Objectives The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. Methods This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. Results The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26-28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fiftythree per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. 123Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000-2000 mL. Conclusion Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.

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A 30-year-old, third gravid with two previous abortions, with in vitro fertilization conception with 11 weeks and 6 days of gestation, came with complaints of mild bleeding per vaginum. Ultrasonography revealed a live pregnancy in the cervical canal corresponding to 12 weeks of gestation. Single dose of intramuscular methotrexate 1 mg/kg was given. Three days postmedical management, transvaginal ultrasound-guided intracardiac instillation of potassium chloride 1.5 mL was carried out. Injection methotrexate, 4 mL, was instilled in the amniotic cavity. On day 5 postprocedure, patient had a bout of severe vaginal bleeding for which emergency vaginal exploration was carried out. Products of conception were suctioned out and placenta was removed. Hemostatic cervical vascular sutures were taken on either side to occlude the descending branch of cervical artery. A Foley catheter (18F) was inserted in the cervical canal and distended with 60 mL of normal saline, thereby compressing the placental bed from within the cervical canal. Hemostasis was achieved and maintained.