The Clinical Profile and Obstetric Outcomes of Patients with Placenta Praevia at a Regional Hospital in Northern KwaZulu-Natal

Abstract

Background: Placenta praevia (PP) is an obstetric complication secondary to an abnormal placentation near or covering the internal cervical os. Prior caesarean delivery is a common risk factor and is associated with placenta accreta spectrum (PAS) with increased risk of maternal and perinatal morbidity and mortality. Evidence shows an increase in caesarean delivery (CD) rate worldwide, increasing the risk of developing PP in future. Objectives: To determine the maternal clinical profile, maternal and neonatal outcomes, and factors associated with serious maternal or neonate outcomes. Methods: Clinical data of 114 women with PP over a two-year period were collected retrospectively from Queen Nandi Regional Hospital’s maternity records using a data collected tool. Descriptive statistics were used to analyse the data. Results: The most common risk factors were multiparity (50%), prior CD (32.5%), advanced maternal age (28.9%). Majority of women received blood transfusion (72.8%). Most of women who had total abdominal hysterectomy (TAH) had history of prior CD (p<0.001) associated with PAS (p<0.001, 95 CI: 0.000-0.021). Women with PAS were more likely to have post-partum haemorrhage (PPH) (p<0.001, 95 CI: 0.03-0.33). There were no maternal deaths. Most babies were delivered prematurely (55.3%), admission to neonatology were 33.6%, mainly due to respiratory problems (19.8%). The perinatal deaths were 5.2%. Conclusion: Prior history of CD is a common risk factor for PP, when associated with PAS, there is an increased risk of complications such as TAH, post-partum haemorrhage and blood transfusion. Prematurity is a major concern in women with PP. Limiting the number of caesarean sections in future will decrease the incidence of PP and its complications.

Keywords

• placenta praevia
• caesarean delivery
• placenta accreta spectrum
• total abdominal hysterectomy.