Outcomes of pregnancies with a morbid adherent placenta from a tertiary referral Centre in North India

Abstract

Morbid adherent placenta (MAP) is an abnormality of placental implantation that is an important cause of maternal and fetal mortality. The maternal mortality may reach up to 7% and is associated with multiple maternal morbidities e.g. massive transfusions, infections, urologic injuries and fistula formation. The present study was a retrospective observational study done to evaluate the profile and outcome of pregnancies diagnosed with MAP over three years. Forty nine patients were diagnosed with MAP. The incidence was 1.21 per 1000 pregnancies. A majority of patients were multi gravidas and had a history of previous caesarean section(CS). Placenta previa was present in 61.2% patients. Forty seven patients had to undergo a hysterectomy and 75% of patients had to undergo the internal iliac artery ligation to achieve hemostasis. 31 patients (63.2%) required intensive care admission and monitoring. There was one death in our cohort. MAP is an important cause of maternal morbidity and mortality and its incidence has been on the rise due to increased CS deliveries. CS and placenta previa are important risk factors for MAP. Early recognition of at risk pregnancies and subsequent risk based counselling and management can help optimise the outcomes in MAP.

Morbidly Adherent Placenta: A Cross-sectional Study in a Tertiary Care Hospital

“…Another study conducted at a local hospital in the same city quoted its incidence as 4.7 per 1000 deliveries 4 . Similar studies done in India and Bangladesh have shown its incidence of 1.2 and 2 per 1000 deliveries respectively 5,6 .…”

“…Maternal morbidity of 60% and mortality of 7% have been reported worldwide in literature 5,11,17 . Whereas in this study maternal mortality was 4.4%, the cause was DIC and multi-organ failure secondary to hemorrhage which is consistent with another study carried out by Yasmeen et al in which 6.6% of patients with MAP died due to a similar cause 10 .…”

“…The most generally accepted lifesaving approach to MAP is cesarean hysterectomy with placenta left in situ after delivery of the fetus 4 . Optimal management of these patients involves a standardized approach with multidisciplinary care team 4,5 .…”