Is it possible to reduce rates of placenta praevia?

To determine factors responsible for rising rates of placenta praevia.

This comparative study was performed at Jinnah Post Graduate Medical Centre Karachi, (Group-A) from September 2000 to February 2002 and (Group-B) from January 2008 to January 2009. All women with major degree of placenta praevia diagnosed on ultrasound who came in emergency or through out patient department were included in the study. Patients with mild degree of placenta praevia were excluded. Group A had 100 patients and Group B, 58 patients. Chi-Squire test was used for comparison of previous study and current study.

The number of unbooked cases in both groups A and B was high (A=76%, B=62%). Most patients were grandmultipara (A=41%, B=34%) with ages ranging from 31-35 years (A=36%, B=43%). Even primigravida had a major degree of placenta praevia (A=17%, B=7%). There was a significant difference in two groups in term of previous caesarean section (A=12%, B=38%). Association of placenta praevia following miscarriages was also noted (A=41%, B=29%). Placenta accrete were noted in two cases in group B, both required obstetrical hysterectomies. The results revealed a favourable foetal out come in both groups, A= 93 (93%), B=55 (95%).

With rising rate of previous caesarean sections over an eight year period from 12% to 38% the frequency of placenta praevia has increased. Most patients continue to present as unbooked cases in emergency, there fore the associated morbidity due to haemorrhage remains high. Therefore efforts should be made to avoid primary caesarean section where possible. In addition antenatal care and timely diagnosis of placenta praevia on ultrasound can decrease the associated morbidity.