engleski

Placenta previa-A life threatening obstetric emergency ; maternal and neonatal outcome in 37 cases

During the three years period from January 1998 to December 2000 a total number of childbirths in the Department of Obstetrics and Gynecology, Women Hospital, Zagreb, Croatia was 14710. We found 37 cases with diagnosis of placenta previa making the incidence in our population 0.25% what was as quoted in literature. All the data about the patient were extracted from the patient's history illness. The following data were analyzed: type of placenta previa, age of pregnant women, parity, prior cesarean scar, complications during pregnancy, the week of the first hemorrhagic episode, type of delivery, mode of delivery, gestational age at the time of delivery, the frequency of emergency cesarean deliveries, maternal postoperative complications, newborn weight, height, Apgar score and neonatal complications. We found that the most frequent placental insertion type was marginal placenta previa with 57.28% of cases. The total placenta previa was found in 38.89% of cases and partial placenta previa in 8.33%. Posterior localization of placenta was more frequent comparing with anterior one (77.42% respectively 22.58%). Most of the diagnoses were based on ultrasonografic examination. The average maternal age was 32.22 years, most of the women were multiparous (75.6%), and prior cesarean scar as a possible risk factor was found in 8.1% of cases. The most frequent complaint was painless vaginal bleeding which was found in 86.49% of cases. One woman presented with eclampsia. The mean gestational age of the first hemorrhagic episode was 33.6 weeks. In 9 cases (24.32%) massive vaginal bleeding with symptoms of hemorrhagic shock was found. Emergency cesarean delivery was needed in order to save the mother and fetus. The postoperative complications included massive bleeding from the implantation site, placenta accreta and atonia uteri. In two cases because of massive postoperative bleeding hysterectomia was performed as a unique mode for saving mother's life. Most of the women with acute placenta previa were uncontrolled or poorly controlled during their pregnancy making the early diagnosis and frequent monitoring very important in preventing such incidents. The most frequent maternal complication during pregnancy was threatened preterm labor, which was found in 12 cases (32.4%). However the incidence of preterm delivered infants (before 37 weeks gestation) was even higher 51.35% making the incidence of preterm deliveries significantly higher among women with placenta previa comparing with normal. Mean Apgar score in the first minute was lower in preterm born infants group than in the group of term born infants (7.438 resp.8.611). 57.89% of them had Apgar score in the first minute lower than 7 and were considered asphyctic. On the other hand of term born infants 27, 11% were considered asphyctic. Other neonatal complications were also more frequent among preterm born infants and included: anemia, infections, respiratory distress syndrom and major congenital anomalies.

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