OBSTETRIC RISK FACTORS ASSOCIATED WITH MAJOR DEGREE PLACENTA PRAEVIA DEVELOPMENT

Objective: To evaluate potential risk factors and perinatal outcome of pregnancies completed with major degree placenta praevia in pregnant women studied in Gynae-A Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar.Material and Methods: This retrospective case-control study included a total of 114 pregnancies with major placenta praevia during one year study period, from Jan-Dec.2005, and 671 randomly selected simple singleton control. studied in Gynae-A Unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar ana Data on potential risk factors for placenta praevia development were extracted from medical records. Data was statistically analyzed with chi-square test and Mann Whitney U test, and crude odds ratio (OR) with 95% confidence interval (CI) were provided.Results: The incidence of major degree placenta praevia was 1.9%. Factors significantly associated with a major placenta praevia development were advanced maternal age(OR 2.66;CI 1.76-4.0) (especially >34 years, even after adjustment for high parity), multiparty (OR 2.2; CI 1.42-3.40), history of previous cesarean sections (OR 2.0; CI 1.02-4.06), previous abortions (OR 2.8; CI 1.85-4.23), and presence of various uterine abnormalities (OR 9.0; CI 2.42-54.5).The risk was significantly increased after two previous cesarean sections and even after one previous abortion. The main perinatal complication was preterm birth, with almost 11-fold higher risk in women with placenta praevia.Conclusion: The most important obstetric factors for placenta praevia development were; advanced maternal age especially >34 years, 3 or more previous pregnancies (gravidity), parity of > 2, rising number of previous abortions, and history of previous cesarean sections. Preterm delivery still remains the greatest problem in pregnancies complicated with placenta praevia.