AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 21 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. Cigarette smokers (n = 86) YES 0.0006 84.9 NO 3 p-value 79 3.7 Substance use (n = 82) YES 0.0002 NO p-value 27 59 31.4 Previous C/S (n = 86) None 0.0050 68.6 Previous C/S 62 p-value 24 Previous abortion (n = 86) NO 0.0019 27.9 YES 60 p-value 24 Previous curettage (n = 84) NO 0.0023 28.6 YES 10 p-value 73 Number of ANC visits (n = 83) 1 – 4 ANC 0.0003 12.0 visits 88.0 ≥ 5 ANC visits p-value FOETAL COMPLICATIONS AND OUTCOMES Table 3 provides information on foetal complications and the eventual outcomes of the deliveries. The neonates with birth weights of between 1,500 kg and 2,499 kg were 42 (48.8%) and neonates with birth weights ≥ 2,500 were 44 (51.2%). Thirteen neonates (15.1%) had a 1-minute Apgar score of <7, this number decreased to 12 (14.0%) at 5 minutes Apgar score. There was only one neonate (1.2%) that was delivered as a stillbirth and eleven other neonates (12.8%) needed ICU admission. Other obstetric complications recorded in this study for the neonates were: intraventricular haemorrhage (n= 2; 2.3%); respiratory distress syndrome (n = 9; 10.5%) and intrauterine growth retardation (n = 3; 3.5%). Table 3: Foetal complications and outcomes Foetal complications and outcomes Number Percentage Birth weight (kg): 1500 – 2499 ≥ 2500 42 44 48.8 51.2 Apgar Scores 1 minute: < 7 > 7 5 minutes: < 7 > 7 13 73 12 74 15.1 84.9 14.0 86.0 Still-births: YES 11 12.8 NO 75 87.2 Neonatal Intensive Care Unit admissions: YES 11 12.8 NO 75 87.2 Intra-ventricular Haemorrhage: YES 2 2.3 NO 84 97.7 Respiratory distress syndrome: YES 9 10.5 NO 77 89.5 Intra-Uterine Growth Retardation: YES 3 3.5 NO 83 96.5 DISCUSSION: In this cohort 15% of patients smoked cigarettes and 3.7% disclosed that they had indulged in substance use, which was similar to the findings by Chung and Jansen et al 43,44 . This was much smaller compared to the study by Ananth et al which reported that 33% of patients with PP were smokers 24 . In their study on aetiology and risk factors for placenta praevia, Faiz et al concluded that cigarette smoking during pregnancy increased the risk of PP to 60% 23 . Rodriguez et al had reported the same relationship between cigarette smoking and the high risk of developing PP during pregnancy 25 . Indulgence in substance abuse during pregnancy increased the risk of having PP by 2.9- fold 23 . Studies have not been unanimous on establishing a relationship between the number of cigarettes smoked and the quantity of uterine bleeding in placenta praevia. Several theories however attempted to explain the pathophysiology of cigarette smoking and placenta praevia 23 . The placenta of patients who were smokers is more enlarged than non- smokers with hypoperfusion of the uterus associated with hypoxia. This placental enlargement has been accredited to the vasoactive property of nicotine and chronic hypoxia- related to carbon monoxide 23 . Suzuki and et al alluded to the same fact that nicotine caused vasoconstriction and inflexibility of arteries leading to cellular death and bleeding 26 . Cigarette smoking and substance abuse in the current study have been found to be solid risk factors of placenta praevia which is in keeping with literature. Sixty eight percent of patients in this study were multipara. This is in keeping with literature that pointed at high parity itself as a risk factor. Pathophysiology of PP in multiparity is similar to that related to age - it is partially explained by atherosclerotic changes in the blood vessels of the uterus and infarction which cause under perfusion of the placenta. Consequences include increased size of the placenta and implantation in the lower uterine segment, thereby increasing the risk of PP 38,41 . Whereas in the Rao et al study the incidence of major PP was 40% in primiparous compared to this study (24.4%). This discrepancy was attributed to high rate of assisted reproductive technology, prior CS and uterine surgery 45 . A study conducted by Chung et al found that 34.9% of their patients were nulliparous which were five times higher than in the current study 43 . Previous abortion or curettage was found in 28% of the cohort; it was significantly lower than 82.6% from Asicioglu 19 , Ojha and colleagues 28 . A possible explanation could be that abortion is legalised and provided for free in those countries. Studies by Nahid 39 and Ahmed 15 found lower rates of abortion and uterine curettage. Culture, religious beliefs, and non-legalisation of abortions contributed to these findings. Previous uterine evacuation is a known risk factor for PP. The current study confirms that finding. Almost 69% of the patients had a history of previous caesarean section with the majority of them having had CS twice in this study. Comparable findings were reported by Jansen, 44 Corinne, 35 Pivano et al 47 . There is a strong association between the number of previous CS and the occurrence of PP. The most probable mechanism is