RESULTS
We investigated medical records of 368 women who were diagnosed with PP from 2009 to 2018. Of these, two thirds (63%) had APH, of whom 66% had major praevia. Women with APH had greater odds of major PP (OR=2.77, 95% CI: 1.79-4.28, p <0.001). Women with APH were on average 1.4 years younger than women without (p=0.01) (Table 1). There was no significant difference between women with and without APH in the mean body mass index, maternal ethnicity, maternal smoking, parity, a history of caesarean section (CS), a history of uterine surgery, and IVF.
< Table 1>
The percentage of emergency (both classical and lower segment) CS, and use of general anaesthetic was greater among women with APH compared to women without (Table 2). Compared to women without APH, women with APH had greater risk of emergency classical CS relative to elective LSCS (RRR=14.9, 95% CI: 3.37-66.0). Women with APH had greater odds general anaesthetics (OR=3.14, 95% CI: 1.90-5.18), and extension of uterine tear (OR=3.67, 95% CI: 0.44-30.81), though this did not reach statistical significance. The median timing of delivery for women with APH (35.4 weeks) was significantly earlier than for women without APH (38.0 weeks) (Table 2). Women with APH had a higher median estimated blood loss, as reflected by the IRR=1.22 (95% CI: 1.06-1.39).
< Table 2>
The percentage of medical measures was greater among women with APH (syntocinon bolus and infusion) and lower for carbetocin, compared to women without APH (Table 3a). Women with APH had higher odds of syntocinon bolus (OR=1.83, 95% CI: 1.14-2.91) and infusion (OR= 1.98, 95% CI: 1.19-3.31), but lower odds of carbetocin (OR=0.27, 95% CI: 0.12-0.59). There was no association of APH with the different types of transfusions and with a higher number of uterotonics (Table 3a). Overall, women with APH had a higher percentage of additional surgical techniques compared to women without, most notably for surgicell (OR=3.43, 95% CI: 1.39-8.44) and Bakri balloon (OR=10.2, 95% CI: 1.34-78.1) (Table 3b). There were 3 women with APH and 1 without APH who underwent hysterectomy. As expected, more packed RBCs were used for women with APH (IRR=3.76, 95% CI: 1.96-7.21) (Table 3c). Women with APH had slightly greater odds of any postpartum complication (OR=1.67, 95% CI: 1.08-2.59) and longer length of post-op hospital stay (IRR=1.28, 95% CI: 1.12-1.47) (Table 4). There were no ICU admissions or maternal deaths recorded.
< Table 3>
<Table 4>