Morbidly Adherent Placenta: Management options

Abstract

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.