17J Gandhara Med Dent SciJuly - September 2025

ORIGINAL ARTICLE

:
:

FREQUENCY OF FETAL OUTCOMES IN PATIENTS WITH PREEXISTING PLACENTAL
ABNORMALITIES. A PROSPECTIVE STUDY IN TERTIARY CARE HOSPITAL

Niama Khan1, Mohsin Khan2, Faiza Khan3, Muhammad Kashif Rafiq4, Kiran Khushal5, Ahtezaz Hussain6,
Fatima Akhtar Khan7

ABSTRACT
OBJECTIVES
This study aimed to access the various types of placental abnormalities and
their impact on fetal well-being, including fetal admission to the nursery,
complications, and outcomes.
METHODOLOGY
This cross-sectional study was conducted from September 1, 2022, to
December 31, 2024, in the Obstetrics and Gynecology department of Ayub
Medical Teaching Institute, Abbottabad, Pakistan. The sample size (n = 63)
was calculated using the WHO calculator 1.1, with an estimated prevalence
of placenta previa of 12%, an absolute precision of 8%, and a 95%
confidence interval. Patients diagnosed with placental abnormalities on grey-
scale sonography were followed until delivery and discharge. The non-
probability convenient sampling technique was applied for the data
collection. In the study, only 63 met the inclusion criteria. The different
maternal and fetal parameters of morbidity and mortality were recorded on a
predesigned written questionnaire. The data were analyzed using SPSS
version 21. The statistical test, ANOVA and chi-square were used to
determine the significance, and the significance value was kept below 0.05
RESULTS
Fifty-four per cent of individuals belonged to the 20-34 years age group, and
this age group had the highest incidence of placental abnormalities, i.e., 54%
(p = 0.002). The most common abnormalities were placenta previa (20/63).
The mean weight of the baby was 2.3Kg±0.6. About 15% of newborns had
congenital anomalies. Nearly half of the sample population's newborns
needed admission to the NICU. The most common reason for admission to
NICU was acute respiratory distress syndrome 14/28 (26%). About 6% of
newborns suffer from hypoxemic ischemic encephalopathy (HIE). The
newborn mortality was 19/63 (30%) and was high in previa and abruption
with a significance of 0.00.
CONCLUSION
Although some congenital disabilities are difficult to detect in neonatal life
but still careful observation of our cohort indicates that placental
abnormalities increase the risk of congenital disabilities, adverse outcomes
and mortality in newborns.
KEYWORDS: Hypoxemic ischemic encephalopathy (HIE), Neonatal
respiratory distress syndrome, Placenta Accrete Spectrum (PAS), Fetal
congenital anomalies, APGAR score

How to cite this article

Khan N, Khan M, Khan F, Rafiq MK,
Khushal K, Hussain A, et al.
Frequency of Fetal Outcomes in
Patients with Preexisting Placental
Abnormalities. A Prospective Study in
Tertiary Care Hospital. J Gandhara
Med Dent Sci. 2025;12(3):17-21.

Date of Submission: 07-02-2025
Date Revised: 26-06-2025
Date Acceptance: 03-06-2025

1Resident gynecologists and Obstetric
Ayub Teaching Hospital, Abbottabad

2Resident, Pulmonologist, Ayub Medical
Teaching Institute Abbottabad

4Assistant Professor, Department of
,

Surgery, Ayub Medical Teaching
Hospital, Abbottabad

5Resident, Department of Gynecologists
and Obstetric, Ayub Teaching Hospital,,
Abbottabad

6Resident Physician, Ayub Teaching
Hospital Abbottabad

7Medical Officer, Ayub Medical Teaching
Institute , Abbottabad

Correspondence

3Faiza Khan, Internee, Ayub Medical
Teaching Institute Abbottabad

+92-343-9289701
faezakhan999@gmail.com

INTRODUCTION

During embryogenesis, the placenta is the first organ to
develop, acting as a vascular interface between the
mother and the fetus. Placental morphological
development is crucial for preventing prenatal and
perinatal complications in both the mother and fetus.
Abnormal placentas, such as placenta accreta, placenta
previa, placental abruption, and abnormal
morphogenesis, are associated with both short-term and
long-term complications for the mother and fetus. Some

