Clincal Analysis of Placenta Previa

Park, Young Se

Abstract

OBJECTIVE
To review the outcome of pregnancies complicated by placenta previa and to describe in detail the antenatal course and the events leading to delivery, assessing whether there are clinical features predictive of outcome.
METHODS
Hospital records of women with a pregnancy complicated by placenta previa at Kangnam- CHA General Hospital between Jan. 1998 and June 2001 were analysed retrospectively.
RESULTS
There were 22,323 deliveries in the study period. Two hundred and fifty women were complicated by placenta previa. Following results were obtained. 1. The overall frequency of placenta previa observed in the study was 1.12% annually (1 in 89 deliveries). 2. The most frequent subtype was totalis (48.4%), then low lying (20.8%), marginal (18.4%), partialis (12.4%) in order. 3. Gestational age at delivery was after 33 weeks in 96.8% of cases. Half (49.6%) of the cases experienced vaginal bleeding. First bleeding episode occurred after 29 weeks in 79 cases (31.6%). Labor pain was accompanied in 40.3% of bleeding cases. 4. Significant difference was noticed between women with total placenta previa and those with low lying. Blood was transfused in 101 cases (40.4%), and 3.5 pints in average. 5. The fetal malpresentation rate was 8.8% (22 cases). 6. No association emerged with the male/female ratio (p>0.05). 7. Perinatal mortality was 2.4% and no maternal death occurred. 8. Higher (est) incidence of placenta previa was noticed. 1) in women with ages between 36 and 40 (2.35%) and significant trend in risk was observed with advancing age (p<0.0001). 2) in pregnant women by assisted reproductive technology (ART) than those with natural pregnancy (4.09% vs. 1.04%, p<0.05). 3) in multipara than nullipara (1.36% vs. 0.98%, p=0.0089) but non-significant trend in risk was observed with increasing parity (p=0.0923). 4) in women who had experienced abortions than women who hadn't (1.37% vs. 0.95%, p=0.0038) and significant trend in risk was observed with increasing number (p=0.0093). 9. In parous women, there was no significant difference of incidence between women with history of C/S and women without (1.34% vs. 1.37%, p=0.9123), but associations was noticed with the women more than two prior C/S (p=0.3862). 10. 69 cases (27.6%) had antepartum admission episodes due to bleeding and/or pain. Among them, 22 cases (8.8%) had more than 2 episodes. This study showed that the more antepartum admission episodes, the poorer perinatal outcomes. But an multiple regression under the condition of dummy variable's control proved that only the transfusion has significant relevance to the antepatum admission episodes.
CONCLUSION
This study suggests that there are no obvious clinical features that are sensitive in predicting the clinical outcome of women with placenta previa. Patients with the history of antepartum admission due to recurrent bleeding and/or pain, are considered as extremely high risk group and predicted to have much poorer perinatal outcomes. Careful antenatal, and intrapartum management is warrented in this group.