Antepartum Bleeding of Unknown Origin and Sequlae.

Antepartum bleeding of unknown origin (ABUO) seems to be one of the most common causes of bleeding in third trimester of pregnancy, but has not been studied well. Objective : The present study was aimed to study the incidence, management strategies and the perinatal outcome in cases of ABUO. Methods : Cases diagnosed as ABUO and managed at the rural referral hospital over last 5 years were analyzed. The diagnosis of ABUO was by exclusion of placental abruption, placenta previa and possible causes of bleeding in the lower genital tract by clinical and ultrasonographic examination. Results : The incidence of ABUO was 0.60 % of births. Of all cases of antepartum haemorrage 18.1% were of teenage and of ABUO10.3% cases were of teenage cases compared to overall 5% cases teenage. Perinatal Mortality Rate (PMR) in cases of ABUO was 237, significantly higher than overall PMR of 66 (p value <0.001) during the study period. Preterm births were the most common cause of perinatal mortality in ABUO. Conclusion : Women with ABUO may not need special interventions, but when ABUO occurs preterm births and perinatal loss increase ,so deaths due to prematurity need to be prevented.

Frequency, causes and outcome of placenta praevia

The objective of the study was to identify and target preventive interventions among women at increased risk of placenta praevia. This is a Descriptive study. All the case records of women with the diagnosis of pregnancy with placenta praevia were reviewed. The frequency of placenta praevia was 1.45% or 1:69 deliveries complicating a singleton pregnancy. Diagnosis of placenta praevia was confirmed by complete history, examination and finally the ultra sound examination, the course of events during antenatal period, their mode of delivery and fetal outcome of all such patients were assessed. Special attention was paid to the past history of dilatation and curettage, previous LSCS and or other forms of uterine surgical procedures. There were 7082 deliveries during the study period. Out of which 103 patients had placenta praevia. The frequency of placenta praevia was found to be 1.45% or 1:69 deliveries. The maximum No. of patients 38 [36.89%] had placenta praevia type III. Highest percentage of the patients with placenta praevia were between 30-35 years. 40 [38.83%] gave history of one or more Gynecological/Obstetrical procedures before the present pregnancy. Incidence of placenta praevia was significantly higher in patients with previous Caesarean Section i.e 15 [15.15%] had previous one or more LSCS. While 18 [17.4%] had history of previous curettage/induced abortion. The poor socioeconomic status illiteracy early marriages, multiparity, long distances from the referral centers, lack of proper health care facilities at the primary and secondary health care centers predisposed the patients in our area to increased incidence and complications of placenta praevia

Frequency of placenta praevia with previous caesarean section

Two hundred Cases of Previous Caesarean Sections were Studied. 130 were associated with Placenta previa. The aim of Study was to evaluate the frequency of Placenta previa with Previous Caesarean Section. Out of 130 Patients 73% were Symptomatic and 27% were asymptomatic. The most Common ante-natal Complications were anemia 40% and repeated Warning haemorrhages 64%. Out of 130 Patients 35 Patients had Previous one Caesarean Section 27%, 80 Patient had Previous two Caesarean Section 61.5% and 15 Patients had Previous three Caesarean Section 11.5%

Placenta previa: the role of ultrasound in assessment during third trimester

To assess the role of ultrasound in detecting the migration of placenta previa during the third trimester at Lady Willingdon Hospital and Jinnah Hospital, Lahore during the period July 2000 to September 2002. Eighty pregnant women with the diagnosis of placenta previa at 28 to 32 weeks of gestation were included in the study. After base line ultrasound, scan was repeated every two weeks until delivery or placental migration for more than 3 cm from internal cervical os. Detailed information for placental position, distance from cervical os and relation to presenting part was recorded. Women with major degree placenta previa were admitted in the hospital at 32 -34 weeks of gestation. Delivery plan was made according to degree of placenta previa by completed 37 weeks of gestation. Cesarean section was done for the women with major degree placenta previa and minor degree placenta previa with antepartum hemorrhage and obstetric indication.Out of 80 women placental migration to a distance of more than 3-5 cm from the internal cervical os occurred in 20 cases [12 anterior/anterolateral, 8 posterior/posterolateral] by 36 weeks of gestation and 20 had complete placenta previa. Out of remaining 40 cases, 12 patients had vaginal delivery and 28 had cesarean section. Placental migration was not observed in women with total placenta previa or posterior placenta previa when the distance of lower edge of placenta was less than 1 cm from the internal os. Ultrasound is important for the diagnosis of placental localization and placental migration during third trimester. Placental migration takes place more often in anterior than in complete or posterior placenta previa

