AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 20 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. deviation were performed to report on the demographic characteristics of the women. The data were assessed through a test for significance if variables such as cigarette smoking, substance abuse, gravity, parity, number of previous caesarean deliveries influenced maternal and foetal outcomes. The variables were expressed as a percentage and compared using chi-square (χ2) or Fisher exact test, as well as odds ratio and 95% confidence intervals where appropriate. A calculated sub-set analysis of prevalence rate of placenta praevia for different maternal age groups. A p-value ≤ 0.05 was noted as statistically significant. RESULTS Slightly more than two-thirds of the women (n = 59; 68.6%) were multiparous, 21 women (24.4%) were primiparous, and 6 women (7.0%) were nulliparous. Similarly, 69.8% of the women were of gravidity greater than 2, with 27.9% being gravida-2 and two women (2.3%) were gravida-1 (Figure 1). Figure 1: Gravidity of the pregnant women in the study. Slightly less than one-third of the women (N = 27; 31.4%) had no history of previous caesarean section (CS) and those who have had two previous CS (n = 32.6%) made up most of the women. Women who have had one previous CS (n = 23; 26.7%) and those who had previous CS x 3 (n = 8; 9.3%) made up the rest of the women in the study. Only one woman (1.2%) delivered at a gestational age of between 28 and 33 weeks (Figure 3). Forty-two women (48.8%) delivered between 34 and 36 weeks and majority of the women (n = 43; 50%) delivered at a gestational age of ≥ 37 weeks, In this series, the total number of women who delivered by C/S was eighty-six, and of this number, 22 (25.6%) were delivered as emergency C/S and 64 (74.4%) were delivered as elective C/S. MATERNAL COMPLICATIONS, MANAGEMENT AND OUTCOMES. Table 1 shows the variety of complications during the management of these women and the number of maternal deaths that resulted from placenta praevia. The most frequently reported complications were haemorrhage (75.6%), and the need for blood transfusion (72.1%). Anaemia was reported in 57.0% and 22 women (25.6%) underwent hysterectomy. Uterine artery ligation was done in 12.8% and ICU admission was 11.6%. There was a 9.3% occurrence of wound infection and 8.1% of the cases resulted in urinary tract injury. Four women (4.7%) demised during this study, giving a maternal death ratio of 47 deaths per 1,000 deliveries among women with placenta praevia. Table 1: Maternal complications, management, and outcomes Complications & outcomes Number Percentage Haemorrhage - Antepartum - Intrapartum - Postpartum 65 17 27 21 75.6 26.2 41.5 32.3 Blood transfusion 62 72.1 Anaemia 49 57.0 Surgical site infection 8 9.3 Hysterectomy 19 22 Urinary tract injury 7 8.1 Uterine artery ligation 11 12.8 Intensive Care Unit admission 10 11.6 Maternal death 4 4.7 Fifty-one women (59.3%) stayed in hospital for less than 4 days, 34 women (39.5%) were in hospital for more than four days and one woman was in hospital for 4 days. Table 2 shows the possible risk factors identified among the pregnant women diagnosed with major placenta praevia in this study. The only risk factors identified among this cohort of patients that could have had an impact on the occurrence of major placenta praevia are multiparity and gravidity of ≥ 2.0. The number of previous C/S did not show any trend suggestive of its association with occurrence of placenta praevia in the index pregnancy. Advanced maternal age, previous abortion, previous curettage, and number of antenatal visits also did not reveal any association with occurrence of placenta praevia. Table 2: Profile of risk factors identified among pregnant women with major PP. Risk Factors Number of women % Maternal age (n = 86): < 35 years ≥ 35 years p-value 7.938 27 0.0039 68.6 31.4 Parity (n = 86): Nulliparous Primiparous Multiparous 6 21 59 7.0 24.4 68.6 p-value (Primiparous vs Multiparous) 0.0019 2 2.3 Gravidity (n = 86) Gravida-(1) Gravida-(2) Gravida-(3) p-value (Gravida 2 vs > 2) 24 60 0.0023 13 73 27.9 69.8 15.1