Demographic profile and high risk factors in morbidly adherent placenta

Rizvi, Syed Masuma; Fayaz, Farhana

doi:10.18203/2320-1770.ijrcog20161336

Cited by 6 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean age of women with PAS in our study was 29.8 years and this was comparable to the study by Aggarwal et al [9] but lower when compared to the study by Rizvi SM et al [10] In our study, the most significant risk factors for the placenta accrete spectrum were previous caesarean section and placenta previa; each present in 72% of the women with PAS. It has been revealed in a prospective study that risk of Placenta accrete spectrum was 3% in women with placenta previa and no prior caesarean section but 11% in women with placenta previa with one previous caesarean section.…”

Section: Discussionsupporting

confidence: 81%

Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre

Rani¹,

Jain²,

Nanda³

et al. 2019

Int. J. Clin. Obstet. Gynaecol.

View full text Add to dashboard Cite

The aim of this study was to evaluate the demographic profile, risk factors, management strategies in women with placenta accrete spectrum and also to see the feto-maternal outcome of these women. Study design-Prospective AnalysisMethods: This study was conducted in the Department of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana from January 2017 to December 2018. All the women who were diagnosed as placenta accrete spectrum (PAS) either on ultrasonography, magnetic resonance imaging or intra-operatively were included in the study. Results: During the two year study period, there were 22745 deliveries, out of which 22 patients were diagnosed to have placenta accrete spectrum, therefore, the incidence was 0.09%. The majority (41%) of the women in study belonged to the age group of 30-35 years. Most of the women (77%) were unbooked and 80% were from rural background. None of the women in our study were primiparous. The risk factors for PAS in our study included history of one caesarean section in 11(50%) patients, two caesarean section in 4 (18%) patients and history of three caesarean section in 2 (9%) patients. Co-existing placenta previa was present in 17 (77%) of the women with placenta accrete spectrum. Eight women (36%) had placenta accrete, one (5%) had placenta increta and rest of the 59% were diagnosed as placenta percreta. The maternal complications encountered in the study were post-partum haemorrhage (95%), bladder injury (59%), DIC (9%) and sepsis (5%). Maternal mortality rate was 9%. The most common neonatal complication was prematurity and low birth weight. Conclusion:The rising rates of caesarean sections is an important factor behind increase in incidence of placenta accrete spectrum. Early diagnosis in antenatal period, timely intervention, multi-disciplinary team approach and adequate arrangement of blood and blood products is a key for successful management of PAS, thereby, reducing maternal and neonatal morbidity and mortality.

show abstract

Section: Discussionsupporting

confidence: 81%

Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre

Rani¹,

Jain²,

Nanda³

et al. 2019

Int. J. Clin. Obstet. Gynaecol.

View full text Add to dashboard Cite

show abstract

“…The average age of women (31.5 ± 0.8) was comparable to the data of Rizvi and Fayaz, 31.8 years, 14 Cheng and Lee 5 , 32.64 to 34.64, 5 and was more than 30 years old, as in the studies of Wu et al 2 In this study, well-known evidence confirmed that AIP is associated with known risk factors, and the scar on the uterus after CS multiplies the risk of AIP by many times. Of the 39 women with recurrent childbirth, 33 had a history of CS.…”

Section: Discussionsupporting

confidence: 85%

“…10 Risk factors for AIP are uterine scar after CS, or other surgical procedures on the uterus, the multiparity, age over 30 years, and living in rural areas. 5,[11][12][13][14] The risk of uterine rupture, hysterectomy, and massive blood loss requiring transfusion is increased with AIP. 12 Modern diagnostic imaging methods, such as different modes of conventional and three-and four-dimensional ultrasound and MRI enabled diagnosis of AIP as early as in the first trimester of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Management of Abnormally Invasive Placenta: One-center Experience

