Research Article
Incidence and Related Factors of Placenta Praevia Observed at a Tertiary Care Hospital
Akhther MH1*, Sarker MA2, Sultana MT3, Parvin MR4
1Dr. Mst. Hasina Akhther, Associate Professor, Department of Obstetrics & Gynaecology, Shaheed Ziaur Rahman Medical College & Hospital, Bogura
2Dr. Most. Afroza Sarker, Professor, Department of Obstetrics & Gynaecology, Shaheed Ziaur Rahman Medical College & Hospital, Bogura
3Dr. Mst. Touhida Sultana, Assistant Professor, Department of Obstetrics & Gynaecology, Shaheed Ziaur Rahman Medical College & Hospital, Bogura
4Dr. Mst. Runa Parvin, Assistant Professor, Department of Obstetrics & Gynaecology, Shaheed Ziaur Rahman Medical College & Hospital, Bogura
*Corresponding author: hasinaakhther.dr@gmail.com
Abstract
Background: Obstetrics haemorrhage is one of the important causes of maternal death and morbidity. Placenta praevia is one of the important causes of obstetric haemorrhage. Incidence of placenta praevia is increasing due to advance maternal age, multiparity, H/O previous caesarean delivery, H/O myomectomy repeated abortion, repeated D&C and multiple pregnancy. This study was conducted to have a look into the high risk group of pregnancies for the development of placenta praevia who should be monitored carefully.
Methods: This cross sectional study was conducted from January 2024 to December 2024 at the department of Obstetrics and Gynaecology, Shaheed Ziaur Rahman Medical College Hospital, Bogura. 120 patients were identified as placenta praevia out of 170 APH patients. Painful abrubtio placenta was excluded, ethical clearance was obtained.
Results: Incidence of placenta praevia was 3.7% out of 3240 obstetrics patients. In this study placenta praevia complicated 8% of cases with H/O previous caesarean delivery, 6.46% pregnancies with H/O abortion, 2.7% with high age group (>35 years), 4.91% cases with multigravida, 8.33% patients with H/O manual removal of placenta, 0.83% with H/O myomectomy and 13.15% patients with multiple pregnancy.
Conclusion: This study showed that advance maternal age, multiparity, H/O previous caesarean delivery, abortion multiple pregnancy, H/O scaring of endometrium due to operation should be regarded as high risk for development of placenta praevia.
Keywords
Placenta praevia
caesarean section
abortion
M/R
D&C
Myomectomy
Hysterotomy
Retained Placenta
Gravidity
Multiple Pregnancy.
1. INTRODUCTION
Placenta praevia, a leading cause of obstetric hemorrhage, occurs when the placenta implants partially or completely over the lower uterine segment.
Its incidence in pregnancies beyond 24 weeks ranges from 0.3% to 0.6%, and it remains a significant cause of maternal mortality in developing regions.1,2,3
Incidence of Different Types of Placenta Praevia4,5
Total Placenta Praevia: 23.0% – 31.3%
Partial Placenta Praevia: 20.6% – 33.0%
Low-Lying Placenta Praevia: 37.0% – 54.9%
Risk Factors6,7
Key risk factors include multiparity, advanced maternal age (>35 years), previous uterine surgery (especially caesarean section), multiple curettages, multiple gestation, closely spaced pregnancies, and smoking.
Classification & Clinical Significance8,9,10
Classification guides management:
Type I (Low-lying): Within 5 cm of the internal os.
Type II (Marginal): Reaches the os margin.
Type III (Partial): Partially covers the os.
Type IV (Total): Completely covers the os.
Types I and II anterior are "minor," while Types II posterior, III, and IV are "major," associated with significant bleeding risk. The risk of placenta praevia and morbidly adherent placenta (accreta) increases substantially with prior cesarean sections.
Maternal Dangers11,12
Major risks include antepartum and postpartum hemorrhage, shock, need for urgent intervention, preterm delivery, morbid placental adhesion (accreta spectrum), puerperal sepsis, and complications of anesthesia.
Fetal Dangers13
Primary risks are prematurity, fetal distress, birth asphyxia (from placental compression), malpresentation, intrauterine growth restriction, and increased perinatal mortality.
Pathophysiology of Bleeding14
Bleeding typically results from mechanical separation of the placenta during lower uterine segment formation in the third trimester, or from trauma/manipulation of the engorged decidual venous sinuses.
Management Principles15
Modern management aims to achieve fetal maturity while safeguarding maternal safety. It is based on:
Early diagnosis via ultrasound.
Avoidance of digital vaginal examination.
Expectant management with readiness for emergency intervention.
Elective delivery (typically by cesarean section) at term, or urgently in cases of severe, uncontrolled hemorrhage regardless of gestational age.
Advances in anesthesia, blood transfusion, antibiotics, and surgical expertise have significantly improved outcomes.
This study may help us find out the high-risk group of pregnancy for the development of placenta praevia who may be monitored carefully.
Published: January 10, 2026
DOI:
324654-5646
ISSN: 1607-5854
