RCOG World Congress 2023

Placenta praevia: audit of management and pregnancy outcomes at a tertiary Hospital

Dr Corha Andrei 1, Dr Diane Nzelu 1, Dr Freweini Tesfai 1, Dr Guldzhan Vorona 1, Mr George Attilakos 1

(1 - University College London Hospital, London, United Kingdom)

Maternal risk factors associated with development of placenta praevia (PP) are increasing in prevalence.

In recognition of this, the RCOG published new recommendations (2018) for the diagnosis and management of women with low lying placenta (LLP) or PP, recommending earlier elective delivery of women with complicated PP between 34 to 36 weeks.

Audit management and pregnancy outcomes of women with PP at their mid-trimester fetal anomaly scan using the RCOG guidelines as the gold standard.

Inclusion criteria included:

•singleton pregnancies

•PP at mid-trimester anomaly scan

•no evidence of placenta accreta

•

PP was defined as a placenta lying directly over the internal os or LLP if within 20mm. PP/LLP was considered complicated if there were previous hospital admissions with APH.

In this cohort 44% had risk factors in their antenatal history, which increased to 62% in those with persistent LLP/PP in the third trimester.

•Of the original cohort, 53 (34%) women had persistent LLP/PP in the third trimester

•27 patients (17%) were admitted with APH with a median gestational age of 26.5 (22.4 – 30.6) weeks.

•Average GA at delivery was 37.5 weeks with persistent LLP/PP (n=53) but 36.2 weeks when there had been a previous admission with APH.

•EMCS was required in 38% of women with persistent LLP/PP (n=20/53),.

•Emergency caesarean could have been avoided in 60% (n=12/20) had women with a complicated persistent LLP/PP been delivered by 36 weeks.

Emergency caesarean could have been avoided in 60% had women with a complicated persistent LLP/PP been delivered by 36 weeks.

üAdopting the RCOG recommendations of earlier elective delivery in women with a complicated PP/LLP would minimise the need for an emergency caesarean and associated maternal morbidity..

üTo reduce complications and improve surgical outcomes consider timing for elective delivery at:

Ø 36 weeks for complicated PP (admission with APH or reduced CL)

Ø 37 weeks for uncomplicated PP, and 38-39 weeks for LLP.

RCOG World Congress 2023

Placenta praevia: audit of management and pregnancy outcomes at a tertiary Hospital

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