Online ISSN: 2515-8260

A clinical study of comparison of maternal and fetal outcome between primigravida and multigravida women with placenta previa admitted at a tertiary care centre in Vellore, Tamil Nadu: A prospective cohort study

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1Dr. K Lavanya, 2Dr. V Rekha, 3Dr. Uthra KG, 4Dr. Suganya Asaithambi


Abstract Introduction: Placenta Previa is the complete or partial covering of the internal os of the cervix with placenta. It is the major risk factor for postpartum haemorrhage and lead to morbidity and mortality of the mother and new born. Uncontrolled postpartum hemorrhage from placenta previa and PAS (placenta accreta spectrum may necessitate need for blood transfusion, hysterectomy, ICU admissions and even death. Aim: To compare the maternal and fetal outcome between primigravida and multigravida women with placenta previa admitted in Government Vellore Medical College, Tamil Nadu. Results: The incidence of placenta previa was highest among the following age groups 20-29yrs i.e.67.32%, most common risk factors are caesarean section 45.5%(1 LSCS-30%, 2LSCS-16%), 1 bleeding episode cases-78% followed by 15% of cases has 2 episodes of bleeding,79% of cases in our study participants had cephalic presentation followed by breech 16% followed by transverse lie 5%,Type 2A Placenta previa had 46%, Type 2B placenta previa had 18%,Type 3 Placenta previa 16%,Type 4-11% Lowest incidence. Type 1 placenta previa 9%, 82% of cases underwent emergency LSCS, 50% of cases underwent prophylactic uterine artery ligation, 32% of cases had PPH managed medically and surgically, 9% of cases underwent elective LSCS, for all 9 cases prophylactic uterine artery ligation done, no postpartum hemorrhage. Type 2A placenta previa - 46 cases (6 cases elective LSCS, 40 cases emergency LSCS) 15 cases had foley tamponade with uterine artery ligation, 12% cases had foley tamponade, 1 cases underwent subtotal hysterectomy). Type 2B placenta previa -18 cases (2 cases elective lscs, 16 cases emergency lscs) 9 cases had foley tamponade with uterine artery ligation, 4 cases had uterine artery ligation, 2cases had uterine artery ligation with B lynch). Type 4 placenta Previa, 11 cases (emergency lscs), 5 cases – Foley with uterine artery ligation, 3 cases total hysterectomy, 1 case subtotal hysterectomy1 bladder repair. Out of 9 perinatal deaths, Asphyxia and prematurity were major contributions 4.3% and 2.6% respectively followed by RDS1.6%) Neonatal mortality was 8-9% with placenta previa. Perinatal death were higher in gestational age between 30-33 weeks. Conclusion: Placenta previa accounts 0.5% of all deliveries still it remains major cause for perinatal morbidity and mortality. It is noted that patient admitted to hospital as emergency admission had maximum chances of maternal morbidity and perinatal mortality. Early detection of placenta previa by USG, conservative management including blood transfusion (mild bleeding cases),early elective termination of pregnancy by assessing fetal lung maturity along with NICU care reduces perinatal mortality .Maternal, perinatal morbidity and mortality is preventable can be achieved by spacing pregnancies, routine USG in pregnancy, early referral of high risk pregnant cases in tertiary care institute.

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