Placenta previa accreta: risk factors, morbidity and new strategy in the management

ABSTRACT

The aims of this study were to identify the risk factors, morbidity and mortality associated with placenta previa accreta, and effectiveness of using new strategy in the management of the placenta previa accreta, particularly those covering the cervix [major placenta previa] with a history of previous Cs. A total number of 280 pregnant patients, with placenta previa as diagnosed by ultrasound after 20 weeks of pregnancy were followed till the time of delivery during the period of4 years. After delivery, patients were divided into two main groups, those with placenta accreta [cases; n = 42], and those with 110 accreta [control; n = 238], and compared. Out of 280 patients with placenta previa, 42 [15%] had placenta aecreta, previous CS, advanced maternal age, grandmultiparity, previous dilatation and curettage were found to be a risky factors associated with a higher incidence of placenta accreta. Previous history of CS showed a significant increase In the incidence of placenta previa accreta [p < 0.0001], and the percentage f placenta accreta, increased linearly with the number of the CS from 0.99% in patients with no history of previous CS to 86.6% in patients with a previous history of 6 CS. However, post partum hemorrhage, and hospital stay were significantly higher in patients with placenta accreta than control [p < 0.0001], both groups had a similar delivery gestational age and neonatal outcome. Bimanual compression for at least 10 minutes, rectal insertion of 4 tablets [800 micro g] of misoprostol with bilateral internal iliac artery ligation were significantly associated with the stop of severe bleeding in cases of placenta previa accreta with. or without previous CS up to 90.5%. Emergency cesareanhystel-ectomy, needed only in 4 patients [9.5%], in addition to the above line of treatments. Previous repeated CS, hyypertensive disorders, previous dilation and curettage, grandmultiparity, advanced maternal age, are risky factors associated with higher incidence of placenta accreta. Placenta accreta is associated with higher maternal morbidity, but with similar neonatal outcomes compared with control. Combination of rectal insertion of 800 micro g misoprostol, bimanual compression for at least 10 minutes and bilateral internal iliac artery ligation were found to be promising treatment for the difficult cases of placenta previa accreta with or without previous CS, which might lead to lowering the maternal morbidity and mortality, saving the uterus and raises the psychological support which may have a direct effect on the women's health and fertility particularly those nulliparous or low parity