10856-Article Text-31211-1-10-20180530
10856-Article Text-31211-1-10-20180530
10856-Article Text-31211-1-10-20180530
Abstract
Placenta previa is a placental location close to or over the internal
cervical os. The aim of this study was to evaluate: risk factors, maternal and
neonatal outcomes in patients with placenta previa. Material and methods:
We conducted a retrospective cohort study of 38 women who have had a
caesarean section for placenta previa at a tertiary referral University Hospital
of Obstetrics and Gynecology “Koço Gliozheni” in Tirana, Albania. The
period of this study was from January 2015 to March 2018. Maternal and
neonatal data were obtained from medical records and the hospital database
system. All cases of placenta previa were managed by medical team, obstetric
consultants and all data were calculated with SPSS.20 program. Results: In
total, 38 women with placenta previa were classified in three different types
of placenta previa: Marginal placenta previa occurred in 16 women(42.1%),
Complete placenta previa occurred in 19 women(50%) and with accreta
placenta previa in 3 women(7.9%). The mean age of mothers was 30,61 years
old, mode = 35, median = 30 and Std. deviation = 4.641 years. Conclusions:
The prevalence rate of section caesarean and placenta previa is increased
during the years. Several obstetrical factors have been found to be risk for
placenta previa including: advancing maternal age, previous caesarean
delivery, previous abortions, previous uterine surgery, multiparity, previous
placenta previa, low socio-economic status, mother’s cigarette smoking
/alcohol use. Placenta previa is associated with an increase in preterm birth
and neonatal and maternal outcome. Other complications of pregnancy can be
associated with placenta previa, but the majority of women deliver
healthy babies.
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
Introduction
Placenta previa (PP) is a placental location close to or over the internal
cervical os. (Cunningham,2010). Placenta previa is the most common cause
of painless bleeding in the later stages of pregnancy (after the 20th week),
because the placenta is rich in blood vessels, if it is implanted near the outlet
of the uterus, bleeding can occur when the cervix dilates or stretches. (James,
2007), (Milosevic,2009).
The exact etiology of placenta previa is unknown. However, it may be
associated with abnormal vascularization. (Charles et al, 2014). The condition
may be multifactorial and several obstetrical factors have been found to be risk
for placenta previa including:
Uterine factors: Previous Caesarean section, Previous Abortion -
curettage (such as D&C procedures for miscarriages or induced abortions) of
the uterine cavity, or any type of surgery involving the uterus (Myomectomy),
include scarring of the upper lining tissues of the uterus. (Ojha, 2012),
(Gulrukh,2006), (Ananth, et al. 1997).
Placental factors: multiple gestation, mother’s cigarette smoking/
alcohol use, and living at high altitude. So in these situations the placenta must
grow larger to compensate for decreased function (lowered ability to deliver
oxygen and/or nutrients). (Ananth, et al. 1997). It has also been observed that
women carrying male fetuses are at slightly greater risk for placenta previa
than are women carrying female fetuses. The risk of having placenta previa
increases with: advanced maternal age, the number of previous deliveries,
women with previous placenta previa. (Faiz, et al. 2003), (Ananth, et al.1996).
Transvaginal ultrasonography is more accurate in diagnosing placenta previa
than abdominal ultrasonography. However, with the technologic advances in
ultrasonography, the diagnosis of placenta previa is commonly made earlier in
pregnancy and then confirmation by magnetic resonance imaging (MRI).
(Williams, et al. 1993), (Sherman, et al. 1992), (Warshak, 2006).
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
managed by medical team, obstetric consultants. All data were calculated with
SPSS. 20. Program.
Data were collected on patient age, parity, gestational age at time of
caesarean delivery, history of previous PP, abortions, history of previous
surgery intervention in uterine cavity, smoking cigarette and alcohol use,
history of previous caesarean delivery, and degree of PP by ultrasound. The
evaluation also included whether caesarean section was done electively or as
an emergency, operative time. Neonatal evaluation included neonatal birth
weight, Apgar score at 1 and 5 minutes, neonatal gender, position of fetus,
generality admission to the neonatal intensive care unit, or any other
complications.
