Massive Haemorrhage in Placenta Praevia during cesarean section is not related to the Grade of Placenta
Abstract Number: 183
Abstract Type: Original Research
Background: Haemorrhage is a major cause of maternal mortality. Placenta praevia remains the leading cause of major obstetric haemorrhage. Higher grade of placenta is widely believed to be associated with massive haemorrhage (1).
Methods: We performed a retrospective audit of blood loss in patients with placenta praevia who underwent LSCS between 2002 to 2008. We collected the following data associated with risk of bleeding: age, parity, position of placenta, grade of placenta, type of anaesthesia, previous CS.
Results: 143 patients were identified during the audit of whom 27(19%) patients had massive blood loss (>1500 ml) in the operating theatre. The factors significantly associated with increased risk of massive haemorrhage were anterior position of the placenta (OR 2.8; 95%CI 1.2 – 6.8; p = 0.019) and general anaesthesia (OR 4.0; 95%CI 1.6 – 9.9; p = 0.003). However the grade of placenta was not associated with excessive risk of massive haemorrhage (table).
Grade of placenta Blood loss > 1500 ml
1 8 (62%) 5 (38%)
2 35 (90%) 4 (10%)
3 11 (85%) 2 (15%)
4 62 (81%) 16 (19%)
P = 0.146
Conclusions: Decision making regarding the risk of bleeding during Caesarean section for placenta praevia should not be based on the grade of placenta praevia as patients with lower grades are at similar risk of massive haemorrhage to patients with Grade 4.
Ref: 1. Anticipation of uterine bleeding in placenta previa based on vaginal sonographic evaluation. Saitoh M, Ishihara K, Sekiya T, Araki T.