The association between Hb levels in placenta previa patients with apgar scores

Herlin Ajeng Nurrahma*  -  Departement of Physiology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
Yulice Soraya Nur Intan  -  Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
Andreanita Meliala  -  Departement of Physiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
Paramita Narwidina  -  Clinical Nutrition Research Group, Yogyakarta 55132, Indonesia

(*) Corresponding Author
DOI: 10.30659/sainsmed.v13i2.26623

Hemoglobin (Hb) level is a biochemical indicator of the nutritional status of pregnant women, and a low Hb level reduces blood supply to the placenta, which influences the incidence of placenta previa. A placenta previa develops in the lower portion of the uterus, completely or partially expanding to cover the entire birth canal and the internal uterine ostium. The APGAR score is commonly used as a predictor of infant mortality and long-term disability and as an indicator of infant health at birth. The risk of maternal and infant mortality and morbidity increases in placenta previa patients with inadequate vascularization, which can be caused by low Hb levels. This study aimed to determine the relationship between Hb levels and APGAR scores in patients with placenta previa at Sultan Agung Islamic Hospital in Semarang. This analytic observation study is a cross-sectional analysis with purposive sampling method. From January 2017 to January 2018, all placenta previa patients hospitalized at Sultan Agung Hospital in Semarang were included in this study. In this study, we used subject data that met the criteria for inclusion. The p-value derived from the chi-square analysis is 0.041 (p< 0.05). A test of association was conducted. This test revealed that the OR was 11.5 (OR > 1). Low Hb levels (11 g/dl) could significantly increase the risk of a lower APGAR score at 5 min in patients with placenta previa who have a low Hb level.

