Background Placenta previa with placenta accreta spectrum is one of the most feared complications responsible for increased maternal morbidity and mortality. This study aims to reduce maternal morbidity and mortality by detecting risk factors, performing relevant investigations, and deciding appropriate management options. Methods: The study design is a descriptive case series, carried out on 72 patients of MAP of a tertiary care hospital, in a 6-years duration from January 2014 to December 2019. Patients of OPD and the emergency department were diagnosed for MAP by using grayscale ultrasounds, color Doppler USG's (in most cases), and MRI's (in only a few cases). Different management options were studied and maternal morbidities were observed.  In the majority of cases, patients had operative deliveries with planned/ emergency hysterectomies, except for some having conservative surgery. Results: In the period of 6 years, the total number of deliveries was 35940. Out of these, 22140 were spontaneous vaginal deliveries and 13800 were C-sections.  The incidence of MAP was 1 per 499 normal deliveries and 1 per 192 in C-sections. The criteria for MAP was fulfilled by 72 patients. MAP diagnosed in the antenatal period was 43% while 57% were diagnosed in an emergency. The majority of patients had a history of C-sections and many underwent emergency obstetric hysterectomies. Blood transfusions were given to all patients in our study. Only 4(5.5%) patients died in our study. Conclusion:      Antenatal diagnosis of morbidly adherent placenta, followed by a well-planned surgical management, avoidance of placental separation and early caesarean hysterectomy ultimately result in a better maternal outcome. Keywords: Morbidly Adherent Placenta, Maternal Morbidity, Massive Obstetric Hemorrhage, Obstetric Hysterectomy.

Pregnancy and childbirth is an event celebrated worldwide. During pregnancy physiological changes and increasing demand causes fall in hemoglobin level leading to anemia and adverse pregnancy outcome especially in young girls. Anemia is a major public health problem. Around 58.27 million women worldwide are anemic during pregnancy 95% of whom live in countries that are developing. To know the frequency of anemia, and obstetric outcome in terms of preterm delivery, low birth weight and rate of caesarean section in young Primigravida. It was a cross sectional study, conducted in the department of Gynae & Obstetric unit 5 King Edward Medical University Lahore during a period of one year from May2013 April 2014. All primigravida young 15-24years with anemia enrolled for the study. Anemia is defined as hemoglobin< 10.5g/dl (WHO Criteria), Iron deficiency Anemia is defined as serum ferritin level less than 12 micro gram per ml and on Red Blood Cell indices, i.e. decrease in MCV, MCH and MCHC, and Microcytic Hypochromic cells in Peripheral Smear. Megaloblastic anemia was labeled when Macrocytic Hypochromic cells seen. Obstetric outcome in terms of Preterm delivery defined as delivery at <37 weeks of gestation (36 +6 weeks) and birth weight <2500g mand a need for operative delivery. Patients fulfilling the selection criteria as per operational definition were included in the study after taking informed consent using non probability consecutive sampling technique. Data was collected on a pre-designed questionnaire. A total of 3855 deliveries during study period in which 1318 were primigravida. Mean age in study group was 15 to 24 years. We observed mild anemia in 46% of woman, moderate anemia in 41% and severe anemia in 13% in young primigravida. Preterm delivery was noted in 25% of the females and low birth weight babies were noted by 33% in teenage and young primigravida. Statistically significant relationship was found between maternal age, education and socio economic status. Anemia in pregnancy nowadays is still a common problem in adolescent and young primigravida and associated with adverse pregnancy outcome. Prompt measure should be taken by the stake holders at local and national level to prevent and treat this problem in order to reduce morbidity and mortality associated with it.

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