**4. Discussion**

In our previous study, we compare our local prevalence rate that is 4.1 per 1000 with other countries, which ranged from 3.5 to 4.6 per 1000 births [2].

1. Comparison between two management

The objective is to compare two

This is a prospective

151 cases were identified as low-

Bakri balloon is an

effective method

of management for

PPH after CS in

cases of PP.

lying placenta and PP.

114 developed PPH.

Only two patients were unstable

and required hysterectomy.

112 cases were managed by

applying Bakri balloon (72 cases)

or non-balloon protocols in (40).

The balloon alone achieving

hemostasis in 87.5% of cases.

cohort study conducted

in two hospitals in Saudi

Arabia

management protocols for(PPH)

during (CS) in (PP), using Bakri

balloon protocol versus non-

balloon protocol

protocols for (PPH) during (CS) in PP

Balloon protocol versus non-balloon

protocol.

J Obstet Gynaecol Res. 2016 [7]

2. A 13-year experience in management of

The aim is to review all cases of

This is a retrospective

The prevalence rate of placenta

Placenta previa is

one of the causes of

maternal morbidity

and death.

Every hospital

must have a clear

procedure, and

protocol designed

for the management

of placenta previa

[8]

There are many

long-term

complications in

these unique cases

of higher order

cesareans.

Complication of Abnormal Placental Implantation http://dx.doi.org/10.5772/intechopen.80030 63

previa was 4.1 per 1000 births.

analysis of all cases of

placenta previa managed

at King Abdulaziz

University Hospital

(KAUH), Jeddah

placenta previa in the last 13

 years.

PP at a tertiary care centre KAUH in Saudi

Arabia.

Saudi Med J. 2016 [8]

3. A retrospective chart review of all cases

The objective looking at

A retrospective chart

It concluded that one of the

complications related to multiple

CS is placenta previa after the

first and subsequent pregnancies.

analysis at King Abdulaziz

University Hospital

(KAUH) in Jeddah

complication and outcome.

of repeat cesarean sections up to 6

J Matern Fetal Neonatal Med. 2016 [9]

Based on available limited data, the management of uncomplicated cases of placenta previa is the elective cesarean section between 36 and 37 weeks.

History of previous one or more cesarean sections, pregnancy termination, high parity, advanced maternal age, intrauterine surgery, smoking, and multiple pregnancies are known reported risk factors for placenta previa [26].


Number 13 (2006) is a retrospective study to compare the complication and outcome of multiple cesarean sections with those with one previous CS. Pelvic adhesions and bladder injury and placenta previa were higher in women with a history of multiple previous CS [19].

Number 14 (2004) is a retrospective study to identify multiple cesarean section morbidity. The maternal morbidity increased with multiple CS. The risk of significant maternal morbidity was significantly higher with more than 4 CS worse at the sixth CS for placenta previa [20]. Number 15 (2004) is a retrospective study of women with multiple CS from 3 or 4 to 5–9 to determine the maternal morbidity and mortality associated with multiple repeats cesarean

Repeat cesarean sections 5–9 carry no particular additional risk for the mother or the baby when compared with the lower (3 or 4) repeat cesarean sections. Repeat cesarean sections carry no particular additional risk for the mother or the baby when compared with the lower

Number 16 (2003) is a retrospective study of higher order multiple repeats cesarean sections: It is concluded that the incidence of hysterectomy, uterine pelvic dehiscence, placenta previa, and accreta and bladder injury was similar in the two groups. The rate of postpartum pyrexia, wound infection, urinary tract infection, and blood transfusion was also comparable in the

Number 17 (2003) is a retrospective study and a review of 17 cases of emergency peripartum hysterectomy. Uterine atony is still the leading cause of primary postpartum hemorrhage and

Number 18 (2001) is a case series of using Tamponed-balloon for obstetrical bleeding, caused by low-lying placenta previa, and in one woman with cervical pregnancy. Hemostasis is

Number 19 (2000) is a prospective observational study with an objective to determine the use of transvaginal sonography in visualizing migration and predict the mode of delivery. All the cases had confirmed the diagnosis of placenta previa before 32 weeks' gestation, and migration up to a distance of more than 3 cm from the internal cervical Os occurred in 24 patients

In our previous study, we compare our local prevalence rate that is 4.1 per 1000 with other

Based on available limited data, the management of uncomplicated cases of placenta previa is

History of previous one or more cesarean sections, pregnancy termination, high parity, advanced maternal age, intrauterine surgery, smoking, and multiple pregnancies are known

sections.

62 Placenta

two groups [22].

**4. Discussion**

(3 or 4) repeat cesarean sections [21].

