A comparative study of feto-maternal outcomes in women with anterior and posterior placenta previa

Document Type : Original Article

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 MSc in Statistics, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran

3 MD, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

Abstract

Introduction: Placenta previa is a common cause of third-trimester hemorrhage. This complication is associated with feto-maternal complications and requires special care since it results in high-risk pregnancy. The site of placental implantation can affect the feto-maternal outcomes, such as postpartum hemorrhage, need for blood transfusion, and cesarean hysterectomy, in the females with placenta previa. Regarding this, the aim of the present study was to compare the feto-maternal outcomes of placenta previa between the pregnant women with anterior placenta previa and those with posterior placenta previa.
Materials and Methods:This descriptive-analytic study was conducted  on 54 patients undergoing pregnancy termination due to placenta previa diagnosed based on ultrasound evidence at Imam Reza Hospital affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran, within 2008-2014. The maternal and fetal variables were extracted from the patients' medical records by means of a checklist. Data analysis was performed in SPSS (version 20) using Chi-square test, and independent t-test, Mann Whitney U test, and Fisher's exact test. P-value less than 0.05 was considered statistically significant.
Results: The abnormal adherence of placenta was more frequent in the females with anterior placenta previa than in those with posterior placenta previa. Furthermore, 12 (44.4%) and 5 (18.5%) out of 27 cases required hysterectomy in the anterior and posterior groups, respectively. Therefore, the two groups showed a significant difference in this regard (P=0.04). In addition, there was a significant difference between the two groups in terms of the need for blood transfusion (P=0.021). Accordingly, 13 (48.1%) and 5 (18.5%) patients needed blood transfusion in the anterior and posterior groups, respectively. However, no significant difference was observed between the two study groups considering the birth weight (P=0.949) and Apgar score (P=0.623). 
Conclusion:As the findings of this study indicated, there was a significant difference between the women with anterior placenta previa and those with posterior placenta previa in terms of the need for hysterectomy and blood transfusion. Consequently, it is recommended to consider the location of placenta prior to the adoption of preoperative strategies for the patients with placenta previa.

Keywords


  1. Latif LU, Iqbal UJ, Aftab MU. Associated risk factors of placenta previa a matched case control study. Pak J Med Health Sci 2015; 9(4):1344-6.
  2. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonat Med 2003; 13(3):175-90.
  3. Brace V, Kernaghan D, Penney G. Learning from adverse clinical outcomes: major obstetric haemorrhage in Scotland, 2003-05. BJOG 2007; 114(11):1388-96.
  4. Suknikhom W, Tannirandorn Y. Previous uterine operation and placenta previa. J Med Assoc Thai 2011; 94(3):272-7.
  5. Akram H, Asia A, Khalid K. Multiple caesarean sections-an association with increasing frequency of placenta Previa. Biomedica 2009; 25(1):28-31.
  6. Farine D, Fox HE, Jakobson S, Timor-Tritsch IE. Vaginal ultrasound for diagnosis of placenta previa. Am J Obstet Gynecol 1988; 159(3):566-9.
  7. Oppenheimer LW, Farine D. A new classification of placenta previa: measuring progress in obstetrics. Am J Obstet Gynecol 2009; 201(3):227-9.
  8. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107(4):927-41.
  9. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accrete. Am J Obstet Gynecol 1997; 177(1):210-4.
  10. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005; 192(5):1458-61.
  11. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13(3):175-90.
  12. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol 1996; 144(9):881-9.
  13. Oya A, Nakai A, Miyake H, Kawabata I, Takeshita T. Risk factors for peripartum blood transfusion in women with placenta previa: a retrospective analysis. J Nippon Med Sch 2008; 75(3):146-51.
  14. Bahar A, Abusham A, Eskandar M, Sobande A, Alsunaidi M. Risk factors and pregnancy outcome in different types of placenta previa. J Obstet Gynaecol Can 2009; 31(2):126-31.
  15. Zaki ZM, Bahar AM, Ali ME, Albar HA, Gerais MA. Risk factors and morbidity in patients with placenta previa accreta compared to placenta previa non-accreta. Acta Obstet Gynecol Scand 1998; 77(4):391-4.
  16. Hasegawa J, Matsuoka R, Ichizuka K, Mimura T, Sekizawa A, Farina A, et al. Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa. Ultrasound Obstet Gynecol 2009; 34(1):80-4.
  17. Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome? Am J Perinatol 2003; 20(7):353-60.
  18. Ikechebelu JI, Onwusulu DN. Placenta praevia: review of clinical presentation and management in a Nigerian teaching hospital. Niger J Med 2007; 16(1):61-4.
  19. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13(3):175-90.
  20. Sekiguchi A, Nakai A, Kawabata I, Hayashi M, Takeshita T. Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage. Int J Med Sci 2013; 10(12):1683-8.
  21. Koai E, Hadpawat A, Gebb J, Goffman D, Dar P, Rosner M. Clinical outcomes of anterior compared with posterior placenta accreta. Obstet Gynecol 2014; 123:60S.
  22. Jang DG, We JS, Shin JU, Choi YJ, Ko HS, Park IY, et al. Maternal outcomes according to placental position in placental previa. Int J Med Sci 2011; 8(5):439-44.
  23. Baba Y, Matsubara S, Ohkuchi A, Usui R, Kuwata T, Suzuki H, et al. Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa. J Obstet Gynaecol Res 2014; 40(5):1243-8.

Young BC, Nadel A, Kaimal A. Does previa location matter? Surgical morbidity associated with location of a placenta previa. J Perinatol 2014; 34(4):264-7