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Placenta Previa; Maternal and Fetal Outcomes in Major Degree of Placenta 1 PLACENTA PREVIA The Professional Medical Journal www.theprofesional.com ORIGINAL PROF-0-600 DOI: 10.29309/TPMJ/2019.26.03.600 PLACENTA PREVIA; MATERNAL AND FETAL OUTCOMES IN MAJOR DEGREE OF PLACENTA 1. MBBS, FCPS (O & G) PREVIA. Senior Registrar Department of Obstetrics/ Gynaecology Bilawal Medical College, Jamshoro. Ifat Baloch1, Naseem Bajari2, Sabrina Talpur3, Abdul Rehman Siyal4, Saima Naz Shaikh5 2. MBBS, (MCPS) Research Associate ABSTRACT… Objectives: To determine the maternal and fetal outcomes in patients presented Department of Research Centre with major degree of placenta previa at tertiary care Hospital. Study Design: Descriptive cases LUMHS, Jamshoro / Hyderabad. 3. MBBS, FCPS (Obstetrics / series study. Setting: Department of Gynaecology and Obstetrics of Liaquat University Hospital Gynaecology) Hyderabad. Period: One year from March 2015 to February 2016. Subject and Methods: All Assistant Professor patients with major degrees of placenta previa were included in study. Following delivery the Department of O & G examination of neonate was carried out thoroughly including congenital abnormalities, weight Liaquat University of Medical and Health Sciences, Jamshoro / of baby and Apgar score. Babies and mothers were examined within postoperative wards till Hyderabad. stitches removal and systematically examined for any postoperative complication. All the data 4. MBBS, DCH. MD (Peads) was entered in the proforma. Results: Total 50 patients with major degrees of placenta previa Associate Professor Department of Paediatric were selected. Majority of the women 40% belonged to the age group of 30-35 years. Most of Liaquat University of Medical and the women 92.0%, were symptomatic and presented with painless vaginal bleeding. Elective Health Sciences, Jamshoro / cesarean section was performed among 20% patients while 80% patients underwent emergency Hyderabad. cesarean section. 70% patients delivered preterm and 30% delivered at term. 3(6%) fetals were 5. MBBS, MCPS, (M.Phil Physiology) Lecturer still births and 1(2.0%) presented macerated still birth. 16% fetuses developed respiratory Department of Physiology distress syndrome, 6% had intrauterine growth restriction and only one had congenital Liaquat University of Medical and abnormality (spina bifida). Neonatal weight less than 2500-grams was among 90%. Perinatal Health Sciences, Jamshoro / Hyderabad. mortality was 6(12.0%), and according to maternal outcome, mortality rate was low i.e. just 1 subjects passed away. Conclusion: Major degree of placenta previa is a significant contributor Correspondence Address: of obstetric hemorrhage in 02nd and 03rd trimester of pregnancy as well as it adversely correlates Dr. Ifat Baloch with feto-maternal outcomes. Instant moving the case of obstetric hemorrhage to hospitals, House No. A-106, Sindhi Muslim Housing Society precise diagnosis, sufficient transfusion provision, intervention without delay can reduce the Qasimabad Hyderabad, Sindh, fetomaternal morbidity and mortality. Pakistan. [email protected] Key words: Placenta Previa, Fetal outcome, Maternal outcome. Article received on: 05/11/2018 Accepted for publication: Article Citation: Baloch I, Bajari N, Talpur S, Siyal AR, Shaikh SN. Placenta previa; Maternal 10/02/2019 and fetal outcomes in major degree of placenta previa. Professional Med J Received after proof reading: 23/02/2019 2019; 26(3):375-379. DOI: 10.29309/TPMJ/2019.26.03.600 INTRODUCTION is inadequate data for APH prevalence among Placenta previa is demarcated as placenta pregnancies but somen studies have found it implanted partly or entirely within lower uterine to be in 6.7% of deliveries.3 Placenta previa is segments. Complication of Placenta previa occurs a substantial problem with serious outcomes around 1 in 200 live births. The placenta previa’s involving low score of APGAR, rate of perinatal reported overl all prevalence was1.24% in china1 death as elevated as 12.6% to 21.3%, prematurity, and prevalence of placenta praevia was 5.2 per and congenital abnormalities1.4 Prevalence 1000 pregnancies in UK.2 It can possibly be of respiratory distress syndrome in neonates categorized as minor & major degrees placenta delivered at gestational age of 30 to 35 weeks previa.2 Placenta previa is a frequent obstetrical by C-section within mothers who have placenta challenge correlated with substantial fetal and previa is considerably greater as contrasted to maternal mortality and morbidity. Antepartum females who do not have placenta previa.5 In hemorrhage (APH) through placenta previa underdeveloped nations nowadays, widespread is a life-threatening, most acute complication pre-existing anemia, transport difficulties and because of risks for substantial hemorrhage