(38%) by 36 weeks' gestation [25].

the primary indications of peripartum hysterectomy [23].

countries, which ranged from 3.5 to 4.6 per 1000 births [2].

the elective cesarean section between 36 and 37 weeks.

reported risk factors for placenta previa [26].

achieved by using a large volume, fluid-filled tamponed balloon [24].


7. Two consultants, 3 years of management

This is a retrospective cohort

The study includes

Two cases of fetal growth

The presence of two

obstetric consultants

among team helped

minimize massive

blood transfusion.

The babies were

relatively small in

pp. cases (level 2

evidence).


increases the risk

of uterine rupture

and intraoperative

complications,

making these

patients a

high-risk group.


limit for the number

of repeat cesarean


informed of the risks

encouraged to have

a tubal ligation.

The accuracy of

prenatal diagnosis

of placenta accreta

by using MRI and

ultrasound

MRI can provide

Complication of Abnormal Placental Implantation http://dx.doi.org/10.5772/intechopen.80030

additional

information in

doubtful cases.

65

9. Is a prospective observational study.

Ultrasound can successfully use

A prospective

All cases of placenta previa

were scanned in a systematic

fashion (trans abdominal and

transvaginal).

observational study.

in the diagnosis MRI can give

additional information in doubtful

cases.

To identify the use of MRI and ultrasound

prenatally to diagnose placenta accreta.

Acta Obstet Gynecol Scand. 2013 [15]

restriction, which has known

to have medical diseases. Only

four cases (3.3%) had small for

gestational age. Fetal growth

chart indicate at the 10–50th

all patients who had

a cesarean section for

placenta previa and accreta

from December 2009 to

December 2012 managed

by a multispecialty team,

percentile

including two consultants

study in patients with placenta

previa (PP) and placenta accreta

to evaluate maternal and neonatal

outcomes

of placenta previa and accreta

Int J Women Health. 2013 [13]

8. Multiple repeat cesarean sections:

To determine maternal/neonatal

144 pregnant women with

The incidence of a single major

complication was higher in

women with > or

 = cesarean deliveries (p

 = 0.0011).

4 previous

complications and outcome in

> or =

4 cesarean sections

were involved in the

retrospective case-control

study and compared

with a control group of

288 women having 2–3

cesarean sections for

maternal, operative and

neonatal complications.

patients with multiple repeat

cesarean sections (CS).

operative difficulties, maternal

complications and outcome.

J Reprod Med. 2013 [14]


4. Grand multiparity: The risk factors and

A comparative study. To

Four hundred thirty grand

The neonatal morbidity and

Grand multiparity

64 Placenta

remains a significant

obstetrics problem,

and it is associated

with many medical

and obstetrical

complications.

intensive care unit admission

were the same with no

statistically significant difference

in cases of placental complication

as abruption, or previa, not

only that but also in cases of

postpartum hemorrhage and

preterm labor, the study did

report any perinatal or maternal

mortality.

−1.3% was the prevalence of

The rate of PP

is equivalent to

previous studies,

but the rate of

placenta accreta is

high.

Because of that,

there are high

rates of neonatal

mortality and

intraoperative

complications.

The study concludes

these patients safely

justify allowing a

trial of labor and

carries a low risk

of subsequent

obstetrical

hemorrhage.

Placenta previa.

−14 patients had placenta accrete

The number of previous cesarean

scars was higher in patients with

placenta accreta.

−8 of women had a postpartum

hysterectomy.

5. The rate, maternal and fetal outcomes in

To determine the prevalence of

A prospective descriptive

placenta previa and maternal and

study

−52 singleton pregnancies

with Placenta previa in A

prospective descriptive

study



PP, maternal and neonatal

outcomes.

6. Trail of labor in women with a placental

To answer the question was could

A prospective

Fourteen patients with

ultrasound diagnosis underwent

a trial of labor during the study

observational study

of women who had

transvaginal sonography

period.

for singleton pregnancies

and a placental edge

between 11 and 20

 mm underwent a trial of labor.

a successful vaginal delivery is

safe if a trial of labor is attempted

in this women.

mm from the internal cervical

edge 11–20

Os.

J Obstet Gynecol Can. 2014 [12]

neonatal outcomes.

cases of major placenta previa "Prospective

Study"

J Clin Diagn Res. 2015 [11]

multiparas (parity 5 or

more) compared with the

multiparous population

(parity 2–4) concerning

obstetrical problems.

determine the prevalence of grand

multiparity and the associated

risks factors.

outcome of grand multiparity in a tertiary

hospital: a comparative study.

