Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt

Authors

  • Mahmoud S. Zakherah Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Mervat Abdel-Aziz Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Essam R. Othman Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20183295

Keywords:

Antepartum hemorrhage, Maternal morbidity, Placenta accreta, Placenta previa

Abstract

Background: The aim of the current study was to estimate the incidence of placenta previa (PP) and accreta (PA) in the period from January 2015 to December 2016 at Women’s Health Hospital, Assiut University, Egypt and to evaluate the maternal and neonatal outcomes.

Methods: The study included all cases of PP with or without suspicion of accreta who were diagnosed preoperatively by ultrasound at Women’s Health Hospital, Assiut University. Maternal and neonatal outcomes were evaluated. All intraoperative and postoperative data were reported. The obtained data was analyzed by means of SPSS software (version 22.0) and p<0.05 was taken as the significant level.

Results: Total number of deliveries was 29027 cases. The number of cases of PP was 494 cases making an incidence of 1.7%, among them 95 cases were confirmed during surgery to be accreta (0.33%). Uterine artery ligation was carried out 300 cases (60.7%) of cases while cesarean hysterectomy was performed in 56 cases (11.3%). Bladder injury occurred in 58 cases (11.7%), ureteric injury occurred in 6 cases (1.2%), colon injury occurred in 1case (0.2%) and vascular injury occurred in 2 cases (0.4%). Maternal mortality was 4 cases (0.8%). The mean gestational age was 34.73 ± 2.8 weeks. Also, over the two years there were 148 neonatal cases (29.9%) needed assisted ventilation in the form of ambu bag or endotracheal intubation gestation. NICU admission needed in 109 neonatal cases (22.06%) and neonatal mortality reported in 18 neonates (3.6%).

Conclusions: The incidence of both PP and PA is very high in our locality due to increase CS rate.

References

Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2003;13:175-90.

Kim LH, Caughey AB, Laguardia JC, Escobar GJ. Racial and ethnic differences in the prevalence of placenta previa. J Perinatol. 2012;32(4):260-4.

Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: A population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol. 2003;188(5):1299-304.

American Congress of Obstetricians and Gynecologists (2011 and 2015): Placenta accreta. Committee Opinion No. 266, January 2011 reaffirmed 2015.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-61.

Eller G, Porter TT, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG. 2009;116(5):648-54.

Bekku S, Mitsuda N, Ogita K, Suehara N, Fujimura M, Aono T. High incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa. J Matern Fetal Med. 2000;9(2):110-3.

Kancherla V, Räisänen S, Gissler M, Kramer MR, Heinonen S. Placenta previa and risk of major congenital malformations among singleton births in Finland. Birth Defects Res A Clin Mol Teratol. 2015;103(6):527-35.

Royal College of Obstetrics and Gynecology. Green top Guideline No. 27 revised 2015: Placenta previa, placenta previa accreta and vasa previa diagnosis and management. RCOG. 2011. Available at https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_27.pdf

Warshak CR, Ramos GA, Eskander R. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 2010;115(1):65-9.

Shellhaas CS, Gilbert S, Landon MB, Varner MW, Leveno KJ, Hauth JC, et al. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol. 2009 Aug;114(2 Pt 1):224.

Alanwar A, Al-Sayed HM, Ibrahim AM, Elkotb AM, Abdelshafy A, Abdelhadi R, et al. Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study. J Maternal Fetal Neonat Med. 2018 (Article in press).

Abbas AM, Ali SEEA, Michael A, Ali SS. Successful fertility-preserving management of a case of placenta percreta invading the urinary bladder and anterior abdominal wall: A case report. Middle East Fertil Soc J. 2018;23(1):77-80.

Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F, et al. Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol. 2010;115:26-34.

Timmermans S, van Hof AC, Duvekot JJ. Conservative management of abnormally invasive placentation. Obstet Gynecol Surv. 2007;62:529-39.

Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet. 2015;291(5):993-8.

Shehata A, Hussein N, El-Halwagy A, El Gergawy A. Could Simple Procedures Minimize Hysterectomy in Management of Placenta Accreta? Ind J Obstet Gynaecol Res. 2015;2(4):213-7.

Iwata A1, Murayama Y, Itakura A, Baba K, Seki H, Takeda S. Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta. J Obstet Gynaecol Res. 2010;36(2):254-9.

Mitwaly AA, Abbas AM. Sequential surgical steps for conservative management of morbidly adherent placenta: case series. Thai J Obstet Gynecol. 2016;24:136-40.

Ali MK, Abbas AM, Abdelbadee AY, Shazly SA, Abdel Magied AM. Use of Foley’s catheter balloon tamponade to control placental site bleeding resulting from major placenta previa during cesarean section. Proc Obstet Gynecol. 2016;6(3):4.

Wright JD, Devine P, Shah M, Gaddipati S, Lewin SN, Simpson LL, et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol. 2010;115:1187-93.

Abbas AM, Abdelbadee AY, Amin MT, Abdelrahman RM, Tolba SM, Abdelkarim AR, et al. Emergency peripartum hysterectomy in a tertiary hospital in Upper Egypt: six years analysis. Int J Reprod Contracept Obstet Gynecol. 2016;5(4):953-8.

Kim TH, Lee HH, Kwak JJ. Conservative management of abnormally invasive placenta: choriocarcinoma with uterine arteriovenous fistula from remnant invasive placenta. Acta Obstet Gynecol Scand. 2013; 92(8):989-90.

Abbas AM, Amin MT, Ali SS, Salem NZ. Maternal mortality: a tertiary care hospital experience in Upper Egypt. Int J Reprod Contracept Obstet Gynecol. 2016;5(5):1466-71.

Kanchert V, Raisanen S, Gissier M, Kramer MR, Heinonen S. Placenta previa and risk of major congenital malformation among singleton births in Finland Birth Defects. Res A Clin Mol Teratol. 2015:103(6):527-35.

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Published

2018-07-26

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Original Research Articles