Fetal status and perinatal outcomes in placenta previa

Introduction. Obstetric hemorrhage associated with placental abnormalities holds a leading place in the pattern of massive hemorrhage and maternal mortality, have been increasingly relevant due to the elevating rate of abdominal delivery.
Aim: to assess fetal condition, parameters of uteroplacental and fetal hemodynamics as well as perinatal outcomes in pregnancy complicated with placenta previa.
Materials and Methods. The retrospective study included 112 women aged 18–38 years who performed delivery between January 2016 and September 2020. Two groups were formed: the main group – 42 patients with placenta previa, and the control group – 70 pregnant women with normal placentation. Examination of women was carried out at admission for delivery within the gestational age between 26 to 40 weeks. We studied the parameters of fetometry and dopplerometry, hemogram parameters, biochemical blood analysis and some hemostasis parameters.
Results. The groups examined were comparable in age and anthropometric data. In the main vs. control group, the course of pregnancy was more often complicated by the threatened termination (45 % vs. 21 %; p = 0.03), anemia (hemoglobin level 107 g/L vs. 110 g/L; p = 0.044), fetal growth retardation. Assessment of uteroplacental state and fetal-placental blood flow revealed differences indicating the presence of pathophysiological basis for developing hypotrophy and fetal hypoxia in the group of women with placenta previa. In the main group, the average gestational age at the time of delivery was 35.0 ± 2.8 weeks, in the control group – 39.0 ± 1.3 weeks (p = 0.003). Delivery showed significantly increased risk of preterm birth and rate of neonatal respiratory disorders in the main group.
Conclusion. The results obtained evidence about a need to provide a careful approach to manage pregnant women with placenta previa to timely prevent anemia, placental disorders and hypotrophy. At the stage of the level III obstetric hospital, it is necessary to be ready for decompensation of placental disorders, birth of children with respiratory disorders, and fetal growth retardation.

1. Barinov S.V., Dikke G.B., Shmakov R.G. Balloon uterus tamponade in prevention of massive obstetric bleeding. [Ballonnaya tamponada matki v profilaktike massivnyh akusherskih krovotechenij]. Akusherstvo i ginekologiya. 2019;(8):7–12. (In Russ.). https://doi.org/10.18565/aig.2019.8.5-11.

2. Barinov S.V., Neustroeva T.N. Analysis of pregnancy outcomes in pregnant women with placenta previa in the perinatal center, Republic of Sakha (Yakutia) from 2013 to 2019. [Analiz iskhodov rodov u beremennyh s predlezhaniem placenty v perinatal'nom centre Respubliki Saha (Yakutiya) s 2013 po 2019 gg]. Mat' i ditya v Kuzbasse. 2020;(4):39–43. (In Russ.). https://doi.org/10.24411/2686-7338-2020-10047.

3. Bushtyrev A.V. Prediction and prevention of obstetric hemorrhage with placental abnormalities. [Predikciya i profilaktika akusherskih krovotechenij pri anomaliyah placentacii: Avtoref. dis…kand. med. nauk]. Sankt Peterburg, 2017. 26 p. (In Russ.).

4. Pamfamirov Yu.K., Samoilenko A.V. Ingrown placenta. Treatment strategy. Realities. Immediate prospects. [Vrastanie placenty. Strategiya lecheniya. Realii. Blizhajshie perspektivy]. Sovremennye innovacii. 2017;(3):33–5. (In Russ.).

5. Medyannikova I.V. Obstetrical and perinatal aspects of abnormal placentation. [Akusherskie i perinatal'nye aspekty anomal'noj placentacii: Avtoref. dis… kand. med. nauk]. Perm', 2007. 24 p. (In Russ.).

6. Devyatova E.A. Placental implantation abnormalities as the risk factors of prematurity, cesarean section and poor perinatal outcome. [Anomalii raspolozheniya i prikrepleniya placenty – faktory riska nedonashivaniya beremennosti, kesareva secheniya i neblagopriyatnyh perinatal'nyh iskhodov]. Akusherstvo i ginekologiya. Novosti. Mneniya. Obuchenie. 2016;(3):17–24. (In Russ.).

7. Kolchina V.V., Azarova L.V. Abnormal placentation and factors of the infectious genesis correlation. [Vzaimosvyaz' anomalij raspolozheniya placenty s faktorami infekcionnogo geneza]. Fundamental'nye issledovaniya. 2014;(7–4):723–7. (In Russ.).

8. Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Placenta previa in the genesis of stillbirth (according to Rosstat in 2012–2016). [Predlezhanie placenty v geneze mertvorozhdeniya (po dannym Rosstata v 2012–2016 godah)]. Mezhdunarodnyj zhurnal prikladnyh i fundamental'nyh issledovanij. 2018;(3):81–5. (In Russ.). https://doi.org/10.17513/mjpfi.12153.

9. Shchegolev A.I., Tumanova U.N., Shuvalova M.P., Frolova O.G. Hypoxia as a cause of stillbirth in the Russian Federation. [Gipoksiya kak prichina mertvorozhdaemosti v Rossijskoj Federacii]. Zdorov'e, demografiya, ekologiya finno-ugorskih narodov. 2014;(3):96–8. (In Russ.).

10. Dandolu V., Graul A.B., Lyons A., Matteo D. Obstetrical hysterectomy, cesarean delivery and abnormal placentation. J Matern Fetal Neonatal Med. 2012;25(1):74–7. https://doi.org/10.3109/14767058.2011.565391.

11. Palacios-Jaraquemada J.M. Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynaecol. 2008;22(6):1133–48. https://doi.org/10.1016/j.bpobgyn.2008.08.003.

12. Petrou S. Health economic aspects of late preterm and early term birth. Semin Fetal Neonatal Med. 2019;24(1):18–26. https://doi.org/10.1016/j.siny.2018.09.004.

13. Darlow B.A, Cheong J.L.Y. The continuum of late preterm and early term births. Semin Fetal Neonatal Med. 2019;24(1):1–2. https://doi.org/10.1016/j.siny.2018.10.004.

14. Salemi J.L., Pathak E.B., Salihu H.M. Infant outcomes after elective earlyterm delivery compared with expectant management. Obstet Gynecol. 2016;127(4):657–66. https://doi.org/10.1097/AOG.0000000000001331.

15. Stewart D.L., Barfield W.D., AAP Committee on Fetus and Newborn. Updates on an at-risk population: late-preterm and early-term infants. Pediatrics. 2019;144(5):e20192760. https://doi.org/10.1542/peds.2019-2760.

16. Sentilhes L., Kayem G., Silver R.M. Conservative management of placenta accreta spectrum. Clin Obstet Gynecol. 2018;61(4):783–94. https://doi.org/10.1097/GRF.0000000000000395.

17. Silver R.M., Barbour K.D. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2015;42(2):381–402. https://doi.org/10.1016/j.ogc.2015.01.014.

18. Ziganshin A.M., Nagimova E.M., Marakanov R.M., Mudrov V.A. Maternal mortality: structure and solutions to the problem. [Materinskaya smertnost': struktura i puti resheniya problem]. Zhurnal akusherstva i zhenskih boleznej. 2021;70(5):5–14. (In Russ.). https://doi.org/10.17816/JOWD77771.