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Background. Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective. To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results. Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion. Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.
The study was conducted in Addis Ababa, capital city of Ethiopia. The city lies at an altitude of 7546 feet (2300 metres). Tikur Anbessa Specialized Referral Hospital and Gandhi Memorial Hospital were selected for this study purposely based on the patient load. The data was collected from March 1 to July 30, 2018. The study design was unmatched case-control study. The source population of this study was the woman medical records in Tikur Anbessa Specialized Referral and Gandhi Memorial Hospitals from September 2015 to January 2018, whereas the study population was all the delivery medical records with singleton pregnancies complicated with placenta praevia at Tikur Anbessa Specialized Referral and Gandhi Memorial Hospitals from September 2015 to January 2018. All singleton deliveries with placenta praevia that took place at Tikur Anbessa Specialized Referral and Gandhi Memorial Hospital from September 2015 to January 2018 were selected for the study. First, all cases were identified from HMIS (Health Management Information System), and their medical registration number was used to access patient’s information. Complete birth registry records were considered for analysis. From 44342 total deliveries, a total of 303 placenta praevia cases were considered for analysis. Regarding control selection, controls were selected after proportional allocation to each year’s total number of deliveries in both hospitals. A systematic random sampling method using the patient’s medical registration number was used, and finally, 303 controls without placenta praevia were regarded for the study. (1) For cases (2) For controls Postpartum hemorrhage (PPH): defined as a blood loss of 500 ml or more within 24 hours after birth. Moderate anemia: corresponds to a hemoglobin level of 7.0-9.9 g/dl. Severe anemia: corresponds to a hemoglobin level of less than 7 g/dl. Urinary tract infection (UTI): an infection involving any part of the urinary system, including the urethra, bladder, ureters, and kidney. Intrauterine growth restriction (IUGR): refers to the poor growth of a baby while in the mother’s womb during pregnancy. Respiratory distress syndrome (RDS): the most common lung disease in premature infants and occurs because the baby’s lungs are not fully developed. Neonatal jaundice: a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Low birth weight (LBW): defined as a birth weight of less than 2500 g (up to and including 2499 g), as per the World Health Organization. A checklist was designed to collect data about study participant’s sociodemographic characteristics, obstetric and gynecological history, history of current pregnancy, mode of delivery, and maternal and neonatal complications. Data was checked for completeness and consistency before data entry by the principal investigator; the completed questionnaire was coded. For data cleaning, the coded data was entered into EPI Info version 3.5. Data was entered into EPI Info version 3.5.1 for data exploration and cleaning. The cleaned data was exported to SPSS version 25 for statistical analysis. Descriptive statistics was used to summarize categorical variables. Both bivariate and multivariable analyses were performed using logistic regression and adjusted odds ratios (AOR) with 95% confidence intervals for risk factors and maternal and neonatal complications associated with placenta praevia. P value < 0.05 was considered statistically significant. Ethical clearance for the proposed study was obtained from Addis Ababa University Institute of Review Board and Addis Ababa Health Bureau. Data was collected from patients' medical record, and confidentiality of the information was maintained throughout by excluding names as identification in the study.
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