Morbidly adherent placenta: management is real challenge

The Journal of Obstetrics and Gynecology of India, 2012

Objective To evaluate the demographic profile, high risk factors, fetomaternal outcome and management options in morbidly adherent placenta (MAP). Study Design Retrospective analysis. Methodology Review of 20 case records of women with MAP during year 2001-2006. Results The mean age and parity of the women was 27.7 ± 4.2 years and 2.5 respectively. 70 % women had previous uterine scar, and similar number had placenta previa. 60 % women presented with antepartum hemorrhage and 20 % with retained placenta. 85 % women underwent hysterectomy with 5 % requiring internal iliac artery ligation, another 5 % partial cystectomy and 15 % bladder repair. Blood loss was between one and nine litres requiring an average of six units whole blood and 4 units FFP. There were six (30 %) maternal deaths. 55 % of the newborns were preterm and the perinatal mortality was 33.3 %. Conclusion Cesarean section and placenta previa are significant risk factors. MAP is associated with high fetomaternal morbidity and mortality.

Pakistan Armed Forces Medical Journal, 2018

Objective: To identify risk factors predisposing to morbidly adherent placenta and to study obstetric outcome insuch patients.Study Design: Retrospective descriptive study.Place and Duration of Study: Department of Obstetrics and Gynaecology Military Hospital Rawalpindi, from Jan2014 to Dec 2014.Material and Methods: A total of 54 patients with morbidly adherent placenta were studied retrospectively.Patient’s data including demographic data, previous obstetric history and outcome was collected from hospitalrecords. Data was analyzed by using SPSS version 20.Results: The incidence of morbidly adherent placenta was 4.74 per 1000 deliveries. Mean age of patients was 33.33± 2.82 years with mean gestational age of 35.13 ± 0.91 weeks. All patients had history of prior caesarean sectionwith 4 (7.40%) patients having four, 32 (59.25%) having three, 16 (29.62%) having two and 2 (3.70%) having oneprevious caesarean section. Associated placenta previa was present in 43 (79.62%) patients. Out o...

Pakistan Postgraduate Medical Journal, 2021

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...

The Egyptian Journal of Hospital Medicine, 2017

Background: morbidly adherent placenta is defined as an abnormal adherence of all or part of the placenta to the underlying uterine wall. Aim of the work: this study aimed to evaluate the management of morbidly adherent placenta in Ain Shams Maternity Hospital during the 5-year period from January 2012 to December 2016.Study Design: this is a retrospective study. Study Setting: Ain Shams University Maternity Hospital. Patients and Methods: records of hospital admissions during the planned time frame with the diagnosis of antepartum hemorrhage or placenta accreta/increta/percreta were reviewed. Results: Ain Shams University Maternity Hospital (ASUMH) is a major tertiary referral hospital in Egypt. In evaluation of the management and short term maternal and perinatal outcomes of morbidly adherent placenta offered to women at ASUMH, the hospital archives were examined for hospital records fulfilling the criteria of this study population during the 5-year period from January 2012 to December 2016. During the 5-year period of the current study, there were 58,529 deliveries; 29,282 cases; they were delivered by CS (50.03%). MAP was diagnosed in 429 cases 0.7 % of total deliveries with an incidence of 1 in 136, 1.5% of total CS. These results indicated a high incidence of MAP, as a result of high rates of CS. Conclusion: morbidly adherent placenta was highly associated with the existence of placenta previa, especially in cases with previous cesarean section. When morbidly adherent placenta was diagnosed or suspected antenatally, the patient must be referred to a tertiary center. Generally, the recommended management is cesarean hysterectomy. However, this approach might not be considered first-line treatment for women who have a strong desire for future fertility. Therefore surgical management of morbidly adherent placenta may be individualized.

2019

Objective: To determine the mortality and adverse outcomes in cases presenting with morbidly adherent placenta presenting to a tertiary care hospital. Study design: This was a cross sectional study. Settings: District Headquarter Hospital Rawalpindi. Duration: 01-06-2015 to 30-11-2015. Methodology: The females between the age of 20 to 40 years, delivering at the same institute with morbidly adherent placenta were selected. The diagnosis of MAP was made on the basis of clinical or histo-pathological examination. These cases then underwent with hysterectomy and were looked for bladder injury, blood loss, ICU admission or maternal death. Results: In the present study 40 cases of morbidly adherent placenta were included. the mean age of the subjects was 33.58±6.34 years. The mean parity was 2.1±0.98 and 54% of the cases had a prior C section and only 18% of the cases had a regular ante natal follow up. After the surgery bladder injury was seen in 10%, ICU admission in 32.50% of the case...

