3. Results
A total of 270 women with major placenta praevia were
identified from the operating theatre book; however only
243 medical notes were available to be reviewed. Out of the
total 243 women who were diagnosed with major placenta
praevia, 56 (23.0%) were primigravidas and 187 (77.0%) were
nonprimigravidas.
The sociodemographic data of the primigravidas and
nonprimigravidas with major placenta praevia are presented
in the Table 1. The primigravidas were younger and
lighter than the nonprimigravidas.The ethnic population in
Malaysia comprises Malays (60%), Chinese (20%), Indians
(10%), and others (10%). The majority of the sample population
was Malays (70%), followed by Chinese (24%), others
(4%), and Indian (1%). This was similar to the Malaysian general population. There was no difference in the ethnicity,
occupation, and smoking habit between the two groups.
Table 2 shows the factors associated with placenta praevia
among primigravidas and nonprimigravidas.Theprimigravidas
had significantly higher assisted conception (8.9% versus
2.1%) and history of endometriosis (21.4% versus 6.9%). A
third of primigravidas (32.1%) had history of subfertility
compared to only 23.5% of nonprimigravidas; however it
was not statistically significant. Thirty-three percent of the
nonprimigravidas gave history of previous scar and 28% had
curettage performed on them.
Table 3 shows the comparison of obstetric data between
the primigravidas and nonprimigravidas. The primigravidas
were admitted earlier than the nonprimigravidas (31.68 ± 4.49
weeks versus 32.92 ± 3.55weeks). There was no significant difference
in the incidence of antepartum haemorrhage (APH)
and receiving dexamethasone in both groups. Interestingly,
none of the primigravidas had placenta located anteriorly. A vast majority of the primigravidas had either posterior type
II or type III placenta praevia. The preoperative haemoglobin
was similar for both groups. Only 5.8% [11] of nonprimigravidas
had undergone MRI for suspected placenta accreta. Out
of 11, seven women had features highly suggestive of placenta
accreta on MRI.
Table 4 shows the comparison of obstetric outcomes
between the primigravidas and nonprimigravidas. Two classical
caesarean delivery cases were performed in the nonprimigravidas.
The estimated blood loss was significantly
higher in the nonprimigravidas as compared to primigravidas.
Nine women (4.8%) required additional procedures
being performed intraoperatively to arrest the bleeding
which include six hysterectomies.. However, the postoperative
haemoglobin was similar between the two groups.There
was no maternal death in our sample population.
Table 5 shows the comparison of neonatal outcomes
between the primigravidas and nonprimigravidas. There
were more female babies being born to primigravida group.
The Apgar score at 1 minute was significantly lower for
the nonprimigravidas as compared to the primigravidas
(7.89 ± 1.72 versus 8.39 ± 1.28). No significant difference was
observed in the weight, Apgar score at 5 minutes, cord pH,
NICU admission, and fetal anomaly between the two groups.
3. ResultsA total of 270 women with major placenta praevia wereidentified from the operating theatre book; however only243 medical notes were available to be reviewed. Out of thetotal 243 women who were diagnosed with major placentapraevia, 56 (23.0%) were primigravidas and 187 (77.0%) werenonprimigravidas.The sociodemographic data of the primigravidas andnonprimigravidas with major placenta praevia are presentedin the Table 1. The primigravidas were younger andlighter than the nonprimigravidas.The ethnic population inMalaysia comprises Malays (60%), Chinese (20%), Indians(10%), and others (10%). The majority of the sample populationwas Malays (70%), followed by Chinese (24%), others(4%), and Indian (1%). This was similar to the Malaysian general population. There was no difference in the ethnicity,occupation, and smoking habit between the two groups.Table 2 shows the factors associated with placenta praeviaamong primigravidas and nonprimigravidas.Theprimigravidashad significantly higher assisted conception (8.9% versus2.1%) and history of endometriosis (21.4% versus 6.9%). Athird of primigravidas (32.1%) had history of subfertilitycompared to only 23.5% of nonprimigravidas; however itwas not statistically significant. Thirty-three percent of thenonprimigravidas gave history of previous scar and 28% hadcurettage performed on them.Table 3 shows the comparison of obstetric data betweenthe primigravidas and nonprimigravidas. The primigravidaswere admitted earlier than the nonprimigravidas (31.68 ± 4.49weeks versus 32.92 ± 3.55weeks). There was no significant differencein the incidence of antepartum haemorrhage (APH)and receiving dexamethasone in both groups. Interestingly,none of the primigravidas had placenta located anteriorly. A vast majority of the primigravidas had either posterior typeII or type III placenta praevia. The preoperative haemoglobinwas similar for both groups. Only 5.8% [11] of nonprimigravidashad undergone MRI for suspected placenta accreta. Outof 11, seven women had features highly suggestive of placentaaccreta on MRI.Table 4 shows the comparison of obstetric outcomesbetween the primigravidas and nonprimigravidas. Two classicalcaesarean delivery cases were performed in the nonprimigravidas.The estimated blood loss was significantlyhigher in the nonprimigravidas as compared to primigravidas.Nine women (4.8%) required additional proceduresbeing performed intraoperatively to arrest the bleedingwhich include six hysterectomies.. However, the postoperativehaemoglobin was similar between the two groups.Therewas no maternal death in our sample population.Table 5 shows the comparison of neonatal outcomesbetween the primigravidas and nonprimigravidas. Therewere more female babies being born to primigravida group.The Apgar score at 1 minute was significantly lower forthe nonprimigravidas as compared to the primigravidas(7.89 ± 1.72 versus 8.39 ± 1.28). No significant difference wasobserved in the weight, Apgar score at 5 minutes, cord pH,NICU admission, and fetal anomaly between the two groups.
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