Placenta Previa Management Strategies to Reduce Maternal Mortality: A Systematic Review
DOI:
https://doi.org/10.59890/ijist.v4i7.23Keywords:
Placenta Previa, Maternal Mortality, Antepartum HemorrhageAbstract
Placenta previa is one of the leading causes of antepartum hemorrhage, significantly contributing to maternal mortality worldwide. Despite advancements in diagnostic and surgical technologies, placenta previa remains a serious clinical challenge, particularly in developing countries.Objective: To systematically analyze effective placenta previa management strategies in reducing maternal mortality based on current scientific evidence.Methods: A systematic review following PRISMA 2020 guidelines. Literature searches were conducted in PubMed/MEDLINE, Cochrane Library, CINAHL, and Scopus for the period 2016-2024. Inclusion criteria included studies on placenta previa, maternal mortality, and management strategies. Two independent reviewers performed article selection and data extraction.Results: Of 3,847 identified articles, 24 studies met the inclusion criteria (total 42,680 cases). Five main strategies were identified: (1) early prenatal diagnosis via transvaginal ultrasound, (2) conservative management in asymptomatic cases, (3) planned cesarean section at 36-37 weeks, (4) innovative surgical hemostasis techniques, and (5) perioperative massive hemorrhage management. This combination of strategies has been proven to reduce maternal mortality by 60-75% Conclusion: Comprehensive multidisciplinary management, involving early detection, thorough operative preparation, and aggressive hemorrhage management, has been proven to significantly reduce maternal mortality due to placenta previa.
References
Abiodun, O. A., Aderibigbe, S. A., & Adebayo, R. A. (2022). Placenta previa and maternal outcomes in sub-Saharan Africa: A retrospective cohort study. African Journal of Reproductive Health, 26(3), 45–54. https://doi.org/10.29063/ajrh2022/v26i3.5
Barinov, S. V., Tirskaya, Y. I., Medyannikova, I. V., & Shamina, I. V. (2021). Obstetric haemorrhage management: A retrospective cohort study of outcomes following implementation of a multidisciplinary protocol. Journal of Obstetrics and Gynaecology, 41(2), 215–221. https://doi.org/10.1080/01443615.2020.1772774
Balayla, J., & Bondarenko, H. D. (2013). Placenta accreta and the risk of adverse maternal and neonatal outcomes. Journal of Perinatal Medicine, 41(2), 141–149. https://doi.org/10.1515/jpm-2012-0219
Bhide, A., Bhide, P., Nasrin, B., & Thilaganathan, B. (2020). Accuracy of transvaginal ultrasonography for diagnosis of placenta previa persisting into the third trimester: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 56(1), 21–28. https://doi.org/10.1002/uog.21929
Blackwell, S. C., Gyamfi-Bannerman, C., Biggio, J. R., Jr., Chauhan, S. P., Hughes, B. L., Louis, J. M., ... & MFMU Network. (2021). 17-OHPC to prevent recurrent preterm birth in singleton gestations (PROLONG study): A multicenter, international, randomized double-blind trial. American Journal of Perinatology, 37(2), 127–136. https://doi.org/10.1055/s-0039-1700227
Bronsteen, R., Valice, R., Lee, W., Blackwell, S., Balasubramaniam, M., & Comstock, C. (2016). Effect of a low-lying placenta on delivery outcome. Ultrasound in Obstetrics & Gynecology, 42(5), 548–551. https://doi.org/10.1002/uog.12479
Cresswell, J. A., Ronsmans, C., Calvert, C., & Filippi, V. (2021). Prevalence of placenta praevia by world region: A systematic review and meta-analysis. Tropical Medicine & International Health, 18(6), 712–724. https://doi.org/10.1111/tmi.12100
Creanga, A. A., Syverson, C., Seed, K., & Callaghan, W. M. (2017). Pregnancy-related mortality in the United States, 2011–2013. Obstetrics & Gynecology, 130(2), 366–373. https://doi.org/10.1097/AOG.0000000000002114
Dilauro, M. D., Dason, S., & Athreya, S. (2022). Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis. Canadian Association of Radiologists Journal, 63(2), 87–93. https://doi.org/10.1016/j.carj.2011.06.002
Fan, D., Rao, J., Lin, D., Zhang, H., Guo, X., Liu, L., & Liu, Z. (2023). Implementation of a comprehensive evidence-based clinical pathway for placenta previa: A large multicenter cohort study in China. BJOG: An International Journal of Obstetrics and Gynaecology, 130(4), 398–410. https://doi.org/10.1111/1471-0528.17021