of these complications include preeclampsia, congenital
disabilities, low birth weight, fetal distress, fetal growth
restriction, and cardiovascular effects, which enhance
the mortality and morbidity of mother and newborn.
The estimated worldwide maternal mortality ratio for
2024 was 292 per 100,000 in rural areas and 100 per
100,000 in urban areas. In middle- and lower-income
countries, the maternal mortality rate (MMR) in rural
and urban areas is 199/100,000 and 144/100,000,
respectively.¹ Peripartum hemorrhages in the placenta
due to placental and uterine malformation are the

https://doi.org/10.37762/jgmds.12-3.686

18 J Gandhara Med Dent Sci

July - September 2025

Frequency of Fetal Outcomes in Patients with Preexisting

leading cause of maternal death in South Asia,
contributing more than a third of the global burden of
stillbirths.2 An extensive literature review suggests that
most of the stillbirths in low and middle-income
countries probably occur secondary to fetal asphyxia
with significant contribution of placental abruption and
placental vascular malformation. In Asia, the placental,
maternal or fetal blood vessel malformation was the
primary placental cause of death in 47% of stillbirths,
among which previa and abruption account for 15%. In
Pakistan, 48% of stillbirths are due to vascular
malformation, either maternal, fetal or placental and
14% of stillbirths are due to placental abruption or
placenta previa.3 In Khyber Pakhtunkhwa, a recent
study reported a stillbirth rate of 8/1,000, among which
placental abnormalities were implicated in 19.9% of
stillbirths.4 In Pakistan, 62% of deliveries happen at
home, and untrained birth attendants assist the majority
of them.5 Hence, the substantial amount of cause of
stillbirth remains unknown. This data reflects that
placental abnormalities are a key cause of stillbirth.
These placental abnormalities not only increase the high
demands on health care resources, but these
abnormalities are considerably associated with poor
fetal outcomes and increased maternal mortality to
several folds. Numerous studies have established that
morphology, including volume, weight, thickness, and
shape, significantly correlates with the birth weight of
the fetus.6,7 Based on ultrasound and Doppler flow, fetal
growth restriction (FGR) can be determined as early as
the late second trimester and third trimester. It has been
postulated that asymmetric fetal growth restriction
(FGR) is responsible for 70 to 80 per cent of fetal
growth restriction and primarily arises due to disruption
of the blood supply, leading to uteroplacental
insufficiency.8 In this study, we will determine the type
of placental abnormalities and assess the fetus for any
gross congenital anomalies. Moreover, this study will
investigate newborn NICU admissions, complications
during delivery, reasons for hospitalization, and the
outcomes for the fetus. Maternal counselling will be
conducted regarding the risk factors for placental
abnormalities, and strategies for neonatal well-being
will be explained to parents.

METHODOLOGY

This was a cross-sectional study conducted in the
Obstetrics and Gynecology department of Ayub
Medical Teaching Institute, Abbottabad, Pakistan. The
hospital’s ethics committee approved the study with
reference number No. RC-2022/EA-01/74. The study
duration was from September 1, 2022, to December 31,
2024. The data of the study were collected using a
predesigned written questionnaire. A non-randomized

convenience sampling technique was used for data
collection. The placental abnormalities were diagnosed
using grey-scale sonography (Curvilinear 5 MHz
frequency probe, Toshiba Xario 100) and further
ascertained by visual examination during the cesarian
section. The level of a sonographer is an assistant
professor or above. The placental abruption was
classified from class 0 to class 3 based on severity. The
International Federation of Gynecology and Obstetrics
(FIGO) classification was used to classify the placenta
accreta spectrum (PAS). The placenta previa was
graded from I to IV (RCOG Grading). The patients with
placental abnormalities were followed till the delivery
of the fetus. The APGAR score of 7-10 is reassuring, 4-
6 is moderately low, and 0-3 is low. Moreover, after
delivery of the fetus, the baby was accessed for
congenital anomalies, complications, admission to
NICU, diagnosis in NICU, blood transfusion and birth
weight. The patients with epilepsy, severe eclampsia,
maternal Folic acid and vitamin B12 deficiency, severe
anemia, previous history of the neural tube, cleft lip,
club foot or other congenital disabilities were excluded
from the current study. The sample size (n = 63) was
calculated using the WHO calculator 1.1, with an
estimated prevalence of placenta previa of 12%, an
absolute precision of 8%, and a 95% confidence
interval. The qualitative data were expressed in terms of
frequencies and percentages, while the quantitative data
were presented as means, medians, and modes. The
normality of the data was assessed using the Shapiro-
Wilk test, along with statistical tests such as the Chi-
square test and one-way ANOVA. The software for
data analysis was SPSS version 21. The level of
significance was maintained at a 95% confidence
interval (CI) or a p-value less than 0.05.