The Journal of Obstetrics and Gynecology of India, 2016

Objectives The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. Methods This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. Results The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26-28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fiftythree per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients.

Background : The morbidly adherent placenta (MAP), once a rare occurrence, is now an increasingly common complication of pregnancy secondary to the increase in cesarean delivery rates. The massive haemorrhage associated with this condition leads to severe maternal morbidity and mortality.There are various surgical methods in use to control bleeding from the placental bed,but MAP has replaced atonic post partum haemorrhage as the leading cause of Cesarean hysterectomy. Aim : to analyse the surgical management of the morbidly adherent placenta with the objective of reducing maternal morbidity and mortality ,by studying the various surgical methods used to achieve haemostasis. Results : 36 cases of MAP managed between January to December 2017 were analysed.The average age of the cases was 24 years,with average gravidity 2.All patients had undergone previous cesaerean delivery with average of 2 previous LSCS.22 cases were diagnosed in the antenatal period and the rest during cesaerean section. 17 cases were delivered between 32 to 38 weeks of gestation. 3 cases were managed by hysterectomy with placenta insitu. In the18 cases where uterine sparing surgery was undertaken 10 cases had to undergo hysterectomy and bilateral hypogastric artery ligation for control of bleeding.Average blood and component therapy was 6 and 8 units.Ionotropic support was required in 13 cases and ventilator support in 9 cases.Bladder injury occurred in 6 cases and ureteric injury in 2.There was maternal mortality in 3 cases-8.3%. Conclusion: Patients diagnosed in the antenatal period undergoing planned surgery had better outcomes with fewer blood transfusions and shorter hospital stay. Uterine sparing surgery was associated with significant maternal morbidity and was not successful in 54 % of cases.Compression sutures ,with bilateral hypogatic artery ligation was the most common surgical technique used to control bleeding from the placental bed.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Background: Morbidly adherent placenta is still a very significant cause of obstetric hemorrhage.Methods: A retrospective, descriptive study was undertaken over a period of one and a half year in a tertiary care hospital of all diagnosed cases of morbidly adherent placenta which were managed conservatively and the maternal and perinatal outcomes were noted. Preparation for conservative management of cases of adherent placenta in the antenatal period included informing interventional radiologists and placement of internal iliac balloon catheters just before classical caesarean section. Post-operative methotrexate was used in a few patients.Results: 11 cases of morbidly adherent placenta diagnosed on Doppler ultrasound scan, and confirmed by MRI were identified. All patients underwent classical caesarean section. 9 patients had internal iliac balloon placement. 5 patients received methotrexate. 3 patients required obstetric hysterectomy. 1 maternal and 2 perinatal mortalities were not...

Bangladesh Journal of Obstetrics & Gynaecology

Objective:The study is aimed to describe the grave maternal outcomes encountered inpatients having morbidly adherent placenta along with history of previous caesarean section. Materials and Methods: This was a cross-sectional study from September 2014 to August2015. All the patients attended in the in-patient department of obstetrics & gynaecology inDMCH during the study period having morbid adhesion of placenta (diagnosed antenatallyby USG or diagnosed preoperatively) along with history of previous caesarean section. Result: Total 10,805 obstetric patients delivered during the study period, of which 6,337patients had caesarean sections. Out of them 37 pregnant patients were found to havemorbid adhesion of placenta along with history of previous C/S. The incidence is 1 in 292deliveries. All of the 37 patients needed hysterectomy for intractable per operativehaemorrhage. All the patients needed transfusion of more than 04 units of blood. Nineteenpatients needed ICU supports Ten (27%)...

2019

Background and Aims: Morbidly Adherent Placenta(MAP) is associated with severe morbidity like severe postpartum haemorrhage (PPH), probable need for massive blood transfusion and invasive procedures such as hysterectomy. We reviewed all cases of MAP in our institute between May 2015 to July 2019. The main objectives of the study were to determine the incidence, risk factors and both fetomaternal outcome in these women. Material and Methods: This was a retrospective study done in the department of Obstetrics and Gynaecology, Father Muller Medical College, Mangalore from May 2015 to July 2019.There were 12 women with MAP during this period. Results: In the present study, there were a total of 12 cases of MAP over 5 year period with incidence of MAP being 0.017%(1/983 live births).The mean age of the women was 31 years. Among 12 women, 10(84%) were multigravida, 7 (58 %) were within 28 weeks to 37 weeks period of gestation(POG). Risk factors associated with MAP included 11(90%) cases h...