Evaluation of outcome of pregnancy in placenta accreta spectrum
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20213444Keywords:
Placenta accreta spectrum, Haemorrhage, Caesarean hysterectomyAbstract
Background: Aim of the study was to evaluate the outcome of pregnancy in placenta accrete spectrum in third trimester pregnancy at tertiary care centre
Methods: This hospital based retrospective study was carried out from 2017 to 2019. The case records of all women identified as placenta accrete spectrum from the hospital registers were retrieved. A total of 166 patients with the diagnosis of placenta accrete spectrum were included in the study.
Results: The incidence of morbidly adherent placenta is 5 per 10,000 deliveries with mean age being 32.4±4.2 (23-39) years. and showed its relation with risk factors such as previous caesarean section (CS), placenta praevia and multiparity. The mean duration of MICU stay in placenta previa was 6.7±1.9 days (range 2-12 days). With complications in 18 cases of which urinary bladder injury (3%), infection (9%), PPH and coagulopathy (4.2%). The placenta was removed successfully in 141 while 25 cases had caesarean hysterectomy (2.4%). In total 166 cases 26 (16.8%) cases are intrauterine device (IUD) and still births. 5 (3%) cases are very low birth weight, 24 cases (14.5%) are low birth weight babies, 76 (45.8%) cases had neonatal intensive care unit (NICU) admissions followed by 10 (6%) cases with <5 APGAR score.
Conclusions: Placenta accreta spectrum can be identified antenatally with a high index of suspicion in the presence of known risk factors and proper radiological studies, allowing for planned attempts to avoid life-threatening haemorrhage and caesarean hysterectomy.
Metrics
References
Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006;107:1226-32.
O’Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175:1632-8.
Ajah LO, Eze MI, Dim CC, Ezegwui HU, Nikwo PO, Eluke CC et al. Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in low resource setting. Niger J Med. 2012;21:359-60.
Belfort MA, Shamsirsaz AA, Fox KA. The diagnosis and management of morbidly adherent placenta. Semin Perinatol. 2018;42:49-58.
Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynaecol. 2010;115:65-9.
Slaoui A, Talib S, Nah A. Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature. Pan Afr Med J. 2019;33:86.
Farquhar CM, Li Z, Lensen S, McLintock C, Pollock W, Peek MJ. Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study. BMJ Open. 2017;7(10):e017713.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177(1):210-14.
Carusi DA. The PAS disorders Spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018;61(4):733-42.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P et al. Incidence and risk factors for PAS disorders/increta/Percreta in the UK: a national case-control study. PLoS One. 2012;7(12):e52893.
Farquhar CM, Li Z, Lensen S. Incidence, risk factors and perinatal outcomes for PAS disorders in Australia and New Zealand: a case-control study. BMJ Open. 2017;7:e017713.
Choudhary D, Nigam A, Yadav R, Choudhary S. Placenta Accreta: Obstetrician’s nightmare. A case series of 7 patients. NJOG. 2012;7(3):56-8.
Wright JD, Herzog TJ, Shah M, Bonanno C, Lewin SN, Cleary K et al. Regionalization of care for obstetric hemorrhage and its effect on maternal mortality. Obstet Gynecol. 2010;115:1194-200 .
Wong VV, Burke G. Planned conservative management of placenta percreta. J Obstet Gynaecol. 2012;32(5):447-52.
Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for PAS disorders. BJOG. 2009;116:648-54.
Zakherah MS, Abdel-Aziz M, Othman ER, Abbas AM. Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt. Int J Reprod Contracept Obstet Gynecol. 2018;7(8):3024.
Singh R, Pradeep Y. Maternal and neonatal outcomes in morbidly adherent placenta: a developing country experience. Trop Doct. 2015;45(3):183-7.
Downloads
Published
How to Cite
Issue
Section