RESULTS

Among 83 mothers, only 63 met the inclusion criteria
(n = 63); the remaining proformas were incompletely
filled and excluded from the current study. Fifty-four
per cent of individuals (34) belonged to the 20-34 years
age group, and this age group had the highest incidence
of placental abnormalities at 54% (p = 0.002). The most
common abnormalities were placenta previa (20/63),
abruption (8/63), accreta (4/63), and percreta (2/63).
The mean weight of the baby was 2.3 kg ± 0.6, as
shown in Fig. 01. Preterm newborns were 37. The
demographic details and placental characteristics are
shown in detail in Table 01.

19J Gandhara Med Dent SciJuly - September 2025

Figure 1: Correlation of fetal birth weight versus placental

abnormalities

Table: 1 Demographic characteristics of patients presented with
different types of placental abnormalities

Variables Frequency (%)
Maternal age <20 Years 13(21%)

20-34 Years 34(54%)
35-40 Years 10(16%)
>40 Years 06(10%)

Birth history Term 26(41.3%)
Preterm 37(58.7%)

Placental
abnormalities

Abruption 14(22%)
Accreta 04(6.3%)
Increta 04(6.3%)
Percreta 06(9.5%)
Previa 35(55.6%)

Placental abruption Class 1 04(6.3%)
Class 2 10(16%)

Placenta previa Grade1 04(6.3%)
Grade2 04(6.3%)
Grade3 06(9.5%)

Fetal Anomalies Club foot 02(3.2%)
Down syndrome 04(6.4%)
Hydrocephalous 02(6.4%)
Pulmonary HTH 02(6.4%)

Diagnosis in NICU ARDS 16(26%)
Anemia 02(3.2%)
Congenital heart
disease

02(3.2%)

Down syndrome 04(6.4%)
Hypoxic Ischemic
Encephalopathy

04(6.4%)

Placenta accrete
spectrum

Type1 02(3.2%)
Type2 08(13%)
Type3 00(0%)
Type4 25(40%)

Discharge status of
newborn

Died 19(30%)
Improved 22(35%)
Stationary 08(13%)

Congenital anomalies were observed in 10 newborns,
and the most common placental morphologies
associated with congenital anomalies were increta and
percreta (placenta accrete spectrum), with a p-value of
0.000. Almost half of the newborns (30/63) needed
NICU admission, among which 28 had serious
diagnoses, and the most common reason for admission
to NICU was acute respiratory distress syndrome 14/28
(26%) followed by hypoxic-ischemic encephalopathy

(6.4%). Only two newborns needed a blood transfusion
in the NICU, while 24 were fed on an N/G tube. The
mortality rate was 19/63, which was high in cases of
previa and abruption, with a significance level of 0.00.
The details of placental morphologies with respect to
newborn morbidities and mortality are shown in Table
02. The mean hospital stay was 3 days ± 2. Details are
shown in Fig 02.

Table 2: Stratification of Placental morphologies to newborn
morbidities and mortality

Variable Abru
ption
(n=14)

Increta
spectrum
(n=14)

Previa
(n=35)

Significan
ce values

Preterm 06 12 19 0.04
APGAR
1min

7-10 04 02 16 0.003
4-6 02 10 10
0-3 08 02 09

APGAR
10min

7-10

0000.05

4-6 02 0 08
0-3 06 02 09

Anomalies 0 10 0 0.000
NICU admission 02 12 16 0.018
Neonatal mortality 04 02 13 0.000

Figure 2: Hospital Stay of the Patient in Various Placental
Abnormalities

DISCUSSION

In the present study, we observed that the most
common age group with abnormal placental
morphologies was the 20 -34-year age group. A recent
study by Khan et al. highlighted the most common age
group, 20-34 years, in patients with placenta previa.9 A
retrospective multicenter study by Jauniaux et al.
reported a mean age of 34 years. The slight difference
could be due to demography as most of the patients
were Caucasian.10 R. Moeini et al. reported a mean age
of 32 years in the placental abnormalities group.11
Many cohort studies have reported age as an
independent factor associated with placental
abnormalities.12 The most common anomaly seen was
placenta previa, but no fetal birth anomalies were
observed in this group, but complications were
commonly observed in neonates. A recent case-control