Keywords: Pregnancy; Hemoglobin; Low-lying Placenta; APGAR Score

  1. Ali, M. K., Mahfouz, I. S., Abbas, A. M., & Sayed, E. H. (2018). The effect of placenta previa on fetal weight and feto-maternal blood flow: a prospective cohort study. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(11): 4485–4492. https://doi.org/10.18203/2320-1770.IJRCOG20184494
  2. Badan Pusat Statistik, Badan Koordinasi Keluarga Berencanan Nasional, Departemen Kesehatan, & Macro International. (2012). Indonesia Demographic and Health Survey 2012 https://kebijakankesehatanindonesia.net/images/2013/9/SDKI-2012.pdf. Accessed on 28 December 2021.
  3. Delli Pizzi, A., Tavoletta, A., Narciso, R., Mastrodicasa, D., Trebeschi, S., Celentano, C., Mastracchio, J., Cianci, R., Seccia, B., Marrone, L., Liberati, M., Cotroneo, A. R., Caulo, M., & Basilico, R. (2019). Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome. Abdominal Radiology, 44(5): 1873–1882. https://doi.org/10.1007/s00261-018-1882-8
  4. Di Renzo, G. C., Spano, F., Giardina, I., Brillo, E., Clerici, G., & Roura, L. C. (2015). Iron deficiency anemia in pregnancy. Women’s Health, 11(6), 891–900. https://doi.org/10.2217/whe.15.35
  5. DS, B., & Bird, I. (2017). Vascular Adaptation in Pregnancy and Endothelial Dysfunction in Preeclampsia. Journal of Endocrinology, 231(1): R27-44. https://doi.org/10.1530/JOE-16-0340
  6. Firmansyah, M. A. (2013). Perkembangan Terkini Diagnosis dan Penatalaksanaan Imflammatory Bowel Disease. CDK 40 (J43), 247–252. https://www.researchgate.net/publication/321824062
  7. Garmi, G., & Salim, R. (2012). Epidemiology, Etiology, Diagnosis, and Management of Placenta Accreta. Obstetrics and Gynecology International, 2012: 1–7. https://doi.org/10.1155/2012/873929
  8. Gebremeskel, T., Mulu, A., Kumbi, S., & Ergete, W. (2020). Histopathological Changes of Placenta Associated with Maternal Anaemia in Northeast Ethiopia: A Comparative Study. Ethiopian Journal of Health Sciences, 30(5): 777–784. https://doi.org/10.4314/ejhs.v30i5.18
  9. Gibbins, K. J., Einerson, B. D., Varner, M. W., & Silver, R. M. (2018). Placenta previa and maternal hemorrhagic morbidity. Journal of Maternal-Fetal and Neonatal Medicine, 31(4): 494–499. https://doi.org/10.1080/14767058.2017.1289163
  10. Hasegawa, J., Nakamura, M., Hamada, S., Matsuoka, R., Ichizuka, K., Sekizawa, A., & Okai, T. (2012). Prediction of hemorrhage in placenta previa. Taiwanese Journal of Obstetrics and Gynecology, 51(1): 3–6. https://doi.org/10.1016/j.tjog.2012.01.002
  11. Iliodromiti, S., Mackay, D. F., Smith, G. C. S., Pell, J. P., & Nelson, S. M. (2014). Apgar score and the risk of cause-specific infant mortality: a population-based cohort study. Lancet, 15(384): 1749-55. https://doi.org/10.1016/S0140-6736(14)61135-1
  12. Jansen, C., Kastelein, A., Kleinrouweler, C., Van Leeuwen, E., De Jong, K., Pajkrt, E., & CJF.Noorden, V. (2020). Development of placental abnormalities in location and anatomy. Acta Obstet Gynecol Scand, 99(8): 983–993. https://doi.org/10.1111/aogs.13834
  13. Jeganathan, R., Karalasingam, S. D., Hussein, J., Allotey, P., & Reidpath, D. D. (2017). Factors associated with recovery from 1 min Apgar score <4 in live, singleton, term births: An analysis of Malaysian National Obstetrics Registry data 2010-2012. BMC Pregnancy and Childbirth, 17(1): 1–12. https://doi.org/10.1186/s12884-017-1293-9
  14. Kattwinkel, J., Perlman, J. M., Aziz, K., Colby, C., Fairchild, K., Gallagher, J., Hazinski, M. F., Halamek, L. P., & Praveen Kumar, George Little, Jane E McGowan, Barbara Nightengale, Mildred M Ramirez, Steven Ringer, Wendy M Simon, G, J. Z. A. H. A. (2010). Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 126(5): e1400-13. https://doi.org/10.1542/peds.2010-2972E
  15. King, L. J., Mackeen, A. D., Nordberg, C., & Paglia, M. J. (2020). Maternal risk factors associated with persistent placenta previa. Placenta, 15(99):189–192. https://doi.org/10.1016/j.placenta.2020.08.004
  16. Kurniawan, H., & Maulina, M. (2015). Hubungan antara usia ibu dan paritas dengan kejadian plasenta previa di Rumah Sakit Umum Cut Meutia Kabupaten Aceh Utara Tahun 2012-2013. Jurnal Lentera, 15(13): 16–22. http://repository.unimal.ac.id/116/1/jurnal-lentera-vol.15.no.13-2015.pdf
  17. Lwanga, S., & Lemeshow, S. (1991). Sample Size Lemeshow.pdf (1st ed.). World Health Organization. https://tbrieder.org/publications/books_english/lemeshow_samplesize.pdf. Accessed on 28 December 2021
  18. Rahmati, S., Delpishe, A., Azami, M., Hafezi Ahmadi, M., & Sayehmiri, K. (2017). Maternal anemia during pregnancy and infant low birth weight: A systematic review and meta-analysis. International Journal of Reproductive BioMedicine, 15(3): 125–134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447828/
  19. Rai, A., & Cross, J. C. (2014). Development of the hemochorial maternal vascular spaces in the placenta through endothelial and vasculogenic mimicry. Developmental Biology, 387(2): 131–141. https://doi.org/10.1016/J.YDBIO.2014.01.015
  20. Rajuddin, R., Roziana, R., Munawar, M., & Iqbal, M. (2019). Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review . AVERROUS: Jurnal Kedokteran Dan Kesehatan Malikussaleh, 5(1):1-12. https://doi.org/10.29103/AVERROUS.V5I1.1628
  21. Stephen, G., Mgongo, M., Hussein Hashim, T., Katanga, J., Stray-Pedersen, B., & Msuya, S. E. (2018). Anaemia in Pregnancy: Prevalence, Risk Factors, and Adverse Perinatal Outcomes in Northern Tanzania. Anemia, 2018, 1–9. https://doi.org/10.1155/2018/1846280
  22. Swarup, A., & Anand, V. (2021). Pregnancy Outcomes in various Types of Placenta Previa: A Clinical Study. Journal of Gynecology and Women’s Health, 21(5): 01–07. https://doi.org/10.19080/JGWH.2021.21.556073
  23. Takeda, S., Takeda, J., & Makino, S. (2020). Cesarean Section for Placenta Previa and Placenta Previa Accreta Spectrum. The Surgery Journal, 6(Suppl 2): S110-S121. https://doi.org/10.1055/S-0039-3402036
  24. The World Bank Data. (2019). Maternal mortality ratio (modeled estimate, per 100,000 live births) - Indonesia. WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. https://data.worldbank.org/indicator/SH.STA.MMRT?locations=ID. Accessed on 21 April 2020.
  25. Woods, L., Perez-Garcia, V., & Hemberger, M. (2018). Regulation of Placental Development and Its Impact on Fetal Growth—New Insights From Mouse Models. Frontiers in Endocrinology, 9(September): 1–18. https://doi.org/10.3389/fendo.2018.00570
  26. Young, M. F. (2018). Maternal anaemia and risk of mortality: a call for action. The Lancet Global Health, 6(5): e479–e480. https://doi.org/10.1016/S2214-109X(18)30185-2

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ISSN: 2339-093X (Online) | 2085-1545 (Print)
DOI : 10.30659/sainsmed

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