BACKGROUNDMorbidly adherent placenta is on rise due to the increasing incidence of caesarean section and other uterine surgery. The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and its management, maternal and perinatal outcome of these patients.
MATERIALS AND METHODSThis was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, VIMSAR, Burla, India from March 2015 to February 2017.
RESULTSIn the present study, there was a total of 21 patients diagnosed of morbidly adherent placenta with the incidence of 1.14 per 1000 pregnancies. Previous caesarean along with placenta previa constitutes 13 (61.90%), which is the main risk factor for the development of morbidly adherent placenta. Out of 21 patients 17 (80.95%) require hysterectomy, 2 (9.52%) managed with subtotal hysterectomy and 2 (9.52%) managed conservatively. Five (23.80%) patients had bladder injury. The mean blood loss during surgery was 2.1 ± 0.312 litre. One case of placenta percreta who later on developed disseminated intravascular coagulation died of the disease. Seventeen (80.95%) of the patients had live birth and 4 (19.05%) had fresh still birth. Six (28.57%) babies admitted in a neonatal ICU for better care. Out of 21 babies, 6 (28.57%) required neonatal intensive care for neonatal complications.
CONCLUSIONPatients with previous caesarean with placenta previa always should be referred to the nearest tertiary care centre keeping adherent placenta as a possibility. It is always preferable to take the help of a senior obstetrician in such cases to reduce the morbidity and mortality.
KEYWORDSPlacenta Accreta, Increta and Percreta; Previous Caesarean Section; Peripartum Hysterectomy; Internal Iliac Artery Ligation. HOW TO CITE THIS ARTICLE: Dandapat AB, Pande B, Dora SK, et al. A retrospective study on adherent placenta-its management, maternal and perinatal outcome. J. Evolution Med. Dent. Sci. 2017;6(34):2785-2788, DOI: 10.14260/Jemds/2017/600 BACKGROUND Morbidly Adherent Placenta (MAP) includes placenta accreta, placenta increta and placenta percreta. Detachment is delayed in MAP, because the placenta is unusually adhered to the implantation site. In this case, the decidua is scanty or absent, and the physiological line of cleavage through the decidual spongy layer is lacking. Incidence of MAP is on rise due to increasing trend in caesarean section rate. 1,2 The incidence of MAP in USA 3,4 is 1 in 2500, that of in Canada 5 is 14.4 per 10,000 and in UK 6 it is 1.7 per 10,000. Besides caesarean section surgery involving uterus like myomectomy, dilatation and curettage, previous hysterotomy all lead to abnormality in placental implantation and defective Nitabuch layer formation. All this also predisposes the women to have placenta previa and more ominously MAP. 7Financial or Other, Competing Interest: None. Submission 06-04-2017, Peer Review 19-04-2017, Acceptance 21-04-2017, Published 27-04-2017. Corresponding Author: Atal Bihari Dandapat, Department ...