Morbidly Adherent Placenta: a 7 year experience

  • Sobha S Nair Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
  • Radhamany K Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
  • Jayashree Nayar Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
Keywords: Morbidly Adherent Placenta, Placenta previa, Pregnancy,

Abstract

Introduction: Morbidly adherent placenta is a life threatening obstetric emergency. There is an increase in the incidence of adherent placenta . An important risk factor is the placenta previa in the presence of a uterine scar Ultrasound is the primary tool for diagnosis but MRI is helpful in cases of inconclusive or if placenta percreta is suspected.Methods: Review of case records (Retrospective case study) of women with adherent placenta during the years 2009 – 2015 at Amrita Institute Of Medical Sciences &Research Centre, Kochi. To evaluate the high risk factors, management of morbidly adherent placenta and the maternal as well as fetal outcome in our institution.Results: Out of 17 cases the incidence of placenta accreta increased from 0.15% in 2009 to 0 .26% in 2015. Placenta previa and LSCS were the major risk factors. Ultrasound and MRI was done in the vast majority. The mean age of termination of pregnancy was 36.51 weeks. Elective surgery were done in 14 with Ceasarean hysterectomy in almost 50%. Haemostatic surgical measures were taken in all cases.The complications included bladder injury, DIC and wound dehiscence. Blood and blood products were replaced .The average time of surgery was 2.21hours and blood loss was 2.34L.. There was no maternal or perinatal mortality.Conclusion: In suspected cases, screening for placenta accrete should be done by 18- 24 weeks. Early admission, prophylactic corticosteroids, elective surgery around 36 -37 weeks in a tertiary care with multidisciplinary appproach helps to reduce the maternal and neonatal morbidity and mortality.

Author Biographies

Sobha S Nair, Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
OBSTETRICS AND GYNAECOLOGYASSISSTANT PROFESSOR
Radhamany K, Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
OBSTETRICS AND GYNAECOLOGY PROFESSOR$ HOD
Jayashree Nayar, Amrita Institute of Medical Sciences and Research Centre,Kochi -41,Kerala, INDIA.
OBSTETRICS AND GYNAECOLOGY PROFESSOR

References

1. Robert Resnik. Clinical features and diagnosis of the morbidly adherent placenta (placenta accreta, increta, and percreta ). www.uptodate.com 2015.

2. Placenta accreta. Committee Opinion No. 529. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:207–11.

3.Wu, S., Kocherginsky, M. and Hibbard, J.U. Abnormal placentation: Twenty-year analysis. American Journal of Obstetrics & Gynecology 2005, 192, 1458-1461.

4.Garmi G,Salim R.Epidemiology ,etiology,diagnosis, and management of placenta accreta.Obstet Gynaecol Int2012:873-979.

5. Richa Aggarwal, Amita Suneja etal. Morbidly Adherent Placenta: Acritical Re-view . J Obstet Gynaecol India 2012 Feb; 62(1):57-61.

6. Leena Wadhwa, Sangeeta Gupta, Prathibha Gupta, et al, Morbidly adherent pla-centa (MAP): lessons Learnt. Open journal of Obstetrics and gynaecology 2013, 3, 217- 221.
7.Miller DA,Chollet JA,Goodwin TM.Clinical risk factors for placenta previa-placenta accreta.AmJ Obstet Gynecol 1997;177:210.

8.Silver RM,Landon MB,Rouse DJ,etal.Maternal morbidity associated with multiple repeat caesarean deliveries.Obstet Gynecol 2006;107:1226.


9. National Institute of Health Consensus Development Conference Statement . NIH Consensus Development Conference:Vaginal birth After Cesarean:New In-sights.March8-10,2010.

10.Flizpatrick KE,Sellers S, Spark P,etal.Incidence and risk factors for placenta ac-crete /increta/percreta in the UK: a national case-control study.PLoSOne 2012;7e52893


11. Royal College of Obstetricians and Gynaecologists. Green–top Guideline No.7: Antenatal corticosteroids to reduce neonatal morbidity and mortality. London: RCOG; 2010

12. Royal College of Obstetricians and Gynaecologists . Green-top Guideline No. 27. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and manage-ment. London. January 2011.


13. Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90:1140.

14. Stotler B, Padmanabhan A, Devine P, et al. Transfusion requirements in obstetric zpatients with placenta accreta. Transfusion 2011; 51:2627.

15. Hull AD and Resnick R. Placenta Previa, Placenta Accreta, Abruptio Placenta, and Vasa Previa. In: Creasy RK, Resnik R, Iams JD, eds. Creasy and Resnik’s Mater-nal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, Pa.: Saun-ders/Elsevier; 2014:736

16.R.Salim,N Zafran,A.Chulski,and E.Shalev,Employing a balloon catheter for occlu-sion and /or embolization of the pelvic vasculature as an adjuvant therapy in cases of abnormal placentation, Harefuah, vol .149,no .6,pp.370-403,2010.
Published
2016-03-29
Section
Original Articles