Study of Placental Location and Pregnancy Outcome with Previous Caesarean Delivery

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.