AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 19 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | High risk of major placenta praevia presents deleterious effects on Maternal and foetal outcomes. ABSTRACT Introduction: Major placenta praevia is a high-risk condition which constitutes a major obstetric dilemma. It is a predisposing factor to foeto- maternal morbidity and mortality. Methods: : A retrospective three-year study from the 1 of January 2018 to 31 December 2020 was conducted. Major placenta praevia was diagnosed on ultrasound or incidental operative findings. Patient clinical records were retrieved for maternal characteristics, pregnancy and foetal outcomes. IBM; SPSS statistical software (version 14) was utilized to analyze data. Results: Eighty-six patients were diagnosed with major placenta praevia with a prevalence of 0.36%. 68.6% of the women were multiparous, 50 % of the participants delivered at 37 weeks of gestation and 57% of the women had anaemia secondary to obstetric haemorrhage. There were 11 (12.8%) neonatal ICU admissions with one neonatal death (1.2%). Conclusion: Major placenta praevia poses a significant obstetric problem that dictates urgent intervention without which there is high probability of maternal haemorrhagic mortality and compromised foetal survival. Timeous identification of, and emergency intervention for patients at risk is an important hallmark for good outcome. Keywords: Major placenta praevia, previous caesarean section, multiparity, obstetric haemorrhage INTRODUCTION Placenta praevia is defined as an obstetric complication where the placenta lies wholly or partially in the lower and non-contractile part of the uterus, presenting an obstruction to the cervix (1) . Placenta praevia is classified in relation to the cervical os. Complete placenta praevia relates to the complete coverage of the internal os, whereas partial coverage is when the internal os is not completely covered (2) . Both complete and partial placenta praevia are classified as major placenta praevia (3) . There is no consensus on the outcomes of placenta praevia based on the classification (4,5,6,7) . Prevalence of placenta praevia is 4.0 per 1000 pregnancies in the general population. Studies based on Asian populations show the highest prevalence of 12.3 cases per 1000 pregnancies and the lowest in sub-Saharan countries reported as of 2.7 cases per 1000 pregnancies (1) . Europe has a prevalence of 3.6 cases and North America has 2.9 cases per 1000 pregnancies. The precise aetiology of placenta praevia remains an enigma, however, several risk factors have been identified in the causation of placenta praevia (8) . Multiple gestations, multiple number of caesarean sections, previous uterine evacuation, previous history of placenta praevia and tobacco smoking have been pointed out as possible risk factors (8.9) . Clinical representation of placenta praevia is painless bright red vaginal bleeding in the second and third trimester. Transvaginal sonography remains the gold standard of diagnosis. It provides good information on the anatomical position of the placenta and its relation to the cervix (10.11) . Placenta praevia is associated with maternal and fetal complications (12) . There is an increase in performance of caesarean sections in South Africa that have an impact on the incidence of placenta praevia, and hence the maternal and fetal outcomes (13) . There is a scarcity of data on maternal and fetal outcomes in placenta praevia in South Africa, hence the necessity of the local study. The study was designed to assess the maternal and foetal outcomes in major placenta praevia managed the Dr George Mukhari Academic Hospital (DGMAH) in Ga-Rankuwa. MATERIALS AND METHODS This was a retrospective cohort study conducted at the Department of Obstetrics and Gynaecology at DGMAH, a tertiary level hospital attached to Sefako Makgatho Health Sciences University. The study population comprised of pregnant women of reproductive age (18 to 49 years), who were diagnosed with a major placenta praevia in the department of Obstetrics and Gynaecology of DGMAH. All women between the ages of 18 and 49 years, in the third trimester follow-up, with ultrasound diagnosis of placenta praevia, who delivered at DGMAH were eligible for recruitment to the study. Women with multiple gestations, Intrauterine foetal death, minor placenta praevia, placenta praevia with any other placental or cord abnormality, and those with incomplete data were excluded from the study A sample size of 86 cases of placenta praevia were required based on the study conducted by Cresswell and co-workers on placenta praevia in sub-Saharan Africa of 2.7 cases per 1000. (1) The number of cases guaranteed 85% power of the study with a confidence interval of 95%. All consecutive cases of major placenta praevia that occurred between the 1st of January and the 31st December 2020 were eligible for inclusion. Data was retrieved from patients’ clinical records through a data collection form which comprised of a demographic, maternal and foetal sections. A descriptive statistical analysis such as range, mean, and standard Darius N.Wawa; Muponisi E Chabalala and Lineo Matsela. Department of Obstetrics and Gynaecology – Sefako Makgatho Health Sciences University CORRESPONDENCE: D N.Wawa | Email: dariuswawa@yahoo.fr High risk of major placenta praevia presents deleterious effects on maternal and foetal outcomes.