Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo

Abstract

Introduction: Placenta Praevia (PP) is frequently associated with severe maternal bleeding leading to an increased risk for adverse outcome of mother and infant. This study aims to determine the prevalence, and to evaluate potential risk factors and respective outcomes of pregnancies with PP in Lubumbashi, Democratic Republic of Congo. Methods: Data were retrospectively collected from patients diagnosed with PP at 4 hospitals in Lubumbashi between January 2013 and December 2016. All women who gave birth to singleton infants were studied. Differences between women with PP and without PP were evaluated. Adjusted Odds Ratios (aOR) with 95% confidence intervals for risk factors, and adverse maternal and perinatal outcomes associated with PP were estimated in multivariable logistic regression. Results: The overall prevalence of PP was 1.49% (227/15,292). The following risk factors were independently associated with PP: multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous cesarean section (aOR=6.74; 95% CI: 2.99-15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). PP was significantly associated with adverse maternal outcomes such as delivery by cesarean section (aOR=3.09; 95% CI: 1.89- 5.06), maternal anemia (aOR=11.43; 95% CI: 6.20-21.06); and hospital stay of >4 days (aOR=2.02; 95% CI: 1.24-3.29). PP was also significantly associated with adverse perinatal outcomes such as Apgar scores of <7 at the 5th minute after birth (aOR=4.39; 95% CI: 2.62-7.36), low birth weight (aOR=4.10; 95% CI: 2.26-7.44), stillbirth (aOR=4.16; 95% CI: 1.39–12.46), and early neonatal death (aOR=5.72; 95% CI: 1.60–20.42). Conclusion: PP is associated with adverse maternal and perinatal outcomes, and multiple independent risk factors were identified. Therefore, detection and careful surveillance of these risk factors are important to ultimately improve maternal and perinatal outcomes.