Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo

Research Article

Austin J Pregnancy Child Birth. 2021; 2(1): 1002.

Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo

Ndomba MM¹, Mukuku O²*, Tamubango HK², Biayi JM¹, Kinenkinda X¹, Kakudji PL¹ and Kakoma JB¹

¹Department of Gynecology and Obstetrics, University of Lubumbashi, Democratic Republic of Congo

²Higher Institute of Medical Techniques, Democratic Republic of Congo

*Corresponding author: Olivier Mukuku, Higher Institute of Medical Techniques, Lubumbashi, Democratic Republic of Congo

Received: January 11, 2021; Accepted: February 02, 2021; Published: February 09, 2021


Introduction: Placenta Praevia (PP) is frequently associated with severe maternal bleeding leading to an increased risk for adverse outcome of mother and infant. This study aims to determine the prevalence, and to evaluate potential risk factors and respective outcomes of pregnancies with PP in Lubumbashi, Democratic Republic of Congo.

Methods: Data were retrospectively collected from patients diagnosed with PP at 4 hospitals in Lubumbashi between January 2013 and December 2016. All women who gave birth to singleton infants were studied. Differences between women with PP and without PP were evaluated. Adjusted Odds Ratios (aOR) with 95% confidence intervals for risk factors, and adverse maternal and perinatal outcomes associated with PP were estimated in multivariable logistic regression.

Results: The overall prevalence of PP was 1.49% (227/15,292). The following risk factors were independently associated with PP: multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous cesarean section (aOR=6.74; 95% CI: 2.99-15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). PP was significantly associated with adverse maternal outcomes such as delivery by cesarean section (aOR=3.09; 95% CI: 1.89- 5.06), maternal anemia (aOR=11.43; 95% CI: 6.20-21.06); and hospital stay of >4 days (aOR=2.02; 95% CI: 1.24-3.29). PP was also significantly associated with adverse perinatal outcomes such as Apgar scores of <7 at the 5th minute after birth (aOR=4.39; 95% CI: 2.62-7.36), low birth weight (aOR=4.10; 95% CI: 2.26-7.44), stillbirth (aOR=4.16; 95% CI: 1.39–12.46), and early neonatal death (aOR=5.72; 95% CI: 1.60–20.42).

Conclusion: PP is associated with adverse maternal and perinatal outcomes, and multiple independent risk factors were identified. Therefore, detection and careful surveillance of these risk factors are important to ultimately improve maternal and perinatal outcomes.

Keywords: Placenta praevia; Prevalence; Risk factors; Adverse maternal outcome; Perinatal outcome


Placenta Praevia (PP) is a potentially severe obstetric complication where the placenta lies within the lower segment of the uterus, presenting an obstruction to the cervix and thus to delivery [1–4]. PP occurs in 1/200 births, complicates about 0.3% of pregnancies and contributes to about 5% of all preterm deliveries [2,5,6]. The recurrence rate is 4 to 8% of subsequent pregnancies [7]. The etiology of this condition remains unclear. The incidence of low placenta insertion increases with advanced maternal age, multiple gestations, multiparity, smoking, previous caesarean sections and history of curettage, voluntary termination of pregnancy [8–11]. This catastrophic complication not only poses a risk to the fetus, but also endangers the life of the mother [12]. On the one hand, main maternal complications of PP are postpartum hemorrhage requiring blood transfusion and hysterectomy [13,14] which can also cause bladder damage during surgery [15]. On the other hand, premature birth, low birth weight, respiratory distress syndrome, admission to neonatal intensive care unit as well as perinatal death are significant neonatal problems [9]. Perinatal mortality in pregnancies complicated by PP is around 4–8 % [2].

Maternal and perinatal outcomes of PP occupy an important place in the literature. But we realized that there is no work devoted to this entity in the Democratic Republic of Congo (DRC) in general and in Lubumbashi in particular.

So the present study aims to determine the prevalence, and to evaluate potential risk factors and respective outcomes of pregnancies with PP in Lubumbashi, DRC.

Materials and Methods

A case–control study comparing women with and without PP was conducted. We conducted a retrospective study using maternally linked data from maternities of 4 hospitals at level 3 on the public health scale (University Clinics, Jason Sendwe Hospital, Gécamines– Sud Hospital and SNCC Hospital) in Lubumbashi (in Haut-Katanga province, DRC) for the period from January 1, 2013 to December 31, 2016.

All deliveries that took place in these 4 maternities from January 2013 to December 2016 with complete birth registry records were considered for analysis. Women diagnosed with placenta abruption were excluded to avoid misdiagnosis of PP. In addition, women with multiple gestation pregnancies were also excluded to avoid overrepresentation of studying high risk women. The study included any parturient having a PP on a single pregnancy. The control group consisted of parturients without PP during the study period, two controls for one case.

The minimum sample size was 58 cases with PP and was calculated using the following formula: Z².p(1-p)/d²where: n= sample size; z= confidence level according to the reduced normal centered law (for a confidence level of 95%, z=1.96); p= estimated prevalence reported by Senkoro et al. [9] who had reported a PP prevalence of 0.6% in northern Tanzania; d= margin of error at 2% (typical value of 0.02).

We took into account all the parturient women who presented themselves during the study period in the abovementioned maternities for childbirth. In all, we collected 227 cases of PP; as for the control group, it was represented by 454 parturients without PP. Thus, our total study sample was 682 parturients.

A standardized questionnaire was used to collect information from the medical birth registry. Maternal age, and obstetric history (parity, previous caesarean deliveries, history of myomectomy, history of abortion, and having antenatal care visits) were examined. The following maternal complications were evaluated: postpartum anemia, caesarean deliveries, hospital stay >4 days, and maternal death. The following neonatal complications and birth outcomes were assessed: preterm birth, fetal malpresentation, Apgar score at the 5th minute after birth less than 7, stillbirth, low birth weight, admission to neonatal intensive care unit, and early neonatal death.

Placenta praevia was defined as an obstetric complication characterized by placental implantation into the lower uterine segment, covering part of or the entire cervix in the second and third trimester [9].

Maternal anemia was established on the basis of clinical signs and/or on a hemoglobin level of less than 11 g/L when it was available and/or receiving a blood transfusion (during or after delivery).

Apgar score was defined as a measure of the physical condition of a newborn infant. The Apgar score has a maximum ten points, with two possible for each of heart rate, muscle tone, breathing, response to stimulation, and skin coloration.

Data analysis was performed using Stata version 15. Frequencies with respective percentages were used to summarize categorical variables. Both bivariate and multivariable analysis were performed using logistic regression and adjusted Odd Ratios (aOR) with 95% confidence intervals for risk factors, and maternal and perinatal outcomes associated with PP were estimated. A p-value of less than 0.05 was considered statistically significant. Our study was approved by the Medical Ethics Committee of the University of Lubumbashi prior to its commencement (Approval number: UNILU/CEM/137/2019).


Placenta praevia complicated 1.49% (227) of 15,292 pregnancies. Risk factors for PP are presented in (Table 1). There were higher rates of age ≥35 years (27.75% vs 21.82%), parity ≥6 (19.38% vs 11.51%), prior caesarean delivery (9.69% vs 2.40%), no having an antenatal care visit during pregnancy (55.51% vs 17.27%), and a history of abortions (29.96% vs 22.30%) among parturients with PP as compared with the comparison group. Significant risk factors for PP after adjusting for potential confounding factors were multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous caesarean section (aOR=6.74; 95% CI: 2.99- 15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). Age ≥35 years, history of myomectomy, and history of abortion had no significant association with PP.