A prospective study of 20 cases of maternal outcome in morbidly adherent placenta in tertiary care hospital

Abstract

Background: Morbidly adherent placenta with its variants is one of the most feared complication causing high morbidity and mortality in obstetrics. Aim of this study is to help in identifying high risk pregnancies, planning line of management of morbidly adherent placenta. The objective of the study wad to evaluate the risk factors, different modes of management, maternal outcome in case of morbidly adherent placenta.Methods: A prospective study for one year was done to describe the incidence, causes, treatment, complications, and maternal morbidity and mortality associated with morbidly adherent placenta.Results: A total of 20 cases of morbidly adherent placenta were studied over one-year span at our Institute. Most of the women with morbidly adherent placenta were in the age group of 26-30years (55%).The most common aetiology of morbidly adherent placenta was previous caesarean scar with placenta praevia (85%). In majority, placenta accreta found. Total abdominal hysterectomy done in 12 patient and subtotal hysterectomy in 6 cases. Trial haemostasis with uterine sparing in 2 cases out of which one case underwent total hysterectomy due to massive haemorrhage on same day. Associated Bladder repair in adherent placenta with invasion of bladder was needed in 10% cases. There was 1 maternal death noted in this study.Conclusions: Leading cause of morbidly adherent placenta is previous caesarean section with placenta praevia, high index of suspicion, early antenatal diagnosis, planned surgery at high care centre with multi-disciplinary expertise, anticipation of blood volume transfusion, Delivery of foetus without manipulating placenta are key steps to reduce morbidity and mortality in morbidly adherent placenta. The decision to perform hysterectomy and conservative management to be individualized. Timely decision is the key to get success in morbidly adherent placenta as in other obstetric emergencies.

Evaluation of Protocol of Management of Morbidly Adherent Placenta in Maternity Zagazig University Hospital

“…Table (2) shows that most of cases had 3 C.S by a percent of 49.1%, 80% had no history of D&C and there was no other previous intraoperative manipulations for the studied cases. Table (3) shows that most prevalent morbid adhesion was accrete by a percent of 62.5% Table ( 4) shows that most of cases were managed surgically by caesarean hysterectomy by a percent of 60%.…”

Maternal Factors and Complications Associated with Morbidly Adherent Placenta: An Experience at a Tertiary Care Hospital in Pakistan

“…1 In the preceding 50 years, a tenfold rise in caesarean deliveries has been witnessed, paralleling the incidence of abnormal placentation. 2 The incidence of MAP has increased from 1/2500 to 1/110 deliveries in the last few years. 3 MAP is commonly associated with placenta previa in women having previous caesarean scars.…”