Morbidly adherent placenta and it’s maternal and fetal outcome

Desai, Ranjana; Jodha, Bhanwar Singh; Garg, Richa

doi:10.18203/2320-1770.ijrcog20171943

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…According to recent study conducted by Desai R et.al. "Morbidly adherent placenta and its maternal and fetal outcome", 60% underwent hysterectomy, 90% had prolonged hospital stay, 80% required blood transfusion, 50% required FFP transfusion, 10% required bladder repair and 10% was the mortality rate which is comparable to our study 9 .In a metaanalysis of placenta percreta with bladder invasion published by Washecka and Behling there was three maternal deaths out of 54 cases 10 . All women with vaginal bleeding after 20 weeks of gestation should be suspected of having MAP.…”

Section: Discussionsupporting

confidence: 82%

Morbidly adherent placenta: management and maternal outcome

2017

Int. J. Curr. Res. Med. Sci.

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Background: Morbidly adherent placenta(MAP) is one of the potentially life threatening conditions and most feared complications causing high morbidity and mortality in obstetrics. The objective of this study is to identify the risk factors to analyse different management options and maternal outcome in different cases of MAP. Methods: This is a retrospective study carried out on 36 patients of MAP(Morbidly adherent Placenta) in a tertiary health centre from July 2015 to January 2017. Diagnosis of MAP was made with the help of Ultrasonography, color Doppler study and MRI in patients presenting in the OPD and emergency department. Almost all the patients were managed by operative delivery with TAH(Total Abdominal Hysterectomy) as the most common procedure done. Different risk factors for MAP, management protocols and maternal outcome were studied in these patients. Results: 36 cases of MAP who presented in OPD and emergency were identified. In this study, frequency of MAP was found to be 1 per every 381 births. Most of the patients had previous scarred uterus and many underwent peripartum hysterectomy. Only 3 patients died in this study. The neonates of mothers whose MAP were suspected prior to delivery were born premature and required ventilatory support, admission to NICU with prolonged hospital stay. Conclusion: MAP is more common in patients with previous Caeserean section with anterior implantation of placenta and in multiparous women. Antenatal diagnosis of morbidly adherent placenta followed by elective TAH without separating the placenta adapting multidisciplinary approach is the best surgical option to reduce maternal mortality and morbidity.

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Section: Discussionsupporting

confidence: 82%

Morbidly adherent placenta: management and maternal outcome

2017

Int. J. Curr. Res. Med. Sci.

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“…To significantly improve fetal maturity and to decrease fetal morbidity, the pregnancy should be carried as close to full term as possible. An elective surgery was done in 47% of patients with PA in our study, an attempt to avoid emergent surgery as some institutions justify elective surgery at 34-35 weeks to decreased neonatal morbidity [28][29][30] .…”

Section: Discussionmentioning

confidence: 99%

Incidence And Risk Factors Of Maternal And Fetal Outcomes Among Patients Of Placenta Previa With And Without Placenta Accreta

Khattak¹,

Akram²,

Pervaiz³

et al. 2018

J. Bahria Uni. Med. Dent. Coll.

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Objective: The aim of the study was to evaluate maternal and fetal outcomes among patients of placenta previa (PP) with and without placenta accreta (PA). Methodology: All patients who underwent cesarean section for PP and PA were analyzed retrospectively at a tertiary care Combined Military Hospital Kharian, Pakistan, from February 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. Results: PA was found in 37 patients from 111 patients of PP and 74 were without PA with the rate of approximately 2/1000 and 4/1000 respectively were included in the study. The mean age was 31.16±2.65 (range 22–37) years, mean gravidity of 3.69 ±1.40 (range 1 - 9), mean parity 2.57±1.01 (range 1–5), mean number of cesarean sections 2.10±0.66, (range 1-3) and a mean gestational age at the time of cesarean section was 35.65±2.46 (range 28–41) weeks. The maternal risk factors revealed marked differences between placenta previa with accreta and without accrete. The mean intraoperative blood loss in PA was 3,000ml, with a loss of 2,000ml occurring in 60%, and 3,000 ml in 21% of the PA cases. The mean pRBC transfusion was 4 units, while 17% received 6 units. Fetal growth restriction was not seen. A total of 12 neonates were admitted in NICU, with 03 neonatal deaths. There was no maternal death. Neonates born to women with placenta accreta had significantly lower birth weight, Apgar scores at 1 min and 12% required admission to NICU with 3 neonatal deaths. Conclusion: The advanced maternal age, past cesarean or uterine surgery, high parity as well as multiple gravidity were the risk factors for adverse fetal and maternal outcomes.

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“…13 In morbidly adherent placenta; peripartum hysterectomy was carried out in 60%( 6), ICU transfer in 80% (8), prolong hospital stay (> than 7 days) in 90% ( 9), blood transfusion in 80% (8), FFP transfusion in 50% (5), bladder injury in 10%(1) , internal iliac artery ligation in 10% (1) , and maternal mortality in 10%(1) cases. 15 Regarding foetal outcome mean gestational age 35.08±2.34 versus 36.45±1.02, and mean baby weight 2.52± 0.66 versus 2.81± 0.37. It was less in cases of placenta praevia versus morbidly adherent placenta praevia (p=0.00).…”

Section: Discussionmentioning

confidence: 98%

Foeto-Maternal Outcome in Women with Placenta Praevia and Morbidly Adherent Placenta Praevia

Sultana¹

2022

Ann Pak Inst Med Sci

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Objective: To determine the maternal and foetal outcome in pregnant women with placenta praevia and morbidly adherent placenta praevia Methodology: A prospective case series was carried out in a tertiary care institution between 2019 and 2021. All pregnant women with placenta praevia and placenta accreta spectrum who were over 28 weeks gestation were included, regardless of whether they received their diagnoses during pregnancy or during surgery. Data was collected on structured proforma regarding demographic characteristics, obstetric factors, management options, and intraoperative complications to determine foeto-maternal outcome in women with placenta praevia and morbidly adherent placenta praevia. Results: Total number of patients with placenta praevia was 140; out of which 31 (22.1%) had placenta accreta spectrum. All cases of morbid adherence were found in major degree placenta praevia (p= 0.00). Antepartum haemorrhage in current pregnancy was more associated with placenta praevia as compared to morbidly adherent placenta praevia (p=0.00). Both placenta praevia with and without morbid adherence led to preterm birth (p=0.00). LSCS as mode of delivery in previous pregnancy, step-wise-devascularization, caesarean hysterectomies, bladder injury, blood loss more than 1000ml, number of blood transfusions, and mothers required ICU care were significantly associated (p≤0.05) with morbidly adherent placenta praevia as compare to placenta praevia without morbid adherence. In cases of placenta accreta spectrum; 11(33.3%) babies were admitted in NICU as compare to 29(25.9%) in placenta praevia without placenta accreta spectrum. Conclusion: Placenta praevia is adversely affected by placenta accreta spectrum is associated with higher foeto-maternal morbidity as compared to placenta praevia without adherence.

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Morbidly adherent placenta and it’s maternal and fetal outcome

Cited by 11 publications

References 11 publications

Morbidly adherent placenta: management and maternal outcome

Morbidly adherent placenta: management and maternal outcome

Incidence And Risk Factors Of Maternal And Fetal Outcomes Among Patients Of Placenta Previa With And Without Placenta Accreta

Foeto-Maternal Outcome in Women with Placenta Praevia and Morbidly Adherent Placenta Praevia

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