Reducing Mortality and Morbidity in Morbidly Adherent Placenta

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...

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...

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...

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome. Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded. Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series. Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.

Pakistan Journal of Medical and Health Sciences

Aim: To determine the fetomaternal outcome in morbidly adherent placenta Study design: Cross-sectional study. Place and duration of study: Department of Obstetrics & Gynecology, Liaquat University Hospital Hyderabad from 1st January 2022 to 30th June 2022. Methodology: Forty five females of adherent placenta were enrolled. The consent was taken from every relevant patient having low lying placenta with previous scar/surgery the following details were collected. The operative events were recorded. Results: The mean age was 30.77 years and mean gestational age was 34.15 weeks. Majority of the cases 53.3% had history of three previous C-sections, 64.4% cases had placenta accreta, 20% had placenta percreta and 15.6% had p Placenta increta. Antepartum haemorrhage was seen in 68.9% of the cases. 55.6% females underwent C-sections, 22.2% were admitted in ICU, rate of the hysterectomy was high, 46.7% one patient was died. Considering the fetal outcome, 22.2% of the cases had fetal growth re...

The professional medical journal, 2020

To determine the burden of Morbidly Adherent Placenta on tertiary care centre in terms of prolonged hospital stay, multiple blood transfusions, Intensive care unit stay, involvement of surgical urological colleges. Study Design: Descriptive Case Series.

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.

Adherent placenta is a serious pregnancy condition, where placenta invades into uterine wall up to varying depth. Rising rate of cesarean section and increasing maternal age are the major causes. There were 8 cases reported in 1 year (2018-2019) study. All were undiagnosed cases of adherent placenta. Maternal morbidity and mortality is caused by life threatening hemorrhage and massive blood transfusion. In our study blood transfusion rate was (100%), hysterectomy (84%), major artery ligation rate (56%) and mortality rate was (14%). Antenatal imaging and high index of suspicion help in the diagnosis.

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...