Retrospective study for outcome of placenta praevia

Abstract

Objective: the aim of this retrospective study was to evaluate the outcome of placenta praevia in relation to the number of previous caesarean section. the study is conducted in zawia teaching hospital  in the period from January 2014 to December 2015 , the total number of deliveries  during this period was7,695 patients in which 77 patient was placenta praevia i.e. around  (1%).maternal and neonatal data were obtained from medical records and the hospital data base system. the placenta praevia was managed by multidisciplinary team. methods: Data are collected are on patient age, parity, occupation, residence, presenting symptoms, gestation age at CS, degree of placenta as assessed by USS , history of previous CS or previous uterine surgery, previous history of curettage, associated complications , blood transfusion ,haemoglobin level after surgery, fetal weight and condition  at delivery. the diagnosis was made on ultrasound and at surgery  results: in total ,77 patient with placenta praevia were identified, placenta accrete found in 5 cases(6.49%),placenta increta in 2 cases(2.59%) and placenta percreta in 3 cases(3.89%).  The higher incidence of caesarean section rate delivery today is strongly associated with abnormal placentation due to deficiency in decidua Basalis at the endometrial scar .the risk of morbidity increase with increasing number of caesarean section .in our study PP was found in 6 nulliparous patients ( 7.7% of total cases ), while around 62 patient(80.51% )were multipara and 9 patient were grand multipara (11.68%)  ,the highest number recorded in para-4patient.  out of 77 cases of PP there were 5 cases with placenta accreta ,1 case increta and 3patient with placenta percreta. The number of patient with previous CS  was 42 patient (54.54%)and those with no previous CS was 35 patient (45.45%) with increased incidence among those with previous one CS . caesarean hysterectomy was performed in 13 patients out of 77 patients ,10 patients have previous CS and the placenta was accreta  in 5 patient , 1 patient increta, and percreta in 3 patients with highest incidence among previous 3 CS , the remaining cases of hysterectomy was done due to massive haemorrhage occurred intraoperative. conclusion: the placenta praevia with the increasing number of CS is associated highest maternal morbidity as CS hysterectomy and excessive blood loss and the need for blood transfusion. introduction: placenta praevia is identified as a placenta implanted partially or completely  in the lower uterine segment, it occurs in 2.8:1000 of pregnancy worldwide ,PP represent  significant clinical problems because the associated complication which could be happened as caesarean hysterectomy, premature delivery, and maternal and perinatal mortality the risk factors for placenta praevia includes previous uterine scar, maternal age over 35 years, smoking, infertility treatment, male gender,  grandmultiparity, the risk of morbidly adherent placenta increase with each previous CS birth, this markedly increases the risk for massive haemorrhage at the time of attempted placental removal and it is the most common cause of caesarean hysterectomy. Placenta praevia increase dramatically with advancing maternal age ,in our study the highest incidence was in 30-40 years age patient.