Study of frequency and outcome of management in pregnancies complicated by morbid adherence of placenta

ABSTRACT

The objectives of this study were to determine the frequency of morbid adherence of placenta, its management outcome and complications in obstetrical patients admitted in Combined Military Hospital Quetta. Non randomized descriptive study. This study was conducted in the Labour and maternity wards of Combined Military Hospital Quetta. The duration of study was 01 year from July 2006 to July 2007. A series of 100 patients [emergency as well as booked cases] fulfilling the inclusion criteria were studied. Factors were studied in these cases included maternal age, parity, clinical presentation, gestational age, previous surgical procedures, ultrasound findings, type of morbidly adherent placenta, mode of removal of placenta, PPH, types of treatments offered, blood transfusions required, maternal morbidity and mortality, duration of hospital stay and condition of the patient at the time of discharge. Our results showed that only 04 patients out of 100 selected cases had morbidly adherent placenta, out of which 03 were booked cases and 01 was unbooked. These 04 cases were between 27years to 35 years of age. Their parity ranged from 2 to 4. Risk factors were found only in 03 patients. Placenta was found in lower uterine segment in 03 patients while in 01 case it was in upper segment. 01 patient presented with pre-term labour, 01 with antepartum haemorrhage, while PPH occurred in 03 patients. 01 patient delivered vaginally and 3 had caesarean sections. Two of these were placenta accreta, 01 placenta increta and 01 case had placenta percreta. Placenta was removed piece meal followed by caesarean hysterectomy in 03 cases and 01 was given a conservative trial followed by post-partum hysterectomy. Blood transfusions were required in all the cases ranging form 3-5 units. Complication of PPH occurred in 3 cases, uterine perforation in one case while DVT developed in one case. Hospital stay ranged from 7-14 days. Maternal mortality was nil in our study. Morbid adherence of placenta is an obstetrical emergency, which carries an increased risk of perinatal and maternal mortality and morbidity. Antenatal care should be improved and morbid adherence of placenta should be prediagnosed. The study showed a strong association of placenta accreta with previous caesarean section and placenta praevia