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Feto-Maternal Outcome of Placenta Praevia after Previous Cesarean Section in a Tertiary Care Hospital

Shabnum Hasan, Fauzia Imtiaz, Arif Ali and Azra Sultana

Introduction: Placenta Praevia Is a condition characterized by partial or complete implantation of placenta in the lower uterine segment. It is one of the main cause of vaginal bleeding in the third trimester and a significant cause of maternal and perinatal morbidity and mortality.

Objective: To determine the frequency and feto-maternal outcome of major type placenta praevia after previous cesarean section

Method: This was a cross sectional study conducted during the period of June to December 2011 at Obstetrics and Gynecology Department Abbasi Shaheed Hospital. 100 patients of previous cesarean section whether booked or unbooked were included in this study. After detailed history, thorough clinical examination and ultrasonic evaluation, patients were registered according to the Performa. Diagnoses were confirmed during cesarean section.

Result: 19% of cases were diagnosed as placenta pravia out of which 6 cases (32%) were booked and 13 cases(86%) were unbooked. Most of the women aged between 26 to 35 years (84%) and had two previous cesarean section 53%. Means age was 30.16 + 3.33 years. Majority of cases 74% presented as painless vaginal bleeding 11% were in shoked. 95% of cases found to have parity 1-5. 11 cases 58% had postpartum hemorrhage. Most of the patients were required blood transfusion 52%. Two cases had cesarean hysterectomy and maternal mortality is recorded in one case. 84% babies born alive out of which 79% were preterm and 21% were termed. Mean apgar scores at one and 5 minutes were 5.2 and 6.8 respectively. Majority of the babies were low birth weight, with mean of 2.2 kg.

Conclusion: This study supports the association of placenta praevia with previous cesarean section. Pregnant women with a history of cesarean delivery must be regarded as high risk for placenta praevia and must be monitored carefully.