Med Arch. 2015 [10]


13. This is a retrospective study to compare

Comparison of complications and

In a retrospective study of

Statistically Significant

Pelvic adhesions,

bladder injury, and

placenta previa

were higher in

women with a

history of multiple

previous CS

Differences Between The

Groups 1, Two About Mean Of

Parity, Maternal Age, Gestation

At Delivery, As Well As The

Experience Of The Obstetrician


186 (72.6%) Of Patients In Groups

1 And 2, Respectively (P

 < 0.05). -The morbidity with successive

The risk of

significant maternal

morbidity was

significantly higher

with more than 4

CS worse at the

sixth CS for placenta

previa.

Repeat cesarean

sections 5–9 carry no

particular additional

risk for the mother

or the baby when

compared with

the lower (3 or 4)

repeat cesarean

sections. Carry no

particular additional

risk for the mother

or the baby when

compared with the

Complication of Abnormal Placental Implantation http://dx.doi.org/10.5772/intechopen.80030

lower (3 or 4) repeat

cesarean sections

[21]

67

CSs increased if less than 3 CS.


morbidity was increased with the

fifth, and much worse at the sixth

CS for placenta previa

371 patients undergoing

repeat CS. Of these,

−115 (31%) had

previously had three or

more Cesarean sections

(P < 0.05).

> (group 1), and

−256 (69%) had previously

had one CS (group

 2).

outcomes of Cesarean section (CS)

in women who have had three or

more with those in women with

only one previous CS.

the complication and outcome of multiple

Cesarean sections with those with those

with one previous CS.

J Obstet Gynaecol Can. 2006 [19]

14. This is a retrospective study to identify

To quantify the maternal risk



who were delivered by CS


morbidity.

associated with multiple cesarean

sections (CS)

multiple cesarean section morbidity. The

maternal morbidity increased with

multiple CS.

Int J Gynecol Obstet. 2004 [19]

15. This is a retrospective study, of women

Maternal morbidity and mortality

Retrospective study.

Operative and post-operative

complications and difficulties.



Saudi Arabia.

in women with multiple repeat

cesarean sections.

with multiple CS from 3 or 4 to 5 to 9 to

determine the maternal morbidity and

mortality associated with multiple repeats

cesarean sections.

BJOG. 2004 [20]


10. Risk of adverse maternal and perinatal

The objective was to compare

From March 2008 to

The risk of postpartum

A higher risk of

66 Placenta

perinatal adverse

outcome was found

in-group A, but the

difference was not

significant.

Risk of maternal

morbidity was

higher than that of

perinatal morbidity

in Group A.

Marginal placenta

previa or low-lying

placenta carried

lower risk

hemorrhage (PPH), blood

transfusion and coagulopathy

was higher in-group A, p

 = 0.008;

August 2009 at the

Department of Obstetrics

and Gynecology, Hera

General Hospital,

p =

0.03, respectively.

Mean days of hospital stay (days

± SD) in group A was significantly

longer than that in group

(p = 0.002).

Makkah, Saudi Arabia.

A prospective study was

carried out

maternal and perinatal adverse

outcomes between groups of

placenta previa (PP) with and

without previous cesarean section

(CS)

11. This s a retrospective study to compare

The risk factors and pregnancy

A retrospective study of

The overall incidence of PP was

306 women diagnosed

0.73%.


PP) occurred in 173 women

(56.5%)


low-lying placenta) in 133 women

(43.5%)

with PP over 10 years

(January 1996 to

December 2005)

outcome in different types of

placenta previa.

risks and outcome between the different

classes of placenta previa (PP).

J Obstet Gynaecol Can. 2009 [17]

12. This is a retrospective study to look at

Packing in controlling primary

This is a retrospective


Packing is of

advantage

in achieving

hemostasis, in cases

of postpartum

hemorrhage due to

low-lying placenta

previa/accreta and

to conserve the

uterus in women

with low parity.

hemorrhage caused by placenta

previa/accreta.


uterovaginal packing alone

For management of bleeding.


surgical intervention. However,

there was no maternal death

among the series.

study covering 7

years (January 2001 to

December 2007).

postpartum hemorrhage due to

placenta previa/accreta. To

the effect of utero-vaginal

Saudi Med J. 2009 [18]

outcome in subjects with placenta previa

with a previous cesarean section.

Kurume Med J. 2012 [16]


19. Is a prospective observational study

to diagnose placental migration

All cases with a diagnosis

Placental can migrate to a

distance of more than 3

the internal cervical Os occurred

in 24 patients (38%) by 36

gestation.

 weeks'

cm from

All the cases

had confirmed

the diagnosis of

placenta previa

before 32 weeks'

gestation, and

migration up to a

distance of more

than 3

cm from the

internal cervical

Os occurred in 24

patients (38%) by

36

weeks' gestation.

