Placenta Previa Frequency and its Outcome in Baghdad teaching Hospital

Background: Placenta praevia is the implantation of the placenta partially or wholly in the lower segment of the uterus. It is graded in two ways, as either grade 1- 4 or minor/major. It is a major cause of obstetrical hemorrhage which leads to increase in maternal morbidity and perinatal mortality, its incidence is still rising worldwide. Objectives: To determine the frequency and outcome of placenta previa at Baghdad teaching hospital. Patients and methods: A prospective observational study was carried out during the period between 1st October 2013 and 31 January 2014 in Baghdad Teaching Hospital, medical city complex. During the study period, total no of deliveries was 4128 of them 2322 were cesarean section and 1806 were vaginal deliveries. Of all those, 92 pregnant ladies who had placenta previa diagnosed ultrasonographically and confirmed during cesarean delivery had placenta previa and were included. Pregnant ladies with normally situated placenta were excluded from the study. Data were collected through Detailed history taking, and clinical examinations of patients. Preparations and interventional procedures included cross matching of at least 6 pints of blood and preparation of fresh frozen plasma and cryoprecipitate, Single course of antenatal corticosteroids was given. All cases in this study where delivered by ceserean section. All mothers were monitored for signs of complication like disseminated intravascular coagulation DIC during and after surgery and for post-partum hemorrhage. Official agreements and verbal consent of all women were obtained prior to participation. Statistical analysis performed by using the statistical package for social sciences and appropriate statistical tests were used with the aid of expert statician. Results: There were 92 women who had placenta previa out of 4128, and the proportion of placenta previa was 2.2%, The mean age of the studied group was 32.2 ± 5.9 (range:20 – 44) years. More than half (56.3%) of the studied group were gravida 5 or more. Nulliparous were only 3 patients (3.3%). History of miscarriage was found in 23 patients (25%). One or more previous cesarean sections were found in 78 (84.8%) patients. At time of delivery 72 (78.3%) patients were at < 37 weeks of gestation and 20 patients (21.7%) were at ≥ 37 weeks. Cesarean sections were performed in 61 patients (66.3%). Caeserian hysterectomy was conducted in 31 patients (33.7%), internal artery ligation was performed in 7 patients (7.6%), uterine artery ligation in 5 patients (5.4%). Morbidly adherent placenta was the more frequent cause of hysterectomy in 18 patients represented (58.1%) and bleeding in 13 patients (41.9%). Conclusion: In the present study the incidence of placenta previa was increased with the advancing age, particularly > 35 years, the incidence of placenta previa was highest in the multiparous group than nulliparous and directly associated with parity and gravidity. Previous caesarean section was an important and significant risk factor and none of the cases died.