Uthra, K G (2022) A Clinical study of Comparison of Maternal and Fetal Outcome between Primigravida and Multigravida Women with Placenta Previa admitted at a Tertiary Care Centre in Vellore, Tamilnadu: A Prospective Cohort study. Masters thesis, Vellore Government Medical College, Vellore.
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Abstract
Placenta previa accounts 0.5% of all deliveries still it remains major cause for perinatal morbidity and mortality. It is noted that patient admitted to hospital as emergency admission had maximum chances of maternal morbidity and perinatal mortality. Early detection of placenta previa by USG, conservative management including blood transfusion (mild bleeding cases), early elective termination of pregnancy by assessing fetal lung maturity along with NICU care reduces perinatal mortality. Maternal, perinatal morbidity and mortality is preventable can be achieved by spacing pregnancies, routine USG in pregnancy, early referral of high risk pregnant cases in tertiary care institute. In present study,101 placenta previa cases taken and studied type of placenta previa, clinical course, maternal and fetal outcome 1. In the present study, the following age groups had highest and lowest incidence 20-29 yrs i.e. 67.32% > 30-35 yrs i.e. 14.85%, > 35 yrs i.e. 7.9%, < 19 yrs i.e.9.9%. 2. Most common risk factors in our study - caesarean section 45.5% (1 LSCS-30%, 2LSCS-16%) > 42.8% of cases had no risk factors > 10.8% cases had previous history of abortions>1 case RH isoimmunization. 3. In placenta previa, primi gravida and multigravida(G2P1L1 With previous lscs) had same incidence -31%. 4. 79% of cases in our study participants had cephalic presentation > breech 16% > transverse lie 5%. 5. Type 2A Placenta previa had 46% > Type 2B placenta previa had 18% > Type 3 placenta previa 16% > Type 4 -11%, lowest incidence Type 1 placenta previa 9%. 6. 82% of cases underwent emergency LSCS, 50% of cases underwent prophylactic uterine artery ligation, 32% of cases had PPH managed medically and surgically 9% of cases underwent elective LSCS, for all 9 cases prophylactic uterine artery ligation done, no PPH. 7. 42 cases had hemorrhage in antenatal period in which 3 patients had profuse bleeding during antepartum period followed by 31 cases had intrapartum hemorrhage treated with blood and blood products. 8. Over all most common intra operative procedure done :34% cases had foley tamponade with B/L uterine artery ligation, 27% had foley tamponade. 9. In present study, Type 1 placenta previa -9 cases (2 cases underwent emergency LSCS and 7 labour natural) 88.9% of cases had foley tamponade, 15% had foley tamponade with uterine artery ligation. 10. In Type 2A placenta previa - 46 cases (6 cases elective LSCS, 40 cases emergency LSCS) 15 cases had foley tamponade with uterine artery ligation, 12% cases had foley tamponade, 1 cases underwent subtotal hysterectomy). 11. In Type 2B placenta previa -18 cases (2 cases elective lscs, 16 cases emergency lscs) 9 cases had foley tamponade with uterine artery ligation, 4 cases had uterine artery ligation, 2 cases had uterine artery ligation with b lynch). 12. In Type 3 placenta previa-16 cases (1 elective lscs, 15 emergency cases) 5 cases had foley with uterine artery ligation, 1 case subtotal hysterectomy, 1 case bladder repair. 13. In type 4 placenta previa-11 cases (emergency lscs) 5 cases-foley with uterine artery ligation, 3 cases total hysterectomy, 1 case subtotal hysterectomy, 1 bladder repair, 2 maternal deaths. 14. 53% cases were nil postoperative complications, 18 cases were developed hypotension managed with IV fluids, 14 cases were developed fever, LRI treated with antipyretics, antibiotics, 2 cases were AKI managed by fluid restriction and serial renal parameters monitoring. 15. 35% of our patients received only packed cell transfusion, 37% received blood along with FFP transfusion 16. Out of 9 perinatal deaths, Asphyxia and prematurity were major contributions 4.3% and 2.6% respectively followed by RDS1.6%. Neonatal mortality was 8-9% with placenta previa. Perinatal death were higher in gestational age between 30-33 weeks.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916956 |
| Uncontrolled Keywords: | Maternal and Fetal Outcome, Primigravida, Multigravida Women, Placenta Previa, Tertiary Care Centre, Vellore. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Apr 2022 10:12 |
| Last Modified: | 11 Dec 2023 02:39 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19274 |
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