Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach

Figures & data

Figure 1 Intraoperative blood loss in patients with placenta accreta (n=25).

Figure 2 Units of packed red blood cells transfusion required in patients with placenta accreta (n=25).

Table 1 Comparison of maternal outcome in women having PP with and without PA (n=122)

Variable	PP without PA (n=97)	PP with PA (n=25)	Significance test	P-value
Age (years) (mean ± SD)	32.4±5.03	35.2±4.60	t=2.5	0.002
Parity (mean ± SD)	3.5±2.55	4.9±2.46	t=2.4	0.002
History of previous CS
Patients (n, %)	46 (47.4%)	24 (96%)	χ^2=19.2	<0.0001
Mean number of CS (± SD)	1.0±1.39	2.8±1.4	t=5.7	<0.001
Grade of PP
Major (complete and partial) (n, %)	55 (56.7%)	25 (100%)	χ^2=16.5	<0.0001
Minor (marginal and low lying) (n, %)	42 (40.3%)	0 (0.0%)	χ^2=14.8	<0.0001
Emergency surgery (n, %)	49 (50.5%)	7 (28%)	χ^2=4.0	0.042
Elective surgery (n, %)	48 (49.5%)	18 (72%)	χ^2=4.1	0.043
Gestational age at time of delivery (weeks) (mean ± SD)	35.7±2.56	36.5±1.38	t=1.67	0.045
Cesarean hysterectomy (n, %)	3 (3.1%)	21 (84%)	χ^2=71.2	<0.0001
Urinary tract injuries (n, %)	4 (4.1%)	8 (32%)	χ^2=14.2	<0.0001
EBL, mean ± SD (mL)	796.6±813.76	2,984±1,685.39	t=2.5	0.001
PRBC transfusion
Patients receiving transfusion (n, %)	45 (46.4%)	25 (100%)	χ^2=23.4	<0.0001
Units
Range	0–10	2–28
Mean ± SD	1.3±2.89	7.7±6.42	t=2.23	0.012
≥10 units	1 (1%)	7 (28%)	Fisher’s exact test	<0.0001
Operative time (minutes) (mean ± SD)	57.2±30.29	146.3±50.05	t=2.9	<0.0001
Admission to maternity HDU (n, %)	15 (15.5%)	25 (100%)	χ^2=64.5	<0.0001
Admission to ICU (n, %)	2 (2.1%)	10 (40%)	χ^2=28.1	<0.0001
Postoperative hospital stay (days), (mean ± SD)	4.4±0.67	7.1±3.01	t=2.07	0.013
Hospital stay >5 days (n, %)	7 (7.2%)	17 (68%)	χ^2=42.7	<0.0001

Abbreviations: CS, cesarean section; HDU, high-dependency unit; ICU, intensive care unit; EBL, estimated blood loss; PRBC, packed red blood cells; SD, standard deviation; PA, placenta accreta; PP, placenta previa.

Table 2 Neonatal outcome in cases of placenta previa (n=122)

Variable	<32 weeks (n=6)	32 to <34 weeks (n=14)	34 to <36 weeks (n=21)	36 to <37 weeks (n=18)	37 to <38 weeks (n=40)	38 weeks (n=23)	Significance test	P-value
GA (mean ± SD)	29±1.89	32.5±0.58	34.7±0.54	36.2±0.27	37.1±0.20	38.2±0.57	F=398	<0.0001
Birth weight (mean ± SD)	1.2±0.23	1.7±0.29	2±0.25	2.6±0.22	2.7±0.30	2.9±0.41	F=71.3	<0.0001
1-minute AS
Mean ± SD	5.3±1.86	5.8±1.88	7.3±1.23	7.3±0.66	7.3±0.79	7.4±0.65	F=8.3	<0.0001
AS <7 (n, %)	4 (66.7%)	9 (64.3%)	6 (28.6%)	2 (11.1%)	4 (10%)	2 (8.7%)	χ^2=28.9	<0.0001
5-minute AS
Mean ± SD	7.4±1.63	8.1±1.30	8.9±0.76	8.9±0.58	9.1±0.68	9.4±0.72	F=559.2	<0.0001
AS <7 (n, %)	3 (50%)	2 (14.3%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	Yates corrected χ^2=1.3	0.259
SGA (no)					3 (7.5%)	1 (4.3%)
FGR (no)		1			1
NICU admissions, (n, %)	6 (100%)	14 (100%)	14 (66.7%)	4 (22.2%)	4/39 (10.3)	1 (4.3)	χ^2=67.9	<0.0001

Abbreviations: GA, gestational age; AS, Apgar score; SGA, small for gestational age; FGR, fetal growth restriction; NICU, neonatal intensive care unit; SD, standard deviation.

Table 3 Comparison between neonatal outcome in cases of placenta previa with and without PA at 37 to <38 weeks (n=40)

Variable	Without PA (n=25)	With PA (n=15)	Significance test	P-value
Gestational age (mean ± SD)	37.1±0.21	37.1±0.21	t=1.52	0.820
Birth weight (mean ± SD)	2.6±0.35	2.7±0.25*	t=0.97	0.634
1-minute Apgar score
(Mean ± SD)	7±1.32	7.5±0.75	t=1.24	0.065
AS <7	3 (12%)	1 (6.7%)	Fisher’s exact test	1.000
5-minute Apgar
(Mean ± SD)	9±0.78	9.3±0.51	t=1.33	0.042
AS <7	0 (0%)	0 (0%)
SGA	3 (12%)	1 (6.7%)	Fisher’s exact test	1.000
IUFD	0	1	Fisher’s exact test	0.375

Note:

* Only 14 patients, one patient presented with IUFD.

Abbreviations: AS, Apgar score; SGA, small for gestational age; IUFD, intrauterine fetal death; PA, placenta accreta; SD, standard deviation.

Figure 3 Risk of placenta accreta in patients with placenta previa and previous CS.

Abbreviation: CS, cesarean section.