SECOND TRIMESTER PLACENTAL LOCATION AS A PREDICTOR OF ADVERSE PREGNANCY OUTCOMES
Authors: VS Bini , Gopal Anitha , KM Bindhu 
Published: January 2025

Background :
Placenta is an important connecting organ between mother and fetus. A lot of fetal and maternal problems are related with the placenta. It is the vital link between the mother and fetus for metabolic exchange, endocrine and other body functions. So it is critical for maternal and neonatal wellbeing. The blood supply of the placenta is not uniformly distributed. The site of the implantation and resultant location of placenta within the uterus are likely to be the important determinants of placental blood flow and therefore pregnancy success. Placental location has been implicated in preterm birth, in fetal mal-position and mal-presentation, IUGR, Low APGAR score and development of preeclampsia.

Objectives:
The objective of the study, is to find out whether there is any significant correlation between second trimester placental location with the following Fetal outcomes such as intra uterine growth restriction (IUGR), preterm birth, low APGAR at 1 Minute (ie <7) , NICU admission, abnormal presentation and maternal outcomes such as preeclampsia, abruption, ante partum hemorrhage due to placental praevia, post partum hemorrhage.

Materials and Methods:
Study Design: A prospective observational study conducted at Department of Obstetrics and Gynaecology, Government Medical College Hospital in Kerala for a period of 12 months after getting the approval of Institutional Ethic Committee (IEC)/ Institutional Review Board (IRB) of the Institution. Population for the study is antenatal women of age group 18 to 35years without any high risk factors. Sample size is calculated as 390 with criteria for inclusion and exclusion. Sampling procedure used is Simple Random Sampling (SRS). The main tools used for the study were case records, obstetric USG, clinical examination findings and lab reports. The location of placenta was identified by Ultrasound Sonography done between 18 and 24 weeks. Location of placenta was classified as fundal, unilateral and low for the study. The outcome variables selected for the study comes under two categories ie maternal outcomes and fetal outcomes. The maternal outcomes are preeclampsia, placental abruption, ante partum hemorrhage due to placental praevia and post partum hemorrhage and fetal outcomes are intra uterine growth restriction (IUGR), preterm birth, low APGAR at 1 minute (ie <7), NICU admission and abnormal presentation.
Analysis: In chi square test we get a p value. If p value is less than 0.05 then we treat it as a significant association between the variables. If the p value is less than 0.01 then there is highly significant association between the variables in the study.

Results :
There is a significant relation between the location of the placenta in second trimester and the maternal outcomes such as preeclampsia, APH in placental praevia and fetal outcomes such as IUGR, low APGAR at 1 minute (ie <7), NICU admission. It is also found that there is no significant association between location of the placenta in second trimester and the maternal outcomes such as placental abruption, post partum hemorrhage and fetal outcomes such as preterm birth and abnormal presentation.

Conclusion :
With the help of ultra Sonography, a simple, non invasive, easy to perform, cost effective diagnostic method, the location of placenta can easily made out and thereby indentifying the above high risk cases such as IUGR, low APGAR at 1 minute (ie <7), preeclampsia and APH in placental praevia. By identifying such patients appropriate treatment can be initiated and regular follow-up can be done in advance.