Prevalence, Risk Factors and Fetomaternal Outcomes of Placenta Previa -A Prospective Observational Study.

Abstract

BACKGROUND: The placenta forms the most important link between the developing fetus and mother. The placenta is usually situated in the upper uterine segment usually near the fundus on the posterior wall of the uterus. Sometimes for other causes, the placental position may alter, lying wholly or partially in the lower uterine segment resulting in placenta previa .It occurs in 2.8/1000 singleton pregnancies and 3.9/1000 twin pregnancies.The overall prevalence of placenta praevia is 5.2 per 1000 pregnancies (95% CI: 4.5-5.9). However, there is evidence of regional variation. The prevalence of major placenta praevia is 4.3 per 1000 pregnancies.

 OBJECTIVES:

• To study the prevalence,risk factors , fetomaternal outcomes of placenta previa in the Kashmiri obstetric population attending SKIMS Obstetric and Gynaecology Department from June 2018 to June 2020.
• To study the high risk factors associated with the predisposition to placenta previa.
• To study the maternal and fetal outcomes in cases of placenta previa.
• To study the accuracy of TAS in cases of placenta previa as a primary diagnostic tool.
• To study the efficacy of MRI as the Gold Standard in localizing the degree of invasion of placenta.

Study Design: A Prospective Observational Study was conducted in the Department of Obstetrics and Gynaecology, SKIMS, Srinagar from June 2018 to June 2020.

MATERIAL AND METHODS: The obstetric patients admitted in our hospital in the period of 2 years  were  8328. Of these 73 were cases of placenta previa who were studied in detail with respect to the aforementioned objectives.

RESULTS AND OBSERVATIONS: The prevalence of placenta previa cases observed in our study was 8.766 per 1000. The risk of occurrence of placenta previa is increased with advancing maternal age, increased parity, previous abortions, previous caesarean sections, history of assisted reproduction techniques, previous uterine surgery and twin gestation. TAS accurately diagnosed the cases of placenta Previa and was also effective in delineating the cases of Morbid Adherent Placenta which were further confirmed on MRI. MRI is the gold standard for assessing the degree of invasion of placenta viz. accreta, increta and percreta. PPH was effectively managed with uterotonics and simple procedures like BLUA ligation and uterine compression sutures. Only two out of 73 patients required a caesarean hysterectomy.

CONCLUSION : As the maternal and perinatal morbidity and mortality due to placenta previa is preventable, efforts should be made to bring down these rates. This can be achieved by early antenatal registration, primary diagnosis by transabodminal sonogram and by judicious use of MRI in suspicious cases of morbid adherent placenta .Both life threatening antepartum haemorrhage and disastrous postpartum haemorrhage can be reduced by proper management protocols, diagnostic aids and timely intervention by caesarean section .The immediate neonatal outcome as observed in our study is better due to the highly efficacious, integrated standard medical management protocols and timely interventions.

KEY WORDS: Placenta previa, TAS, MRI, Morbid Adherent Placenta, Accreta, increta, percreta, PPH, BLUA ligation, uterine compression sutures.