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

Abstract

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 .