of the University of Lubumbashi prior (parity, previous caesarean deliveries, history of myomectomy, to its commencement (Approval number: UNILU/CEM/137/2019). history of abortion, and having antenatal care visits) were examined. Results The following maternal complications were evaluated: postpartum anemia, caesarean deliveries, hospital stay >4 days, and maternal Placenta praevia complicated 1.49% (227) of 15,292 pregnancies. Submit your Manuscript | www.austinpublishinggroup.com Austin J Pregnancy Child Birth 2(1): id1002 (2021) - Page - 02 Mukuku O Austin Publishing Group Table 2: Maternal outcomes associated with placenta praevia.
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