Minor degree placenta praevia; mode of delivery

To find out the mode of delivery when the distance of placenta edge to internal is more than 2 cm and less than 5 cm i.e minor degree placenta praevia. Descriptive Study. The study was done at Combined Military Hospital Rawalpindi and Military Hospital Rawalpindi from January 2005 to January 2006. Patient and A total of 100 patients admitted in obstretic ward were selected according to the inclusion and exclusion criteria by convenience sampling. Patients with ante partum haemorrhage after 34 weeks admitted, resuscitated and then investigated by blood tests and transvaginal ultrasound. Only patients with placental edge to internal os distance of more than 2 cm were selected for study. Booked patients of placenta praevia type 1 and type 2 of more than 37 weeks after bishop scoring and cervical ripening were delivered vaginally by ARM and Oxytocin. In our study, out of selected patients 100 patients of placenta praevia type 1 and type 2 were selected, results of these patients were [a] 63% patients were delivered vaginally. [b] 37% of patients were delivered by caesarean section. [c] 46% of patients with para 4 had placenta praevia as compared to primigravida who had placenta praevia 15%. [d] 59% of deliveries occurred at 34-36 years of gestation while 41% of deliveries were occurred at gestation of>36 years. Patients with placental edge more then 2 cm should be given a trial of vaginal delivery instead of going straight away to caesarean section

Impact of antenatal diagnosis and management strategies in morbidity adherent placenta

To study the pattern, demography and management options in placenta accreta in a tertiary care centre. 1st January 2004 to 15 August 2008 at Military Hospital, Rawalpindi and between 1[st] Sep 2008 to 30[th] Oct 2009 at Combined Military Hospital, Multan. All cases of placenta accreta seen during the study period were included in the study. Placenta accreta was defined as placenta being adherent to uterine wall without easy separation. Patient's demography, presence or absence of prenatal diagnosis and the management strategy i.e. conservative or otherwise was documented on a proforma. Success or failure of surgical approach used was noted. Assessment of maternal morbidity in the form of amount of blood/blood product transfused and early and late complications was made and compared with other cases that were antenatally diagnosed or were undiagnosed. A total of 28 cases were analyzed during study period. The incidence of placenta accreta was 6.3/10000. Mean maternal age was 30.7 years. Placenta praevia obstetrical hysterectomy was performed in 17 [61%] cases and had to be backed up by internal iliac artery ligation in 7[25%] Requirement for blood transfusion in antenatally diagnosed cases was almost 50% less than those of undiagnosed cases and the same was true for fresh frozen plasma [3.75 +/- 4.18 versus 6.75 +/- 5.41], platelet transfusion [P=0.04], stay in intensive care unit [1.56 +/- 1.82 versus 3.41 +/- 3.28] and use of mechanical ventilation [7% versus 11%]. There was no mortality in this series. Intra-operative internal iliac artery ligation reduces blood loss before and after hysterectomy and should be done in cases with placents accreta to reduce morbidity and mortality