Assessment of the Maternal Morbidity Profiles Associated with Placenta Praevia Occurring in Pregnancy With Previous Uterine Scar in a South- Western Nigerian Government Hospital

Abstract

Background: The dual burden of a placenta praevia occurring in pregnancy with a previous caesarean scar carries a greater risk than having each morbidity occurring alone. Evidence of the complications associated with the occurrence of these two risk factors together is scarce in low resource sub-Saharan Africa countries. Objectives: This study assessed the maternal morbidity profiles associated with placenta praevia coexisting with a previous uterine scar in a government-owned hospital in Nigeria. Methods: A two-year review of records of 146 women who had a diagnosis of placenta praevia and also delivered the index pregnancy via caesarean section was carried out. The morbidity profiles assessed were duration of index caesarean section, morbidly adherent placenta, estimated blood loss at surgery and length of hospital stay post-delivery. Data were analysed using descriptive and inferential statistics at 5% level of significance. Results: The caesarean section rate was 23.3 and the prevalence of placenta praevia was 2.4%. The mean age of the respondents was 31 ± 6.0 years. Twenty-two (15.1%) respondents had coexistence of placenta previa with a previous scar, 66.4% delivered via emergency caesarean section and 86.3% of the index caesarean sections lasted < 60 minutes. Two (1.4%) respondents had morbidly adherent placenta, 68.5% had estimated blood loss = 500mls and 78.6% stayed = 3 days in the hospital post-delivery. Longer duration at caesarean section was significantly associated with placenta praevia coexisting with previous scar (p = 0.045). Conclusions: Caesarean section in placenta praevia coexisting with the previous scar lasts longer, hence adequate resources should be made available before commencing such procedures.