Maternal and Fetal Morbidity Associated with Placenta Previa Management: Experience from a Tertiary Hospital in Sudan"

Abstract

Placenta previa is a high-risk obstetric condition linked to significant maternal and neonatal morbidity and mortality. Risk factors include prior cesarean delivery, multiparity, advanced maternal age, cervical curettage, and assisted reproduction. Effective antenatal, intrapartum, and postpartum management improves outcomes. This study aimed to assess maternal and neonatal outcomes and peripartum management among Sudanese women diagnosed with placenta previa in a cross-sectional study conducted at Omdurman Maternity Hospital from January 2020 to January 2021. Eighty-two women were enrolled and data were collected using structured interviews and hospital records. Of 8,125 total deliveries, the prevalence of placenta previa was 1%. Most patients were aged 31–35 years (42.7%) and multiparous (58.5%). Diagnosis was primarily made by ultrasound (84.2%), while MRI and both modalities were used in 8.5% and 7.1%, respectively (p=0.003). Major placenta previa was present in 47.6%, accreta in 36.6%, and percreta in 6.1% (p=0.002). All women were delivered via cesarean, with 72% delivered before 37 weeks. Surgical interventions included bilateral uterine artery ligation, B-Lynch sutures, uterine packing, and hysterectomy in 9.7% of cases. Maternal complications included transfusion (25.4%), postpartum hemorrhage (13.4%), bladder injury (7.3%), ICU admission (4.9%), and maternal death (2.4%). Neonatal death occurred in 6.1%. Women with major placenta previa and placental invasion faced elevated risks of hemorrhage, surgical intervention, and adverse perinatal outcomes. Early diagnosis, multidisciplinary planning, and timely delivery remain essential to reducing morbidity and improving maternal-fetal outcomes.