Prevalence, outcomes, and predictors of antepartum hemorrhage due to placenta previa in Nigeria

Background: Despite the enormous burden of antepartum hemorrhage (APH) due to placental previa, there are not much recent data on prevalence, outcomes, and predictors of this major obstetric condition in low-resource settings. Objectives: The objectives of this study are to determine the prevalence, outcomes, and predictors of APH due to placenta previa in Enugu, South-East Nigeria. Materials and Methods: It was a retrospective review of pregnant women admitted to the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria, with a diagnosis of APH due to placenta previa from January 1, 2010 to January 31, 2019. Relevant data such as biodata, obstetrics characteristics, and management protocols were extracted from eligible case notes retrieved from the Medical Records Department of the hospital. Results: Of the 6001 pregnant women managed, 91 had APH due to placenta previa, giving a prevalence rate of 1.5% (91/6001). In terms of maternal and fetal outcomes, no maternal death or delivery due to fetal distress was recorded. Thirty-seven (40.7%) women had primary postpartum hemorrhage (PPH), 1.1% had obstetric hysterectomy due to PPH, 45.1% had blood transfusion, 51% were delivered due to intractable APH, 98.9% of the babies were delivered alive, 39.6% required admission into newborn special care unit, and 40.7% had babies with low birth weight. The predictors of APH due to placenta previa were low socioeconomic status (P = 0.011, odds ratio [OR] = 0.15, 95% confidence interval [CI]: 0.03–0.64), high parity (P = 0.032, OR = 6.61, 95% CI: 1.18–37.02), adopting conservative management (P = 0.004, B = 2.765, OR = 0.06, 95% CI: 0.01–0.40), and unbooked status (P = 0.018, B = 2.724, OR = 15.24, 95% CI: 1.61–144.16). Conclusion: The prevalence of PPH in the study population is high and the outcome is favorable. It is predicted by the unbooked status, multiparity, and adopting conservative management. The study findings should guide obstetricians in counseling and managing women with APH due to placenta previa.