ABSTRACT
Introduction: Placenta previa is a rare obstetric catastrophe associated with high maternal morbidity and mortality. This condition is multifactorial and can lead to life threatening conditions like postpartum hemorrhage, obstetrical hysterectomy and placenta accreta. A concerted effort should be made towards careful evaluation, timely delivery and provision of skillful management to reduce the associated morbidity. In low socio-economic background and poor settings, these complications may even lead to maternal death
Objective: To determine the frequency of maternal morbidity in placenta previa in terms of placenta accreta, obstretical hysterectomy and postpartum hemorrhage in patients with placenta previa
Study Design: It is a descriptive case series study
Setting: Department of obstetrics and gynaecology, Punjab Medical College and affiliated hospitals, Faisalabad
Duration of Study with dates: The study was carried out over a period of six months from 01-04-2011 to 01-10-2011
Subjects and Methods: A total 215 cases were included in the study. The patients with diagnosed placenta previa or those with painless vaginal bleeding subsequently diagnosed on ultrasonography to have placenta previa were included in the study. Majority of patients were delivered by caesarean section. Active management of third stage was done to prevent primary postpartum haemorrhage [PPH]. In cases of PPH, conservative management was done first in the form of intramuscular syntometrine [Oxytocin 5 IU/ergometrine 0.5mg] and intravenous infusion of syntocinon [40 IU in 500ml 0.9% saline over 4-6 hours]. In cases of failed medical management of PPH and morbidly adherent placenta [placenta accreta] obstretical hysterectomy was carried out
Results: Mean age of the patients was 28.14 +/- 5.57 years. Distribution of cases by gestational age shows that the majority of patients 147 [68.36%] were between 32-37 weeks of gestation and 25[11.62%] patients were <32 weeks while 43 [20%] were >37 weeks. Mean gestational age was 34.60 +/- 2.95 weeks. Parity distribution was as follows: 31 [14.40%] patients had parity 0-3, 89 [41.39%] patients had parity 4-6 and 95 [44.18%] had parity > 6 with mean parity of 5.46 +/- 1.82. Postpartum hemorrhage developed in 61[28.4%] of patients. Placenta accreta was present in 18 [8.37%] patients. Obstetrical hysterectomy was done in 13 [6.04%] of patients and none of the patients expired
Conclusion: Placenta previa usually leads to life threatening complications. Close attention should be paid to massive hemorrhage. Adequate blood transfusions and prompt intervention to deliver by cesarean section and anticipating the risk of placenta accreta and necessity of obstetrical hysterectomy can reduce the maternal morbidity