Placenta Praevia: Clinical Presentation and role of Examination under Anaesthesia in Diagnosis in Clinical Practice

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Khalifa, Afaf
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46 cases with placenta praevia, in the year 2001, were reviewed. The average maternal age was found to be 30.9 years. The greatest amount of cases was among multiparae who had 1 to 4 previous deliveries, while only 1.6% of the cases were nulliparae. In 3 5 .0% of the cases there were antecedent uterine scar (previous caesarean delivery). Ultrasound diagnosis was done in 64.1% of the patients. Examination under general anaesthesia, EUA, was done to 15.6% of the patients. 20.0% of patients were diagnosed intraoperatively. The most frequent presentation was antepartum haemorrhage, severe bleeding in 17.1 % of cases and minor episodes of bleeding in 54.8% of the cases. The first haemorrhagic episode occurred at less than 28 gestational age in 1.6% of the patients, while 32.8% occurred equally in each of the following three gestational age groups: 28-34, 34-37, and 37-42 weeks. The-mean time between first episode of bleeding and delivery was 26 days. Breech presentation and abnormal lie complicated 10.4% and 12.5% of the cases, respectively. All the pregnancies were terminated via the abdominal root.71.9% the patients could be managed 'conservatively until term, while the pregnancy was interrupted at gestation age less 37 weeks in 28.1% of the cases. Intraoperatively, the placental site of insertion was major degree in 79.7% of the patients and minor degree in 20.3%. Morbid adherence of the placenta was found in 14.1% of the patients. The mean number of days of admission was 17.1 days.Maternal complications include severe intrapartum haemorrhage and postpartum haemorrhage in 35.0% 4.7% of cases, respectively. Blood transfusion was given to 71.9% of patients, with average amount of3 units per patient. Hysterectomy was done for 15.6% of cases and tubal ligation was done for 17.5%. Maternal death complicates 1.6% of cases compared to 1.0% in the control group. Neonatal complications included prematurity in 12.5% of patients.Foetal loss was 4.7% compared to 6.0% in the control group. Congenital anomalies represent 1.6% and 1.0% of the study group and control groups, respectively. Both percentages were in the normal range .