Frequency of Fetal Outcomes in Patients with Preexisting

20 J Gandhara Med Dent Sci

July - September 2025

study highlighted the prevalence of placenta previa,
with a frequency of 47%.11 A recent meta-analysis
included seven high-quality studies that reported a
significant association between congenital anomalies
and placenta previa. The risk of fetal anomalies
increased to 6.3% in placenta previa as compared to
normal placenta.13A recent multicentered study reported
congenital fetal anomalies with frequency of 5%.14 All
the cases in this study belong to PAS (placenta accreta
spectrum). We also observed that all congenital
anomalies were associated with PAS (specifically
increta and percreta). The mean weight of newborns
with placental anomalies was recorded as 2.3, which is
less than the standard weight of a baby. The lowest
weight of 2.1 kg was observed in patients with placenta
increta. A study conducted in Finland by Riihimäki O et
al. reported a 2.5 kg birth weight in patients with
placenta abruption. However, other national studies
conducted in Karachi reported that 12.58% of
individuals with placenta previa had very low birth
weight, while 10.8% of patients with placental
abruption had very low birth weight.15,16 A study
conducted by R. Moeini et al. reported a statistically
significant difference in the mean weight of 2.7 kg in
the abnormal placentation group versus 3.3 kg in the
control group, with a p-value of < 0.00.11 In patients
with placental abruption, the 1-minute and 10-minute
APGAR scores were recorded as low, and this
difference was statistically significant. Research studies
have reported that the APGAR score of neonates can be
low if placental abnormalities are managed in an
emergency.17,18 Roksana Moeini et al. also reported a
statistical difference in the 5-minute APGAR score
between the abnormal and normal placentation groups,
with a p-value of less than 0.001.11 The NICU
admission rate was 47% and significantly high in
patients with placenta increta. This could be due to a
high rate of congenital anomalies. R. Moeini et al.
reported that 49% of abnormal placentations require
NICU admission, which is consistent with our
observations.11 In our cohort, 54% of the neonates were
preterm, whereas Siddiqui SA et al. reported 51%,
which is slightly lower. The difference could be due to
a larger sample size. R. Moeini et al. reported an
average age of 35 weeks for newborns with placental
abnormalities, which was significantly lower than that
of the normal placentation group (p < 0.001). It is
important to reduce the risk of stillbirth with placental
abnormalities. There is a paucity of information, and we
did not observe any cases in our study. The hospital
stay for patients with placenta accreta spectrum was 6
days, which is similar to the case group reported by R.
Moeini et al. The neonatal mortality was high (30%) in
patients with placenta previa, which is consistent with
the result reported by Siddiqui SA et al.13 R. Moeini et

al. reported a mortality of 1.2%. The difference in
mortality could be due to the difference in the
distribution of types of placental abnormalities, as 84%
of cases belong to PAS, while we observed high
mortality in the placenta previa group. The majority of
confounding variables, like the previous history of
congenital anomalies, vitamin B12, folic acid
deficiency, neural tube defects, severe maternal anemia,
and teratogenic drugs used, were controlled.

LIMITATIONS

The study has no comparison group. The study was
conducted in single centred. Mother complications and
mortality were not recorded. Some maternal
confounding variables, such as parity and smoking
status, were missed. The morbidities of the first and
second trimesters were not assessed.

CONCLUSIONS

Placental abnormalities increase the risk of congenital
anomalies. There is an increased risk of low birth
weight, NICU admission and premature deliveries, but
we did not observe any risk of stillbirths with placental
abnormalities. It is necessary to screen such patients
early and deliver them to a hospital equipped with a
NICU facility. The neonatal morbidity increased the
importance of antifibrinolytics in early maternal
hemorrhage, maternal prophylactic antibiotics and
steroids for fetal lung maturity.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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21J Gandhara Med Dent SciJuly - September 2025

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Frequency of Fetal Outcomes in Patients with Preexisting

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.

Niama Khan - Concept & Design; Data Acquisition;

Mohsin Khan - Concept & Design; Data Analysis/

Faiza Khan - Concept & Design; Data Acquisition; Critical

Muhammad Kashif Rafiq - Concept & Design; Data

Kiran Khushal - Concept & Design; Data Acquisition;

Ahtezaz Hussain - Concept & Design; Data Acquisition;

Fatima Akhtar Khan - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Interpretation; Drafting Manuscript; Final Approval

Revision; Drafting Manuscript; Final Approval

Acquisition; Drafting Manuscript; Final Approval

Drafting Manuscript; Final Approval