The Association between Placenta Previa in Pregnant Women with Previous Caesarian Section at Combined Military Hospital

Abstract

Background: Placenta praevia is defined as a placenta implanted partially or completely over the lower uterine segment. Placenta praevia is a major cause of massive obstetric bleeding that leads to significant maternal morbidity and mortality. In the present day, the hypothesis is that previous cesarean section is the risk of development of placenta praevia. Objective: To assess the relationship between placenta praevia and previous cesarean section. Material and Methods: It was a descriptive cross-sectional study carried out in the Department of Obstetrics and Gynaecology, Combined Military Hospital, Dhaka, from July 2021 to July 2022. Total 35 patients with placenta praevia were included in this study. Informed verbal and written consent were taken from the study participants. A detailed history was taken, general physical and per abdominal examination and previous records were reviewed properly.  Placenta praevia was diagnosed by patient clinical presentation, ultrasonogram, and incidentally during cesarean section. Results: The study shows the incidence of placenta praevia was 1.75% and incidence of placenta praevia in woman with previous caesarean section was 1% compared with 0.75% without previous caesarean section. The commonest age group was 26-30 years, which included 44%, and 32% belonged to 31-35 years age group. The mean age was 29.28± 10 years. Most of the patients were multigravida (62%). In maximum number of cases, (52%) were admitted at the gestational period between 35-38 weeks. Common clinical presentations were per vaginal bleeding 84% and 16% of patients were symptomatic. Regarding preoperative findings, 30(62.5%) patients had average preoperative bleeding. Postpartum hemorrhages corrected conservatively were 14(29.1%), and postpartum hemorrhage needed hysterectomy were 4(8.3%). In patients with no history of previous cesarean section 90% were delivered by cesarean section and 10% were delivered vaginally. Among patients with a history of the previous cesarean section all patients underwent cesarean section. Conclusion: There is a strong association between having a previous caesarean delivery and the subsequent development of placenta praevia. The risk increases with the number of cesarean sections. So, pregnant women with a history of caesarean section must be regarded as high risk for placenta praevia and must be monitored carefully.