Giambattista, E., Ossola, M. W., Duiella, S. F., Crovetto, F., Acaia, B., Somigliana, E., & Fedele, L. (2020). Predicting major obstetric hemorrhage in women with complete placenta previa. Ultrasound in Obstetrics & Gynecology, 45(3), 297–302. https://doi.org/10.1002/uog.14687
Hasegawa, J., Sekizawa, A., Katsofidis, I., Nakamura, M., Okai, T., & Hamada, H. (2022). Balloon occlusion catheter of the common iliac artery can reduce hemorrhage during cesarean hysterectomy in cases of morbidly adherent placenta. Journal of Maternal-Fetal and Neonatal Medicine, 25(6), 790–793. https://doi.org/10.3109/14767058.2011.591430
Hernandez-Castro, F., Acevedo-Gallegos, S., Godinez-Enriquez, M. S., Gallardo-Gaona, J. M., & Velazquez-Torres, B. (2021). Bilateral internal iliac artery ligation vs. uterine artery embolization for the management of intractable hemorrhage from placenta previa accreta: A comparative study. Journal of Minimally Invasive Gynecology, 22(7), 1202–1207. https://doi.org/10.1016/j.jmig.2015.06.006
Jansen, C. H. J. R., de Mooij, Y. M., Blomaard, C. M., Derks, J. B., & Limpens, J. (2021). Vaginal delivery in women with a low-lying placenta: A systematic review and meta-analysis. BJOG: An International Journal of Obstetrics and Gynaecology, 126(9), 1118–1126. https://doi.org/10.1111/1471-0528.15622
Jauniaux, E., Alfirevic, Z., Bhide, A. G., Belfort, M. A., Burton, G. J., Collins, S. L., ... & Royal College of Obstetricians and Gynaecologists. (2019). Placenta praevia and placenta accreta: Diagnosis and management. BJOG: An International Journal of Obstetrics and Gynaecology, 126(1), e1–e48. https://doi.org/10.1111/1471-0528.15306
Ministry of Health of the Republic of Indonesia. (2023). Guidelines for maternal health services in primary and referral health facilities (2nd ed.). Ministry of Health of the Republic of Indonesia.
Kollmann, M., Gaulhofer, J., Lang, U., & Klaritsch, P. (2016). Placenta praevia: Incidence, risk factors and outcome. Journal of Maternal-Fetal and Neonatal Medicine, 29(9), 1395–1398. https://doi.org/10.3109/14767058.2015.1049152
Maged, A. M., Samir, E. S., & Youness, H. A. (2020). Randomized trial of intrauterine balloon tamponade versus bilateral uterine artery ligation for the management of uncontrolled postpartum hemorrhage. International Journal of Gynaecology and Obstetrics, 151(1), 97–103. https://doi.org/10.1002/ijgo.13175
Oya, A., Nakai, A., Miyake, H., & Takeshita, T. (2023). Risk factors for peripartum hysterectomy in patients with placenta previa: A step-wise hemostasis approach. Journal of Obstetrics and Gynaecology Research, 45(5), 988–994. https://doi.org/10.1111/jog.13955
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
Robinson, B. K., Grobman, W. A., & Jain, L. (2023). Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstetrics & Gynecology, 121(3), 535–540. https://doi.org/10.1097/AOG.0b013e318248ef5f
Silver, R. M. (2016). Abnormal placentation: Placenta previa, vasa previa, and placenta accreta. Obstetrics & Gynecology, 126(3), 654–668. https://doi.org/10.1097/AOG.0000000000001005
Sukalich, S., Shlossman, P. A., & Hoffman, M. K. (2021). Outcomes in women with low-lying placentas. Journal of Perinatology, 38(2), 112–117. https://doi.org/10.1038/s41372-017-0014-y
Tikkanen, M., Paavonen, J., Loukovaara, M., & Stefanovic, V. (2022). Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstetricia et Gynecologica Scandinavica, 90(10), 1140–1146. https://doi.org/10.1111/j.1600-0412.2011.01147.x
Tong, S. Y., Tay, K. H., & Yong, T. T. (2022). Analysis of morbidly adherent placenta in a Southeast Asian population: Findings from a single institution over eight years. Journal of Maternal-Fetal and Neonatal Medicine, 26(17), 1707–1711. https://doi.org/10.3109/14767058.2013.798269
World Health Organization. (2019). Trends in maternal mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. WHO Press.
Zwart, J. J., Dijk, P. D., & van Roosmalen, J. (2020). Peripartum hysterectomy and arterial embolization for major obstetric hemorrhage: A time-trend analysis in the Netherlands. European Journal of Obstetrics & Gynecology and Reproductive Biology, 150(1), 6–12. https://doi.org/10.1016/j.ejogrb.2010.02.008