Complication of Abnormal Placental Implantation http://dx.doi.org/10.5772/intechopen.80030 69

of placenta previa before

32

weeks' gestation

included in a prospective

observational study

using transvaginal sonography

(TVS)

with an objective to determine the use of

transvaginal sonography in visualizing

migration and predict the mode of

delivery?

Ann Saudi Med. 2000 [24]

PPH =

**Table 1.**

Postpartum hemorrhage, CS

 =

Cesarean section, PP

19 PubMed publication … complication of placenta previa and its management.

 =

Placenta previa.


16. This is a retrospective study of higher

Multiple repeat cesarean is

The relationships between

The incidence of cesarean

Concluded that

68 Placenta

the incidence of

hysterectomy,

uterine pelvic

dehiscence, placenta

previa, and accreta

and bladder injury

was similar in the

two groups. The

rate of postpartum

pyrexia, wound

infection, urinary

tract infection, and

blood transfusion

was also comparable

in the two groups.

Uterine atony still is

the leading cause of

primary postpartum

hemorrhage and the

primary indications

of peripartum

hysterectomy.

Hemostasis in cases

of post-partum

bleeding caused by

low-lying placenta/

placenta previa

can be achieved

by using a large

volume, fluid-filled

tamponade balloon.

hysterectomy, uterine scar

dehiscence, placenta previa,

placenta accreta, and bladder

injury was similar in two groups.

the number of cesarean

sections and various

clinical variables in 150

patients


sections (mean 6.0)

compared with a control

group of 140 patients


sections (mean 2.5)

during the period from

(1996–2000) at

17. This is a retrospective study and a

The aim to determine the

A retrospective analysis

The incidence rate was 0.5 per

1000. Uterine atony 11 (64.7%,

nine without previa and 2 with

previa)

of 17 (January 1, 1991–

December 31, 2002.)

incidence, indications, and

complications

review of 17 cases of emergency peripartum

hysterectomy,

Indication of emergency peripartum

hysterectomy: a review of 17 cases.

Arch Gynecol Obstet. 2003 [22]

18. Tamponade-balloon for obstetrical

The objective of this is to study the

For an action of

The tamponade balloon was used

in five women with post-partum

bleeding caused by low-lying

placenta/placenta previa, and

in one woman with cervical

pregnancy.

tamponade function

a silicone, fluid-filled

balloon

Five women with

postpartum bleeding

caused by low-lying

placenta and one woman

with cervical ectopic

pregnancy underwent

a balloon insertion as a

conservative measure

in the management of

bleeding.

effect of a balloon (large volume,

fluid-filled tamponade) in the

management of post-partum

hemorrhage from the implantation

site of low-lying placenta/placenta

previa.

bleeding.

Int J Gynecol Obstet. 2001 [23]

common in many institutions of

Saudi Arabia.

A retrospective study to determine

the major and minor complications

as well as the neonatal outcome

associated with multiple repeat

cesarean sections.

order multiple repeats cesarean sections.

Ann Saudi Med. 2003 [21]

PPH = Postpartum hemorrhage, CS = Cesarean section, PP = Placenta previa. **Table 1.** 19 PubMed publication … complication of placenta previa and its management. Ultrasonography is the known diagnostic modality of placenta previa [4].

In spite of the significant improvement in obstetric care and management and modern transfusion service, antepartum and postpartum bleeding continues to be an essential cause of maternal morbidity and mortality [27].

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A structure, a protocol, and an organized plan should be part of policy and procedure for the management of cases of massive bleeding [28].

A Canadian group has alerted the obstetrician for management of suspected placenta accrete by a multidisciplinary checklist for the preparation of these cases [29].

Placenta previa is a significant complication of pregnancy; there is no obvious case, but the risk factor is enormous, and the risk factors for placenta previa are the previous history of one or more cesarean sections, pregnancy termination including dilatation and curettage, high parity, advanced maternal age, intrauterine surgery, smoking, and multiple pregnancies.

Complication of placenta previa repeated placenta previa or major abnormal placentation like placenta accreta or percreta or increta, antepartum and post-partum hemorrhage, as well as Pelvic and uterine adhesion, urinary and bowel injury. Emergency hysterectomy, the complication of massive bleeding such as massive transfusion and effect on mother like Sheehan syndrome (**Table 1**).

The limitations of the study are: (1) a retrospective study and (2) a different obstetrician managed the cases.
