Maternal Morbidity

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: Ante partum hemorrhage is defined as any vaginal bleeding from the 24 th week of gestation till delivery. The number of cases of placenta previa and placenta accrete are increasing with the increasing caesarean section rate.Ante-partum hemorrhage is an important cause of maternal and fetal morbidity and mortality, despite modern improvement in obstetric practice and transfusion service. Placenta previa has been well documented to be associated with adverse maternal outcomes as well as neonatal outcomes. The indication for emergency peripartum hysterectomy in recent years has been changed from traditional uterine atony to abnormal placental implantation. The incidenceplacenta previais on rise because of the increasing rate of caesarean section being performed, and a trend of child bearing at a later age among the women , with the sametime the dangerous complication placentaaccreta which is associated with placenta previa and prior caesarean deliveries has also been increased in frequency 16. Material and Methods: This retrospective study was designed to see the incidence of placenta previa , ultrasound finding, management and maternal outcome in women suffering from placenta previa .in region of Taifkingdom of Saudi Arabia. Result: In two year total no of deliveries was 17757 out of that 213 was cases of placenta previa that makes the 1.19 % of placenta previa out of total deliveries .Out of 5498 L.S.C.S, 213 cases were because of placenta previa which make about 3.8 %.out of 213 lscs 62 cases were done in emergency (29.1%).and 151 was done as elective cases(70.8). as far as age women's were concerned highest percentage of placenta previa was seen in age group of 31-36 years (35.2%) followed by age group of 26-30years (26.2%..Out of 213 women of placenta previa 144 (67.74%)women suffered from antepartum hemorrhage from moderate to severe bleeding .All women had lower segment caesarean section as mode of delivery whether in emergency or as an elective procedure dependent upon amount of bleeding ,gestational age and condition of mother. All patent had ultrasound done to confirm the localization of placenta and to exclude placenta accreeta or percreeta. 14 patient underwent bilateral uterine ligation and because of bleeding and severe nature of placental adherence out of 213 women 56 (26.29%) had caesarean hysterectomy and 6 patient received injuries to urinary tract in form of bladder injury or uretric injury which could be because of adhesion, excessive bleeding or difficult c/hysrectomy .By the bless of God there was no maternal death recorded in this period of study Conclusion: In summary, history of previous lower segment caesarean section were found to be associated increased rate of placenta previa and its severe form i.e. placenta accreta.It is also concluded that with good antenatal care we can pick patient who are at high risk of placenta previa and its related risk.

2019

Background and Aims: Morbidly Adherent Placenta(MAP) is associated with severe morbidity like severe postpartum haemorrhage (PPH), probable need for massive blood transfusion and invasive procedures such as hysterectomy. We reviewed all cases of MAP in our institute between May 2015 to July 2019. The main objectives of the study were to determine the incidence, risk factors and both fetomaternal outcome in these women. Material and Methods: This was a retrospective study done in the department of Obstetrics and Gynaecology, Father Muller Medical College, Mangalore from May 2015 to July 2019.There were 12 women with MAP during this period. Results: In the present study, there were a total of 12 cases of MAP over 5 year period with incidence of MAP being 0.017%(1/983 live births).The mean age of the women was 31 years. Among 12 women, 10(84%) were multigravida, 7 (58 %) were within 28 weeks to 37 weeks period of gestation(POG). Risk factors associated with MAP included 11(90%) cases h...