Incidence, causes and outcome of placenta previa

The incidence of Placenta Previa, associated factors, complications, mode of delivery, fetal and maternal outcomes were evaluated in a one year of hospital based study.In a prospective study, 100 cases of pregnancy beyond 28 weeks of gestation, complicated by Placenta Previa were identified. The total number of deliveries were 2828, patients presented with Placenta Previa were 100. Patients with placenta previa were 100 giving and incidence of 3.5%. Of 3.5% major degree of Placenta previa were 2.3% while 1.2% were type I and II. The maximum number of patients were 35 years and above. There were 7 times as many multipara having Placenta previa as nullipara, repeated myometrial/endometrial damage due to repeated pregnancy being the most common cause. About 60% of patients had at least one or more gynaecol / obstet procedures before the present pregnancy. Incidence of Placenta previa was significantly higher in patients with previous C. Section [5.3%] than overall incidence of 3.5%. However, in our study cases were thrice as likely to have had curettage [46%] than previous C. section [15.9%]. Our data suggests that clinical judgment and skills in the performance of C. section, dilatation and curettage, and other forms of uterine invasive technique may help to keep the subsequent incidence of Placenta previa at a reasonably low rate. Routine curettage after all spontaneous abortions may be avoided unless it is needed

Placenta prévia: aspectos obstétricos / Placenta Previa: obstetrical aspects

Este estudo teve como objetivo analisar alguns parametros obstetricos relacionados a placentacao previa em gestantes atendidas no HCFMRP-USP, visando identificar quais fatores negativos permeiam a conducao destes casos e propor medidas no sentido de melhorar o prognostico materno. Foram avaliados retrospectivamente 85 pacientes portadoras dessa entidade clinica num periodo de cinco anos. Analisaram os seguintes parametros maternos: idade, cor, paridade, tipo de parto, local de insercao placentaria, necessidade de transfusao sanguinea,...

Placenta previa, repercusiones maternas y perinatales: análisis de 170 casos / Pacenta previa , maternal and perinatal repercutions: analysis of 170 cases

Ciento setenta casos con placenta previa en el Instituto Nacional de Perinatología, fueron revisados de 1989 a 1993. La incidencia en nuestra población fue de 0.62 por cientio, la edad materna media fue de 31 años, el mayor número de casos se presentó nulíparas, en 72 por ciento de ellos existió el antecedente de cicatriz uterina. El diagnóstico por ultrasonido se realizó en 81 por ciento de las pacientes, siendo el tipo de inserción placentaria más frecuente la inserción baja en 49 por ciento y en 31 por ciento la placenta central total. El primer episodio hemorrágico se presentó a una edad gestacional media de 34 semanas. La complicación más frecuente fue la amenaza de parto pretérmino, utilizándose como uteroinhibidor el etiniladrianol. Todos los embarazos se interrumpieron por vía abdominal. El acretismo placentario fue una complicación frecuente. Sin lugar a dudas la hemorragia durante la segunda mitad de la festación es una de las principales causas de morbimortalidad perinatal. La frecuencia de esta complicación oscila en términos generales entre el 3 y 5 por ciento. La placenta de inserción baja es una complicación poco frecuente. En la mayoría de los reportes se estima su frecuencia entre 0.3 y 0.5 por ciento de todos los embarazos en población abierta, y cuando se presenta, constituye una de las urgencias más serias, por lo que su diagnóstico precoz y el tratamiento oportuno repercutirán en la disminución de la morbimortalidad materna y perinatal. Su etiología es desconocida, pero se presume que la vascularización endometrial disminuida a nivel de fondo y cuerpo uterino, constituye el factor causal. Existen otras causas predisponentes como son: edad materna avanzada, multiparidad, tumoraciones, cicatrices y tabaquismo. El objetivo del presente estudio, es analizar las repercusiones maternas y perinatales de la placenta previa, con base a la experiencia adquirida en el Instituto Nacional de Perinatología

Mortalidad materna; maternidad 18 de Mayo de la CNSS La Paz / Maternal mortality in the obstetric hospital of the CNSS, La Paz

Se hizo un estudio retrospectivo de la mortalidad materna institucional de la Maternidad 18 de Mayo de la CNSS de la ciudad de La Paz, del periodo comprendido entre 1973 a 1982 (10 anos), basado en parametros encontrados en el libro de Registro Hospitalario de defunciones maternas, no habiendose ubicado las respectivas historias en Archivo. Pese a la falta de muchos datos, se elaboro el trabajo con el deseo de demostrar la situacion de la mortalidad materna en el centro de referencia y el de hacer notar la importancia de llevar un Archivo Pasivo de historias clinicas de las defunciones con fines de estudios posteriores