ABSTRACT
Background:The Placenta is an organ of pregnancy that provides nutrition, excretory functions and oxygen to the fetus.Aim:The purpose of the study is to determine and provide information on the commonest sites of placental localization in pregnant women in their second and third trimesters in Umuahia, Abia state because there are few documented reports on the sonographic assessment of placental localization in Umuahia.Methodology:Prospective study of pregnant women in their second and third trimesters was carried out trans- abdominally using an ultrasound scan machine with a 3.5 MHz transducer. Placental localization was classified into anterior, posterior, fundal and low-lying, Ultrasonography was used because it is non-ionizing, cheap and readily available. Exclusion criteria; pregnant women with a history of Caesarian section, uterine fibroids and multiple gestation.Results:One hundred women between the ages of 20yrs and 42yrs with a mean age of 28.60±4.95 on their routine antenatal visit were used for the study. The women were in their second and third trimesters, and fetal gender distribution was 55 males and 45 females. Placental localization was classified into Anterior 44%, fundal 20%, posterior 30% and previa 3%.Conclusion:Anterior placentation was the commonest, followed by posterior, then fundal with placenta previa being the least site of placental localization. There was no statistical significance between placental localization and maternal age, gestational age, fetal weight, gender, fetal presentation and heart rate. Evaluation for placental localization in the second and third trimesters is important to rule out placenta previa.
ABSTRACT
Background: With the globally emerging trend of Caesarean deliveries, there arises a more pressing matter of subsequent pregnancy outcomes with previous caesarean deliveries. Especially, the physiology of Placental localisation being a poorly understood phenomena, question arises, whether a previous caesarean scar can influence the site of placental implantation, subsequent migration and pregnancy outcome. The objective of present study is placental localisation and study of maternal and foetal outcome in previous caesarean delivery patients. Methods: A prospective longitudinal study on 100 previous caesarean patients was conducted over a period of 20 months at Department of obstetrics and gynaecology at JNIMS. Placental location was determined ultrasonographically between 28 to 42 weeks gestation, Patients followed up and feto-maternal outcomes analysed. Results: In most, placenta located fundo-anterior and fundo-posterior (30% each) and five (5%) patient reported placenta previa. The study suggests that maternal complications like postpartum haemorrhage (60% vs 6.3) and requirement for interventions (40% Vs 11.6%) were higher among praevia patients. Foetal complications like low Apgar (40% Vs 9.5%) were higher in patients with placenta praevia w.r.t. normal placentation. Low birth weight was 57 fold higher, Preterm birth 10.9 fold higher and NICU admissions were 1.7 fold higher among placenta praevia. Conclusion: A caesarean first birth is associated with increased risks of low lying placentation, previa and abruption, intraoperative blood loss, perioperative morbidity and increased operative time in subsequent pregnancy.