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
The mean age of mothers that are with PP and their have had previous
story with PP is 32.8 years old (SD=3,54 and SE =1,4), but mothers that didn’t
have previous story of PP, the mean age is 30.1 years old (SD=4.74 and
SE=0.83).
Tab. Nr. 4. Uterine factors
Nr. of fetus Nr % Previous Nr % Previous Nr %
intervention PP story
story
Unic 36 94.7 No 32 84.2 No 32 84.2
(Singleton)
Multiple 2 5.3 Yes 6 15.8 Yes 6 15.8
Gestation(Twins)
Total 38 100 Total 38 100 Total 38 100
As we can see at the Table Nr.5 that are three types of placenta previa
(42.1 % Marginal, 50% Complete and 7.9% Accreta).However, maternal and
fetal complications of placenta previa are well documented. Preterm birth is
highly associated with placenta previa, with 57.9 % of women delivering
between 32-36 weeks and 26.3% of them delivering > 36 weeks. Also from
these 38 patients: 26 (68.4%) delivered with emergency caesarean and 12
(31.6%) were planned.
Tab. Nr. 5 Position of P.P, Gestational Age of delivery and mode of S.C
Position of Nr % G. Age of Nr % S.CNr%
P.P Delivery
Marginal P. 16 42.1 28-32 6 15.8 Emergency 26 68.4
P weeks
Complete 19 50.0 32-36 22 57.9 Planned 12 31.6
P.P weeks
Accreta P.P 3 7.9 >36 weeks 10 26.3 Total 38 100
Total 38 100.0 Total 38 100
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
Analyzing all cases with PP, using ANOVA test we didn’t evidenced
significant differences between weight of fetus, position of fetus position of
PP, GA and mother’s age. On the other hand we evidenced a very significant
positive correlation between fetus weight and gestational age at the moment
of birth. (p≤0.001, Pearson`s R =0.781). So increasing GA is increased also
the weight of fetus. This is represented in the table nr. 7.
Tab. Nr.7. Correlation between GA and fetus weight
Gestational Age (GA) Total
Weight 28-32 32-36 >36
weeks weeks weeks
1500-1900 gr Count 6 2 0 8
% within GA 100 9.1 0.0 21.1
2000-2400 gr Count 0 12 1 13
% within GA 0 54.5 10 34.2
2500-2900 gr Count 0 7 3 10
% within GA 0 31.8 30 26.3
>= 3000 gr Count 0 1 6 7
% within GA 0 4.5 60 18.4
Total Count 6 22 10 38
% within GA 100 100 100 100
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
Conclusions
● The prevalence rate of section caesarean and placenta previa is
increased during the years 2015-2018. There are three types of placenta previa:
50% Complete, 42.1 % Marginal and 7.9% Accreta.
● Several obstetrical factors have been found to be risk for placenta
previa including: advancing maternal age (> 30 years), previous caesarean
delivery (42.1 % after 1 s/caesarean), previous abortions (65.8 % had 1
abortion), previous uterine surgery (myomectomy), multiparity (50% second
parity), previous placenta previa, low socio-economic status (57.9%) ,
mother’s cigarette smoking /alcohol use (39.5%).
● Placenta previa is associated with an increase in preterm birth and
neonatal and maternal outcome. Preterm birth with 57.9 % of women
delivering between 32-36 weeks, Abnormal fetal presentation (31.6% breech,
28.9 % transverse), Low birth weight (34.2 % 2000-2400 g) and some of them
IUGR. So 68.4% of women delivered with emergency caesarean and 31.6%
were planned. Also women carrying male fetuses (73.7%) are at slightly
greater risk for placenta previa. Other complications of pregnancy can be
associated with placenta previa, but the majority of women deliver
healthy babies.
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European Scientific Journal May 2018 edition Vol.14, No.15 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431
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