Browsing by Author "Gayathri, SS"

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    Determination of Pregnancy Outcome in High-Risk Cases of Placenta Previa in Tertiary Care Center
    (International Research Organization for Life & Health Sciences, 2023-02) Gayathri, SS; Lakshmi, SP; Vijayalakshmi, M.
    Background: Placenta previa is the life-threatening complication which endangers both maternal and fetal life; it is one of the obstetric complications which alter the health indicators of any institution. With the increase in cesarean rate, there is an increase in the incidence of placenta previa and the obstetric complications there on. Furthermore, in rural districts, where there is increased incidence of infection resulting in pelvic inflammatory disease and increased abortions result in increased incidence of placenta previa. Placenta previa is complete or partial depending on its relation to the internal os of the cervix with the placenta. It is a major risk factor for antepartum and postpartum hemorrhage. It can lead to renal failure, DIC, and MODS when associated with other complications or when diagnosed or managed late. In the past decade, it has contributed to major risk for hemorrhagic cause of maternal death. The presence of placenta previa would increase a woman’s risk for placenta accreta spectrum (PAS). Uncontrolled postpartum hemorrhage from placenta previa or PAS may need multiple blood transfusion, in situ hysterectomy, admission to the intensive care unit, or even mortality, thereby ending the reproductive career. The incidence of placenta previa is 3–5/1000 pregnancies worldwide. Assisted reproductive technology and maternal smoking or tobacco consumption increases the risk of placenta previa. It highlights the role of an interprofessional team in managing patients with this condition to improve outcomes for mother and neonate. Aims: This prospective study was conducted in the CEMONC center of Government Sivagangai Medical College, tertiary care center catering to three districts: (1) To analyze the common risk factors of placenta previa in rural set up, (2) role of serial monitoring, early admission and intervention in modifying maternal and fetal outcome, and (3) effectiveness of the intervention in reducing maternal and fetal mortality. Materials and Methods: This prospective study was conducted in the Department of Obstetrics and Gynecology, Government Sivagangai Medical College from October 2021 to October 2022. Targeted populations for this study were all women diagnosed with placenta previa transabdominally either during the second and third trimesters of pregnancy or intraoperatively. Data were carefully extracted from medical records, reviewed, and analyzed. Inclusion criteria was placenta previa diagnosed preoperatively or intraoperatively. Exclusion criteria were patients with placenta located in upper segment, cases of bleeding per vaginum with abruptio placenta, bleeding per vagina due to local causes, and vesicular mole. Statistical Analysis: Statistical analysis was done with SPSS, version 25.0. Categorical variables were expressed as number of cases and percentages (%). Results: Pregnancies complicated by placenta previa were 41. Total delivery in that period was 5267. The magnitude of placenta previa was 0.78%. About 41.46% women were above 28 years of age and 70% were multigravidas. About 39.01% had major degree placenta previa, 51.2% had prior cesarean deliveries, 4.88% had prior abortion, and 56.09% preterm deliveries. About 100% cases delivered by cesarean delivery, 68.3% cases had postpartum hemorrhage and 9.76% had adherent placenta. Conclusion: This study showed that the magnitude of placenta previa was 7 in 1000 pregnancies. Advanced maternal age, multiparity, and previous cesarean section were significantly associated risk factors of placenta previa. Adverse maternal outcomes due to placenta previa were postpartum hemorrhage, anemia, and also the need for blood transfusion due to significant amount of blood loss due to the disease condition and its complications. Neonates born to women with placenta previa were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome. Hence, the detection of placenta previa should be encouraged and careful evaluation with timely delivery to reduce the associated maternal and perinatal complications is recommended.