Major Placenta Previa in Advanced Age Among Nulliparous With Cesarean Section: A Cross-Sectional Study

Abstract

INTRODUCTION: Major placenta previa with advanced maternal age (AMA) is a significant risk factor for obstetric hemorrhage and associated maternal and neonatal complications. OBJECTIVE: The objective was to study major placenta previa in advanced age among nulliparous with cesarean section. METHODS: This prospective cross-sectional study analyzes 78 pregnant women of advanced age with major placenta previa under a cesarean section. Data were collected using interview questionnaires between January 2019 and June 2020. RESULTS: The mean gestational age at delivery was 35.7 ± 3 years. Antepartum hemorrhage, premature membrane rupture, and placenta accreta occurred in 15.4%, 35.9%, and 15.4% of cases, respectively. About 12.8% of women were at risk of post-traumatic stress disorder symptoms. Fetal distress, postpartum hemorrhage (PPH), and cesarean hysterectomy occurred in 37.2%, 46.2%, and 15.4% of patients. Mean Apgar scores in the first and fifth minutes were 7.0 ± 0.90 and 8.0 ± 0.82, respectively. The mean birth weight was 2.7 ± 0.14823. Of neonates, 37.2% were premature, 37.2% required resuscitation, less than half (44.9%) were admitted to the neonatal intensive care unit, and 37.2% had respiratory distress syndrome. Moreover, there is a statistically significant relationship between placenta accreta and cesarean hysterectomies and the occurrence of PPH. Also, a highly significant association was observed between the use of antenatal steroids, fetal distress, Apgar score <3 at 1 minute, and neonatal respiratory distress syndrome. CONCLUSION: Major placenta previa with AMA significantly influences pregnancy outcomes and is considered an obstetric emergency. Therefore, early detection of major placenta previa and proper management during clinical care is essential.