Review of placenta Previa and pregnancy outcomes at Charlotte Maxeke Johannesburg academic hospital from January 2017 to December 2018

Abstract

Aim This study aims to report on the profile, radiological investigations and findings, maternal and neonatal outcomes amongst patients diagnosed with placenta previa (PP) at Charlotte Maxeke Johannesburg Academic hospital (CMJAH) from January 2017 to December 2018 Methods A cross-sectional retrospective review of clinical records of patients diagnosed with PP at CMJAH during 2017-2018 was collected and data were analysed using Stata 14.2. Results There was a total of 17284 deliveries, 8966 (51.8%) of which were caesarean sections. Eighty four patients who were diagnosed with PP delivered at CMJAH from 01 January 2017 to 31 December 2018 giving a prevalence of PP of 0.49%. Only 71 (84.5%) files were available for analysis. The median maternal age was 33 years (IQR 29-38) and 62 (87.3%) patients were booked with 59 (83.1%) having booked with an Hb < 8g/dl. More than 30 % of patients were aged < 30 years and > half of the cohort had a previous caesarean section(C/S). The diagnosis of Placenta Previa (PP) and Placenta Accreta Spectrum(PAS) was assessed using transabdominal ultrasound(TAU). Results indicate that TAU had a sensitivity of 87.3% for the diagnosis of PP and, specificity and negative predictive value (NPV) with a sensitivity and positive predictive (PPV) of 93% and 20 % respectively for at diagnosing PAS. A majority (62.0%) of patients with PP were delivered electively and just below two fifths had an emergency caesarean section. The most common indication for an emergency C/S was antepartum haemorrhage(APH) occurring in 24 out of the 27 (88%) in this group. Only 8% required a total abdominal hysterectomy(TAH) as a lifesaving procedure after primary intervention to achieve haemostasis failed. All four patients who had placenta left in situ ended up with a hysterectomy at some stage either because of sepsis, bleeding or calcified placenta. There were no maternal deaths. There was 92.9% admission to HCA/ICU when other procedures were done with C/S (OR=24.05, p =0.003). Maternal age > 35 years and pregnancy interval of > 5 years had an ICU/HCA admission rate of 54.2% and 56.1% respectively. The blood transfusion rate was 39.4%, however, only 20% of patients admitted to ICU/HCA received a blood transfusion. The median GA at delivery was 36 weeks (IQR 25-37) with a mean neonatal birth weight of 2360g, a very low birth weight (VLBW) rate of 37.0 % and a neonatal ICU admission rate of 16.9 %. Conclusion The diagnosis of PP can be established using TAU. TAU is a good tool for predicting patients without PAS and is essential for low-resource settings. Emergency and inappropriately planned C/S with other procedures were associated with an increased risk of TAH, HCA / ICU admission, preterm delivery and VLBW. There is a high rate of hysterectomy later on if the placenta is left in situ.