limited facilities of medical remain accountable to the both fetus and mother. In Pakistan there for loss of several maternal lives.6,7 The source Professional Med J 2019;26(3):375-379. www.theprofesional.com 375 PLACENTA PREVIA 2 of placenta previa is not fully-understood, certain perinatal outcome, blood transfusion extent and risk factors involve male fetal sex, multiparity, abortion history after curettage and dilatation. After advanced age of mother, cocaine use and obtaining detailed history informed consent was cigarette smoking in the course of pregnancy, taken. Abdominal examination was done for lie of prior history of placenta previa, uterine surgeries, fetus, fundus height, fetal cardiac sounds, fetus prior abortions, and a history of C-section.8 presenting part, expected fetal weight, absence/ Placenta praevia contributes to estimated 35% presence of tangible uterine contractions within of Antepartum haemorrhage and its assiation laboring female. with severe maternal morbidity and maternal mortality is obout 30% in the Asia.9 As a maternal Patients were generally examined including morbidity factor, placenta previa continues routine urine examination, blood group, complete to be a substantial source of hospitalizations blood picture, ultrasonography, blood sugar, and C-sections. Fetal mortality is considerably routine urine examination, fetal cardiography, more frequent contrasted to maternal mortality. Doppler study and biophysical profile. Patients Around 15% rate of perinatal mortality can be with premature gestation and little vaginal bleeding because of antepartum hemorrhage (APH) with were admitted within the ward for observation life-threatening prematurity. Perinatal mortality and rest. Two 12-mg doses of betamethasone risk among women having placental previa is Injection were given intramuscular with 12 hours projected to be 4% to 8% but, when suplimrnted of gap, to improve the maturity of fetal lung. by prematurity, the mortality rate may elevate to Following delivery the examination of neonate 50%.10 The rates of mortality and morbidity have was carried out thoroughly including congenital been diminished remarkably in West. With much abnormalities, weight of baby and Apgar knowledge and technology transfer the similar score. Babies who had severe birth asphaxia effect can be noted on my part as well. This study were moved to nursery. Babies and mothers was intended to assess fetomaternal outcomes were examined within postoperative wards till within cases with major degreesplacentasprevia. stitches removal and systematically examined The significance of this study is attributable to for any postoperative complications, which the reality that yet placenta previa is a vital factor include wound infection, anemia and potpartum of fetal and maternal morbidity and mortality in hemorrhage. Patients were generally released our frame. The likelihood of the study because from wards on 5th postoperative day following of cost-effectiveness was one more significant stitches removal. All the data regarding foeto- factor. maternal outcome was recorded in the proforma. Data was analyzed by SPSS version 20. MATERIALS AND METHOD This descriptive cases series study was carried out RESULTS within one year of duration. This study comprised This study included total 50 subjects with placenta fifty cases and study was carried out at department previa. Maternal age was noted as 31 to 35 years of Gynaecology and Obs. of LUH Hyderabad, within 20 (40%) cases, 26 to 30 years within 13 Sindh. Patients with abruptio placenta and type 1 (26%) subjects, 18 to 25 years within 7 (14%) and 2 of placenta previa were not included in the subjects and >35 years within 10 (20%) cases. study. Patients were collected from emergency Most of cases exhibited vaginal bleeding. Out of and some of the subjects were admitted via 50 patients, just 13 (26%) subjects were booked outpatients department (OPD). Complete history whereas 37 (74%) subject remained un-booked. of the subjects was documented together with According to the parity, para 0-1 were 8 (16%), age, last menstrual cycle, parity, estimated date para 2-3 were 4 (8%), para 4-5 were 21 (42%) and for delivery and event of bleeding as well as blood para ≥5 were found 17 (34%). Placenta previa transfusion history within current pregnancy. For diagnosis was achieved at a range of gestational previous pregnancy, data was recorded including ages. In 6 (12%) cases 24 to 28 weeks of gestation bleeding episodes extent, mode of delivery, was diagnosed as gestational age, in 9 (18%) Professional Med J 2019;26(3):375-379. www.theprofesional.com 376 PLACENTA PREVIA 3 cases it was 29-32 weeks, in 20 (40%) cases 33- 90.00% 36 weeks and ≥37 weeks within 15 (30%) cases. 80.00% 80.00% (Table-I) 70.00% 70.00% 60.00% Most of the
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