Placenta Previa in Scarred and Nonscarred Uterus and Its Effect on Maternal Fetal Outcome

  • Wahid F Assistant Professor, Dept. Of Fetomaternal Medicine, BSMMU, Dhaka, Bangladesh
  • Kulsum U Assistant Professor, Dept. Of Fetomaternal Medicine, BSMMU, Dhaka, Bangladesh
  • Islam N Assistant Professor, Dept. Of Fetomaternal Medicine, BSMMU, Dhaka, Bangladesh
  • Akhtar N Professor, Dept. Of Fetomaternal Medicine, BSMMU, Dhaka, Bangladesh
  • Parveen T Professor and Chairman, Department of Fetomaternal Medicine, BSMMU, Dhaka, Bangladesh
  • Sayeeda S Assistant Professor (Obstetrics and Gynecology), BSMMU, Dhaka, Bangladesh
Keywords: Placenta previa, cesarean section, uterine scar, maternal morbidity, placenta accreta spectrum

Abstract

Introduction: Placenta, the life support system of foetus, when implants in lower uterine segment affects fetomaternal outcome adversely. Placenta previa when diagnosed in 2nd or 3rd trimester is associated with series of complications. Placenta previa is a major cause of vaginal bleeding in late 2nd and 3rd trimester.

Objective: To compare feto-maternal outcomes in cases of placenta previa occurring in scarred versus non-scarred uteri.

Methods: This study was prospective observational study, conducted in department of fetomaternal Medicine, BSMMU from January 2023 to June 2024. 60 casesanalyzing of placenta previa managed at a tertiary care center. Patients were categorized into two groups: scarred uterus (n=46) and non-scarred uterus (n=14). Maternal outcomes including hemorrhage, hysterectomy rates, and perioperative complications were compared. Fetal outcomes such as gestational age at delivery, birth weight, and NICU admission rates were also evaluated.

Results: Women with scarred uteri had significantly higher estimated blood loss (1850 ± 950 mL vs 1200 ± 650 mL, p=0.012), increased need for blood transfusion (76.1% vs 42.9%, p=0.021), and higher rates of peripartum hysterectomy (39.1% vs 7.1%, p=0.025) compared to those with non-scarred uteri. Placenta accreta spectrum disorders were more common in the scarred uterus group (37.0% vs 7.1%, p=0.038). After adjusting for confounding factors, having a scarred uterus remained an independent risk factor for peripartum hysterectomy (aOR 6.2, 95% CI 1.8-21.5, p=0.004) and for requiring blood transfusion (aOR 3.8, 95% CI 1.2-12.1, p=0.023). Fetal outcomes showed a trend towards being poorer in the scarred uterus group, but these differences did not reach statistical significance.

Conclusion: Placenta previa in the context of a scarred uterus is associated with significantly worse maternal outcomes, particularly in terms of hemorrhage, transfusion requirements, and hysterectomy rates. These findings highlight the importance of strategies to reduce primary cesarean section rates and emphasize the need for specialized care in managing pregnancies complicated by placenta previa in women with previous cesarean deliveries.

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How to Cite
Wahid, F., Kulsum, U., Islam, N., Akhtar, N., Parveen, T., & Sayeeda, S. (2024). Placenta Previa in Scarred and Nonscarred Uterus and Its Effect on Maternal Fetal Outcome. Obs Gyne Review: Journal of Obstetric and Gynecology, 10(1), 16-24. Retrieved from https://obstetrics.medresearch.in/index.php/joog/article/view/169
Issue
Vol 10 No 1 (2024): Jan-Dec
Section
Original Article

Copyright (c) 2024 Author (s). Published by Siddharth Health Research and Social Welfare Society

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