Risks of adverse pregnancy outcomes among women with placenta previa at Kawempe National Referral Hospital

Abstract

Background Placenta previa is a condition where the placenta is attached partially or entirely on the lower uterine segment, and occurs at a 0.005% global, 0.4% South Sudanese and 1.7% Ugandan prevalence. Many predictors; (advanced maternal age, previous uterine surgery, existing medical conditions, gravidity and parity) of adverse pregnancy outcomes like; hemorrhage, hypovolemic shock, anemia, hysterectomy and death are exacerbated by the presence of placenta previa. Despite the risk of adverse pregnancy outcomes in presence of placenta previa, the predictors of adverse pregnancy outcomes complicated by placenta previa have not been widely studied in Uganda and particularly in Kawempe National Referral Hospital. This study will inform healthcare providers know these predictors thus plan better to avoid the adverse pregnancy outcomes. Methods; An ethically approved cross sectional study was done among 113 sonographically diagnosed with placent previa mothers in the antenatal and labour suite wards of kawempe national reffral hospital that were scheduled for immediate delivery. These were consecutively enrolled and research assistant administered questionnaires were used to collect data about the preditors including; maternal age, previa grade, parity, previous uterine scar, gestational age, hemoglobin level and platelet count at admission. Data about maternal and neonatal outcomes was also collected during follow up. And was later coded, cleaned and analyzed using binary logistic regression in stata version 14. Results: major previa (aPR 4.48, 95%CI 1.6-12.4, p=0.004), Maternal age (aPR 0.8, 95%CI 0.22- 2.89, p=0.728) and secondary education (aPR 0.28, 95%CI 0.082 - 0.94, p=0.04) were predictors for adverse maternal outcomes and Gestation age 34 to 37 weeks (aPR, 95%CI, p=0.132),Gestation age(aPR, 95%CI, p=0.002),PV bleeding(aPR, 95%CI, p=0.051),Major Previa(aPR, 95%CI, p=0.070),Multi parity (2 to 4) (aPR, 95%CI, p=0.185), and Grand multi parity(> 5) (aPR, 95%CI, p=0.190) were predictors for adverse neonatal outcomes. Conclusion: Major previa, maternal age, and secondary education are predictors of adverse maternal outcomes and Gestation age of 34 to 37 weeks and of < 37weeks, PV bleeding, Major previa, multi parity (2 to 4) and grand multi parity (> 5) are predictors of adverse neonatal outcomes.