Page 78 - JCTR-11-3

Journal of Clinical and
Translational Research Outcomes of placenta previa with APH

the third trimester of pregnancy. However, variations in hospital in Karachi, Pakistan, from January to October
the incidence rate of PP have been reported in certain 2024. These participants were of a gestational age ranging
regions including Pakistan. 1 from 24 to 42 weeks. The study was approved by the
There are four types of PP: Low-lying, marginal previa, Institutional Review Board of PNS Shifa Hospital Karachi.
partial previa, and full previa. Vaginal bleeding occurring All subjects provided informed consent before being
2
in the second half of pregnancy (after 20 weeks of gestation included in the study. All relevant protocols were adhered
and before the onset of labor) is known as antepartum to. The participants were divided into two groups: APH
hemorrhage (APH), which is the global leading cause of and non-APH. The diagnosis of PP was confirmed using
maternal morbidity, with PP being one of the underlying transabdominal and transvaginal ultrasounds conducted
causes. Research has shown a significant link of very at admission, which were later validated at the time of
3
early APH to the occurrence of intrapartum hemorrhage, delivery. In this study, APH was defined as intermittent
leading to cesarean delivery. For example, some women or continuous vaginal bleeding leading to ≥20 mL, or
4
experience life-threatening APH, necessitating not only an total antepartum blood loss from the second half of
early cesarean section but also a hysterectomy. In contrast, pregnancy till delivery. Individuals who had more than
in other cases, the woman may elect a planned term one pregnancy, no prenatal treatment, a gestational age
cesarean section for no other reason than constitutional of >24 weeks, or no access to medical data were excluded.
vagaries. APH is typically induced by both PP and placental Additional exclusion criteria also include women bearing
abruption, although the precise etiology remains uncertain. 5 fetuses with abnormalities, individuals with incomplete
antenatal or outcome data, and women suffering vaginal
PP is at the top of the list of the most unfortunate bleeding with total antepartum blood loss not exceeding
abnormalities in pregnancy, causing various maternal 20 mL. It is demanding to set apart the blood with tinged
and neonatal complications. These outcomes are most mucus or minute quantities of blood, which is why women
commonly attributed to maternal antepartum and with vaginal bleeding but total antepartum blood loss of
intrapartum hemorrhage. A study has reported that the <20 mL were not included.
prevalence of PP in women with APH was ten times
greater than that in women without PP. The rapid We assessed various clinical characteristics of the
6
increase in cesarean birth rates has led to a concomitant mother, including the age, gestational age at delivery, parity,
upsurge in the prevalence of PP, so much so that PP gestational diabetes mellitus, pre-gestational diabetes
is now recognized as a significant global public health mellitus, obesity, prior cesarean delivery, preeclampsia,
problem. APH is commonly seen in pregnant women in vitro fertilization, antepartum uterine contractions, and
7,8
with PP but has received little attention in certain areas. prior dilatation and curettage. The WHO classified pre-
According to several studies, as well as the World Health pregnancy obesity as having a body mass index (BMI) of
2
Organization (WHO) definition, pregnant women with PP >25 kg/m for Asian populations. Three or more uterine
are at an increased risk of APH than those without. The contractions per 30 min between 24 and 34 weeks were
4,9
16
prevalence rate of PP reported by research studies varies considered antepartum uterine contractions. Adherent
in a range of 20 – 90%. 10,11 The incidence of previa is also placenta is a condition determined with the presence of
predicated on maternal age, position of previa (anterior ultrasound markers for placenta accreta spectrum disorder
or posterior), type of previa (complete or incomplete), and sonographic features such as retroplacental clear
population characteristics, lifestyle habits, and diagnostic space depletion, ≥4 lacunar spaces, cervix jellyfish sign,
standards used. 12-15 increased blood supply to the non-uniform bladder wall,
and reduced myometrial thickness (<1 mm diameter). 16
This retrospective case–control investigation evaluated
maternal and newborn results using data from pregnant 2.2. Ultrasound examination
women who did have pregnancy proteinuria alongside
those who did not have APH to find clinical markers which In each case, transvaginal and transabdominal
could help in the early diagnosis of APH and preventive ultrasonography was used for assessment. According to the
strategies. new diagnostic criteria, the internal cervical os is covered,
either completely or partially, by the placenta in women
2. Materials and methods with PP. Standardized methods were used to conduct
cervical exams. We acquired a sagittal plane to view the
2.1. Study population cervix in its entirety. Three cervical length measurements
In this retrospective study, we examined 56 cases of were made, with the shortest measurement being noted,
singleton pregnancies in women who were diagnosed and <2.5 cm length was considered a short cervical
with PP and subsequently delivered at a tertiary care length. 13,16

Volume 11 Issue 3 (2025) 72 doi: 10.36922/jctr.25.00002