Maternal and Perinatal Outcome of Major Degree Placenta Previa at Mansoura University Hospital

Abstract
Background: To study risk factors, management, and outcome of major degree placenta previa in our tertiary health care hospital.
Patients and Methods: A Prospective observational study was conducted in Obstetrics & Gynecology, Department, Mansoura University Hospital, Egypt during the period from July, 2014 to December, 2015. The patient criteria, method of diagnosis, management, fetal and maternal outcomes of cases with major degree PP were reported and analyzed.
Results: This study included 115 cases. Mean age of our cases was 31.1 years (range: 21-40), mean gestational age at delivery was 36.8 weeks (range: 28-39). Previous cesarean deliveries were reported in 93.9% of the cases. Abnormal placental adhesions were found in 30.4%. A stepwise system was used for intraoperative interference. Peripartum hyster-ectomy was performed in 13 cases (11.3%). There were three cases of maternal mortality; one due to anesthetic complication, one due to uncontrolled atonic postpartum hemorrhage and the third was due to postoperative pneumonia.The mean gestational age at delivery was 36.82±1.6 weeks. There were 5 cases (4.3%) of IUFD and 2 cases (1.8%) of early neonatal deaths.
Conclusions: Major placenta previa with accrete had significant difference in maternal morbidity and mortality than non-accrete type. Pathological placental adhesions should be excluded by Doppler ultrasound and or MRI. All surgical procedures to control bleeding must be done including hys-terectomy without hesitation to save the patient. Cases must be managed by a collaborative team work in a tertiary center with available ICU.