Incidence, management, and outcomes of pregnancies complicated by major placenta praevia at Tygerberg Hospital: A two-year review

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Stellenbosch : Stellenbosch University
ENGLISH ABSTRACT: Introduction Obstetric haemorrhage is the third most important cause of direct maternal death (19,1% of all deaths) in South Africa. Although most of these deaths are due to postpartum haemorrhage, antenatal haemorrhage also contributes significantly. Placenta praevia is a major source of obstetric haemorrhage as it carries risks for both antepartum haemorrhage, intrapartum haemorrhage, and postpartum haemorrhage. Massive obstetric haemorrhage is also a major cause of perinatal morbidity and mortality. Placenta praevia represents a complex clinical challenge due to the prolonged in-patient monitoring that is often advised. Additionally, patients are at increased risk for hysterectomy and blood transfusions as well as perinatal morbidity and mortality mainly due to premature delivery. Methods This is a retrospective audit including all women with major placenta praevia during a twoyear period (1st January 2016 until 31st December 2017) at Tygerberg Hospital, a large regional and tertiary referral centre in the Western Cape province of South Africa. It was conducted as a retrospective folder review. Results The total number of deliveries during the study period was 15 780, of which 121 were diagnosed with major placenta previa, giving an incidence rate of 0.4%. Of the 121 patients in the study, complete data was available for 119 patients (98%) of which 31% (n=38) had a previous delivery by caesarean section. Of all the patients with major placenta praevia (MPP), 19.8% (n=24) had a morbidly adherent placenta (MAP). Intraoperative interventions used to control bleeding were multiple haemostatic sutures in 11.6% (n=14), followed by compression sutures 5.8% (n=7) and uterine artery ligation 2.5% (n=3). The hysterectomy rate was 16.5% (n=20). Of all the mothers, 24.8% (n=30) required a high dependency unit (HDU) of which 1.7% (2) went to the intensive care unit (ICU), 8.6% (n=8) to a step-down acute post-natal ward (APN) and the majority 16.5% (n=20) went to the obstetric critical care unit (OCCU). Relook laparotomy was required in 2.5% (n=3) of the cases. There were no maternal deaths. Of all the deliveries 62.8% (n=76) were preterm and 5.8% (n=6) required admission to neonatal intensive care unit (NICU), and 78.8% (n=93) had good APGAR scores (5-minute score ≥6), while 21,2% (n=25) had poor APGAR scores (5-minute score 5 or less). The overall hospital still birth rate (SBR) during the study period was 63 per 1000 births, and major placenta praevia accounted for 0.2% (16 per 1000 births) of all the still births. Conclusion The incidence of MPP was 0.4% which is comparable to other studies. MPP is one of the leading causes of feto-maternal mortality and significant morbidity. The prematurity rate was very high, however the majority (78.8%) of the babies had good 5-minute APGAR scores. Effective management protocols may help to identify high risk patients, thus improving management and outcomes of both the mother and the neonate.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Thesis (MMed) -- Stellenbosch University, 2022.
Placenta previa, Labor (Obstetrics) -- Complications, Hemorrhage, Puerperal disorders, Gynecologic emergencies, UCTD