Introduction: Worldwide, placenta previa has been seen to complicate 0.3%-0.8% of all pregnancies. (1,2) Risk factors for placenta previa include previous uterine scar, smoking, age of women over 35 years, grand multiparity, recurrent abortions, low socioeconomic status, and taking infertility treatment. (3) With the increasing rate of Caesarean sections, the incidence of placenta previa is also increasing. Transvaginal Sonography is a safe and most accurate method in the diagnosis of placenta previa. Materials and methods: The present study is a prospective study and the study group consists of 106 cases of placenta previa, during the study period from Results: In the present study, total number of cases of placenta previa were 106, giving proportion of 1.37 (n=7717). In the present study maximum number of cases of placenta previa were in the age group between 20-29 years that is 52 cases (16+36) (49.05%). The maximum number of cases of placenta previa were found in multigravida that is 84 cases (79.26%). 22(20.75%) cases of patients with placenta previa were primigravida. 22 cases (20.75%) had prior cesarean section, 15 cases (14.15%) had abortions and all these factors acted as important risk factors for the occurrence of placenta previa. Antepartum bleeding was found in 34 cases (32.07%), anemia was found in 32 cases (30.19%). Malpresentation was found in 20 cases (18.87%). Minor degree placenta previa was found in 43 cases (40.57 %) and major degree placenta previa in 63 cases (59.43 %). Among the patients who received blood transfusion, 32 cases (49.20%) had major degree placenta previa, while among patients with minor degree placenta previa only 7 cases (16.28%) required blood transfusion. Caesarean section rate in the present study was 81.13% and vaginal delivery rate was 18.87%. 7 cases (6.60%) had febrile morbidity, 6 cases (5.66%) had UTI. Post partum hemorrhage was seen in 19 cases (17.92%). 6 patients(5.66%) had morbidly adherant placenta. 7 patients (6.60%) underwent hysterectomy out of which 6 were done for morbidly adherent placenta and one was done for post partum hemorrhage. In the present study there was one maternal death (0.94%). 11 cases (57.89%) of post partum hemorrhage were managed conservatively, in 5 cases (26.32%) uterine artery ligation was done, in 2 cases (10.53%) B-Lynch sutures were taken and in one case (5.26%) hysterectomy was done. Conclusion: The awareness of this obstetric complication can help with earlier diagnosis timely referral and to higher centres, blood availability, NICU care availability to prevent the complications and mortality.

Turkiye Klinikleri Journal of Gynecology and Obstetrics, 2001

Placenta previa has been one of the great concerns in obstetric practice as it is associated with considerable perinatal morbidity (1). Patients with placenta previa, usually experience third trimester vaginal bleeding resulting from the lower uterine segment thinning (2,3). Bleeding is painless in most instances without an apparent causative factor such as preterm uterine activity. Disruption of the placental implantation site has been argued as a main reason for bleeding. Management of patients with symptomatic placenta previa mainly targets a reduction of maternal bleeding and prevention of preterm birth and thus, the overall maternal and fetal morbidity decreases. Recently a conservative approach has gained popularity among obstetricians as it provides reduction of fetal morbidity without enhancing maternal morbidity. Although tocolytic therapy may be considered in the management of symptomatic placenta previa, close patient monitoring and fetal assessment are still the mainstays of therapy. In the present study, retrospective data analysis of patients with placenta previa presenting with vaginal bleeding and preterm uterine contractions was done. Materials and Methods Patient charts of eighty-five women suffering from placenta previa with initial episode of vaginal bleeding who were admitted to Dr. Zekai Tahir Burak Women's Hospital between January 1, 1994 and December 31, 1995 were reviewed. Patients enrolled into the study had uterine irritability or regular moderate to strong contractions docu

2020

Background: Morbidly adherent placenta is a condition which placenta adheres and invades deeply into the myometrium and, in some cases, until uterine serosa, thus contribute to peri-partum hemorrhage and significant maternal mortality. Purpose: To identify prevalence, clinical characteristics and their odds ratio to increasing se-verity of morbidly adherent placenta case in RSUP Persahabatan from 2015 to 2018 Methods: Cohort retrospective study Results: From 2015 to 2018, prevalence of morbidly adherent placenta was around 0.8%. The risk factors which contribute to increasing severity of morbidly adherent placenta were: age above 35 years (OR 1.6, 95% CI 0.41-6.24) and history of Caesarean section more than 2 times (OR 1.63, 95% CI 0.41-6.46). The presence of increasing severity of morbidly adherent placenta were related to volume of blood loss more than 1000 ml during surgery (OR 2.13, 95% CI 0.52-8.76). Conclusion: The prevalence of morbidly adherent placenta at Persahabatan Gener...

International Journal of Clinical Obstetrics and Gynaecology, 2021

Background: Placenta previa is a disorder which occurs during pregnancy that is characterized by the presence of placental tissue close to or covering the cervix increasing the risk of antepartum, intrapartum and postpartum hemorrhage. Rapid significant loss of intravascular volume can lead to hemodynamic instability, decreased oxygen delivery, decreased tissue perfusion, cellular hypoxia, organ damage and death. Infants born to such patients are also at risk of premature deliveries and increased perinatal mortality. Method: This prospective randomized clinical study was conducted in the Department of Obstetrics & Gynecology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh the period 2018-2020 after considering the inclusion and exclusion criterias. Result: Primigravida were more affected than multigravia. Majority patients underwent Emergency LSCS than Elective one. PPH, Pre-operative and Post-operative anaemia and Adherent placenta was significantly more among Emergency LSCS. NICU admission was significantly more among Emergency LSCS. Conclusion: The current study suggested that there is an association between advancing age, previous caesarean section and abortion as the risk factors for placenta previa. Placenta previa as noted from the study was seen to be associated with increased risk of maternal complications like PPH and neonatal complications including prematurity and low birth weight.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2015

International Journal of Advanced Research (IJAR), 2024

When the placenta is implanted partially or completely over the lower uterine segment (over and adjacent to the internal os) is called placenta previa.. The incidence of placenta previa has risen during the past 30 years. Reported incidences average about 0.4 percent or 1 case per 250 to 400 deliveries, It complicates 0.3-0.5% of all pregnancies at term.Classified in four types on the basis degree of extension of placenta to lower segment. Several demographic factors may contribute to this higher rate of placenta previa, are ,old maternal age, high parity, multifetal gestation, uterine surgery (curettage), smoking and cocaine use, and abortion.. Regardless of etiology, maternal and fetal risks are increased by several folds in patient of placenta previa; in mother, the risks are mainly due to life threatening APH and postpartum haemorrhage (PPH). Placenta previa is a major cause of antepartum haemorrhage (APH) accounting for 35% of all the causes. With regard to baby, incidences of low birth weight (LBW), intra uterine growth restriction (IUGR), preterm deliveries and congenital malformations are increased. 3 Classified in four types on the basis degree of extension of placenta to lower segment.

2016

Background/ Objectives: To study predisposing factors, management options, maternal & fetal outcome of placenta previa. Methods: The present study was carried out on 30 diagnosed cases of placenta previa admitted in Padmashree. Dr. D. Y. Patil Hospital and Research centre, Pimpri, Pune from 2008 to 2011. Results: In our study it was found that advancing age, parity, previous cesarean section, abortion were associated with placenta previa. Maternal morbidity and surgical interventions were significantly associated with amount of blood loss and type of placenta previa (P<0.0001). In our study perinatal mortality and morbidity was mainly due to prematurity. Expectant management was significantly associated with better maternal and fetal outcome indicated by APGAR score (<0.0001). Conclusion: Expectant management, good neonatal care and timely surgical intervention improve maternal and perinatal outcome in placenta previa.

2023

About 15 % to 20 % of maternal mortality due to postpartum hemorrhage caused by retained placenta. There are risk factors that lead to retained placenta in labor. The purpose of this study was to determine the risk factors which most influence the incidence of retained placenta. This was observational analytic study with case control study design. The population were all mothers who were treated in Regional Public Hospital of Muntilan at January 2019 to November 2022. The sampling method of case used simple random sampling technique. Data were obtained from medical records. Analysis which used in this study were chi square test. The results showed that there was a significant difference between the spacing of delivery (pvalue = 0.004) in the case group and the control group, while the risk factors for age, parity, and history of caesarean section did not show a significant relationship to the incidence of retained placenta (p> 0.05). Delivery interval is a risk factor that influences the incidence of retained placenta in Regional Public Hospital of Muntilan.