DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20161336

Demographic profile and high risk factors in morbidly adherent placenta

Syed Masuma Rizvi, Farhana Fayaz

Abstract


Background: Morbidly adherent placenta with its variants is one of the most feared complications causing high morbidity and mortality in obstetrics. The main objectives of the study were to evaluate the demographic profile and risk factors in morbidly adherent placenta.

Methods: A retrospective study was done in which case records of 40 patients diagnosed to have morbidly adherent placenta were reviewed. Demographic data including age, parity, gestational age and previous caesarean delivery or other uterine surgery, details of medical and obstetric history were recorded.

Results: A total of 24232 deliveries were conducted in the hospital. 40 patients were confirmed to have morbidly adherent placenta. The average age of the patients was 31.8 years and the mean parity was 1.80. 95% percent of the patients were booked in the study centre and only 5% percent were unbooked.  80% of the patients were from the rural area and 20 % from the urban region. The average gestational age of the patient at diagnosis was 35.3 weeks and average gestational age at delivery was 36.2 weeks. The risk factors included previous caesarean section in 32 patients (80%) , with history of  one C.S in 11 patients(27.5%),with two C.S in 19 patients(47.5%), and with history of three C.S in 4 patients (5%). 8 patients (20%) had history of both previous C.S and curettage and none had the history of curettage alone.

Conclusion: Morbidly adherent placenta is a potentially life threatening condition. Management of such patients requires early recognition of high risk women based on their clinical risk factors, with accurate preoperative diagnosis, good maternal counselling and planning of delivery.


Keywords


Placenta accreta, Caesarean section, Curettage

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References


Breen JL, Neubecker R, Gregori CA, Franklin JE Jr. Placenta accreta, increta, percreta: survey of 40 cases. Obstet gynecol. 1977;49:43-7.

Read JA, Cotton DB, Miller FC. Placenta accreta: changing clinical aspects and outcome. Obstet Gynecol. 1980;56(1):31-4.

Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175:1632-7.

Benirschke K, Burton, Baergen RN: Pathology of the Human Placenta, 6th Ed. New York, Springer. 2012;204.

Wong, HS, Cheung. YK, Zuccollo, J et al, Evaluation of sonographic diagnostic criteria for placenta accreta; J Clin Ultrasound. 2008;36(9):551.

Wadhwa L, Gupta S, Gupta P, Satija B, Khanna R. ESI-PGIMR, Basaidarapur, Delhi Open Journal of Obstetrics and Gynecology, 2013, 3, 217-21.

Sofiah S, MMed, Late Fung YC, FRCOG. Department of O & G, medical faculty, university Malaya, 59100 Kuala Lumpur, fetal medicine specialist, mater mothers hospital, Brisbane Med J. 2009;64(4).

Aggarwal R , Suneja A , Vaid NB,Yadav P , Sharma A, Mishra K. The Journal of Obstetrics and Gynecology of India. 2012;62(1):57-61.

Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Am J Obstet Gynecol. 2013;208:219.e1-7.

Sultana N, Mohyuddin S, Jabbar T. Department of obstetrics and gynaecology, combined military hospital Rawalpindi. J Ayub Med Coll Abbottabad. 2011;23(2).

ACOG committee opinion. Placenta accreta. American College of Obstetricians and gynecologists. INT J Gynaecol Obstet. 2002;202;77:77-8.

Wu S, Kocherginsky M, HIibbard JU. Abnormal placentation 20 year analysis. Am J Obstet Gynecol 2005:192:1458-61.

Hasan AA, Hasan JA, Khan AA. Hamdard University Hospital and Two Private Hospitals, Journal of Surgery Pakistan. 2009;14(4).

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty year analysis. Am J Obstet Gynecol. 2005;192:1458-61.

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.

Al-Serehia, Mhoyan A, Brown M, Bernichke K, Hull A, Pretorius DH. Placenta accreta: an association with fibroids and asherman syndrome. J Ultrasound med. 2008;27;1623-8.

Hamar BD, Wolf EF, Koddmann PH, MarcoviciI. Premature rupture of membranes. Placenta increta and hysterectomy in a pregnancy following endometrial ablation. J Perinatol. 2006;26;135-7.

Pron G, Rski MF, Benet J, Vilos G, Common A, Vanderburghl. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multi-center trial. Obstet Gynecol. 2005;105:67-76.