The optimal timing for delivery: analysis of neonatal outcomes by gestational age in patients with placenta previa

Introduction: Placenta previa is an obstetric complication in which the placenta is inserted partially or wholly in the lower uterine segment. It is a leading cause of antepartum haemorrhage (vaginal bleeding). It affects approximately 0.4-0.5% of all labours. Women with placenta previa often present with painless, bright red vaginal bleeding. This commonly occurs around 32 weeks of gestation, but can be as early as late mid-trimester. Much debate has been given to the optimal timing of delivery in cases of placental abnormalities. Given these risks, numerous official organizations have been proponents of active medical management in cases of placenta previa, as well as placenta accreta, increta, and percreta. In particular a prophylactic, elective cesarean delivery prior to the onset of labor is theorized to reduce the rates of spontaneous hemorrhage, which increase proportionally with advancing gestational age. The optimal timing of delivery in placenta previa is an important issue that is understudied in the literature. After all, with the increasing rate of cesarean deliveries, an increase in the incidence of placenta previa is expected to be observed. Materials and Methods: A retrospective study, data files and the case notes was retrieved from the medical records department at Aswan university hospital from January 1/2013 to December 31/2013. in the form of data relating to the age, parity, gestational age, method of termination, perinatal outcomes, and related maternal complications. We sought to compare neonatal outcomes among pregnancies with placenta previa delivered at the late-preterm period, namely 35 and 36 weeks gestation, relative to the early-term period at 37 and 38 weeks gestation, taking 38 weeks gestation as reference. The data was entered in the computer for statistical analysis using one proprietary statistical package which is statistical packages for the social science (SPSS). Results: There were 4284 deliveries during the period under review of these 67 patients had placenta previa the age of the patients ranged from 20- 40 years with average 30 years .The gestational age at delivery ranged from 28 – 39 wksAs regard perinatal morbidity and mortality, 2 cases complicated by IUFD which represents (2.98%). Birth at 35, 36 and 37 weeks was associated with no greater odds of meconiumpassage, fetal distress, fetal anemia, neonatal seizures, increased ventilator needs, or infant death. However, APGAR scores<7 were more common at 35 and 36 weeks 4cases (33%) and 3cases (21%) respectively; as were NICU admission rates:3 cases(25%) and 2 cases(14%) Conclusion: Barringmaternal indications, early-term deliveryin placenta previa appears to be associated with fewerneonatal complications and no greater risk than late-pretermneonatal complications and no greater risk than late-pretermdelivery