Placenta previa : who is at risk ?

الملخص EN

Objectives: To determine the etiologic factors of major degree placenta previa (PP) and placenta accreta.

Methods: This is a retrospective study conducted at King Fahad Hospital of the University (KFHU), Al-Khobar, Saudi Arabia.

Case records of all women with a diagnosis of major degree placenta previa confirmed by ultrasound scan, delivered at this hospital between the years 1991-2000 were reviewed.

Relevant data collected Included: maternal age, parity, gravidity, previous abortions and previous cesarean section (CS).

Management of these women included a diagnosis of PP by ultrasound, bed rest in hospital, and serial scans for fetal growth.

Women with low hemoglobin, < 8 g/dL, were transfused with packed red blood cells.

Elective CS was planned at >37 weeks.

There were no obvious congenital fetal abnormalities and multiple pregnancies in the study group.

Results: From 26,437 deliveries, 81 women (0.30%) had major degree placenta previa.

Of these, 56 (69%) were anterior, and 14 (17%) were posterior.

An appreciable number (33.3%) of these patients were between 36-40 fears of age, and were of high gravidity and parity: Gravida > 5 (49.4%), Parity > 5 (22.2%).

Surprisingly, the majority of these patient had no history of previous abortion (69.1%) and no previous CS scar (66.7%).

The women who were hospitalized for observation had fewer blood transfusions and better maternal and fetal outcome as compared to women who stayed at home.

The single maternal and perinatal mortality occurred in the domiciliary care group.

Seven patients with PP (9%) had placenta accreta.

A significant number of these women (P <0.5) had the following characteristics: between 35-40 years of age, parity higher than 3, 2 or more previous abortions, 2 or more previous CSs, and anterior placenta previa.

Conclusion: Ideally placenta previa should be managed by a senior obstetrician in a tertiary care hospital with a veil-equipped NICU and blood transfusion center.

Domiciliary care is fraught with the danger of maternal or/arid fetal mortality/morbidity, and is not recommended.