Penzhoyan¹,

Новикова²

2016

Donald School Journal of Ultrasound in Obstetrics and Gynecology

View full text Add to dashboard Cite

Aim: To present one-center experience of the management of abnormally invasive placenta (AIP). Materials and methods:This was a retrospective cohort study of clinical cases of abnormally invasive placenta (the AIP) in Perinatal Center (PC), which is part of General Hospital-Regional Clinical Hospital N2 of Krasnodar city, in the period from 2014 to August 2016. Results:The total number of childbirth for the period was 24 078, and AIP was diagnosed in 0.17%. The average age of women was 31.5 ± 0.8 years. About 97.5% were multiparous women and 85% women in the previous pregnancy had childbirth by cesarean section (CS): One CS-41.18%, two-32.35%, and three-23.53%. An AIP was first diagnosed in pregnancy at 11 to 39 weeks of pregnancy by ultrasound or magnetic resonance imaging (MRI). Cesarean section performed in the conditions of the X-ray operating of the endovascular department. The relative risk (RR) for accurate diagnosis of AIP by ultrasound was 1.789 ± 0.709 [95% confidence interval (CI) 0.446-7.186], and for MRI RR was 0.944 ± 0.142 (95% CI 0.715-1.246). At CS, in 85% of women balloon dilatation of the iliac vessels was performed, in 15%, uterine artery embolization (UAE), and in 72.5%, metroplasty. In 15% of women with AIP were the cause of hysterectomy without adnexa. The total blood loss was 1152.56 ± 107.67 (4,000-35,000) mL or 15.539 ± 1.7374 (5,0000-58,330) mL/kg. Maximum blood loss was in women with placenta previa and its localization in the area of the scar on the uterus that required a hysterectomy. Conclusion:Despite increasing incidence of AIP, it is possible to prevent massive blood loss during delivery by combined treatment using radiological endovascular procedures for devascularization of the lower pelvis. Early diagnosis of placental abnormalities with regionalized approach in perinatal health makes it possible not only to preserve the women's reproductive health and fertility but also to minimize postpartum hemorrhage.

show abstract

“…Placenta Accreta Spectrum (PAS) is a complication that commonly arises following a previous caesarean section (CS) or uterine surgery [1][2][3]. The placenta is inseparably attached to the myometrium with varying depths of invasion.…”

Section: Introductionmentioning

confidence: 99%

“…Increasing depths of invasion is associated with increased rates of complications which can be life-threatening and life-altering. PAS is associated with antenatal, intrapartum, and postpartum complications that have increased maternal and foetal morbidity and mortality [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions

Wijesinghe

Rishard

Srisanjeevan³

2022

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Introduction Placenta accreta spectrum (PAS) is associated with a multitude of maternal and fetal complications. Events related to its management have resulted in significant psychological morbidity, with lifelong consequences which warrant continuous support to cope with their lives. The objective of the study is to highlight the importance of multidisciplinary holistic care and explore room for improvement in the provision of care for women with PAS. Methods Our study was conducted on deliveries complicated with PAS from January 2019 to June 2021. 27 women were diagnosed with PAS during this period and received treatment. Impact of life event scale- revised (IES-R) and short form health survey-36(SF-36) questionnaires were administered to assess the impact of PAS on their lives. In depth interviews were conducted with the women. A multidisciplinary team meeting was later conducted to formulate a comprehensive care plan for women with PAS. Results The response rate was 96.2%. Mean age of the sample is 34.1 years (SD 4.3). Interval to current pregnancy varies from 0.6 years to 10 years with mean of 4.6 years. Mean gestational age of diagnosis of PAS was 25.4(SD 6.7) weeks. The care bundle provided for women with PAS was evaluated in all cases. Surgery was conducted electively in 82% of patients. Blood transfusions were noted in 85%. Mean pre-operative stay was 9.5 days (SD 8.3) and mean post-operative stay was 8.8 days (SD 8). Total hospital stay ranged from 6 to 48 days (mean 19.5 days, SD 11.4). IES-R scores were significant in 4/26 patients. There was no correlation with the interval from the surgery with any of the subscales or with the total scores. The lapsed time after the surgery had a significant correlation with physical functioning and pain domains of the SF-36 questionnaire. Description of the experience, loss of femininity with loss of the uterus, concerns and fears about the future and measures to improve the quality of care were the themes identified and described. A multidisciplinary team meeting, consisting of consultant obstetricians performing surgery for PAS, anesthetists, hematologist, transfusion medicine specialist, urologist, physiotherapist, nutritionist and nursing officers from ICU and wards, was held and their contributions helped to map out a definitive care plan. Conclusions PAS is associated with long term physical and psychological morbidity. Continuous support through quarterly clinic visits and telephone conversations may alleviate the psychological trauma. However, some physical disabilities may be lifelong and life changing. Importance of reducing primary caesarean section and promoting trial of labour after caesarean delivery should be promoted among patients and caregivers.

show abstract

Demographic profile and high risk factors in morbidly adherent placenta

Cited by 6 publications

References 9 publications

Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre

Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre

Management of Abnormally Invasive Placenta: One-center Experience

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions

Contact Info

Product

Resources

About