Management and maternal outcome in morbidly adherent placenta

ABSTRACT

To describe the management and maternal outcome in diagnosed cases of morbidly adherent placenta. Descriptive case series. Hamdard University Hospital and Two private hospitals, from May 2005 to June 2009. All diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay were recorded. Thirty cases of morbidly adherent placenta diagnosed on doppler ultrasound scan were identified. Scheduled caesarean hysterectomy without attempting placenta removal, was done. Sub total hysterectomy was performed in 26 cases and total hysterectomy in remaining 4 cases. Two patients sustained urinary bladder injury and two went into DIC. One needed ventilatory support. No patient died in this series. Significantly reduced maternal morbidity was observed. In diagnosed cases of morbidly adherent placenta, antenatal diagnosis and avoidance of placental separation and caesarean hysterectomy results in better maternal outcome: