Fetomaternal outcome in morbidly adherent placenta in a tertiary referral hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20184504Keywords:
Caesarean hysterectomy, Fetomaternal outcomes, Morbidly adherent placentaAbstract
Background: Morbidly adherent placenta is often associated with major pregnancy complications requiring massive blood transfusions, peripartum hysterectomy, etc. The prior number of caesarean sections and placenta previa are the critical risk factors. The aim of this study is to evaluate the fetomaternal outcome in women with morbidly adherent placenta and to quantify the risk factors predisposing to it.
Methods: This is a retrospective cohort study. The study population comprises women, who had C-section for placenta accreta, increta and percreta at Government Raja Mirasudhar Hospital, Thanjavur from May 2016 to September 2017.
Results: Eighteen women out of 21,083 who delivered during the study period had morbidly adherent placenta with an incidence of 0.085%. The mean gestational age at the time of C-section was 32.4 weeks. Twelve (66.66%) out of eighteen women had prior one C-section, two (11.11%) women had prior 2 C-section and two (11.11%) women had prior 3 C-section.10 cases were diagnosed antenatally by radiological imaging. Seventeen out of eighteen women underwent caesarean hysterectomy (94.44%). Average blood loss was 1.8 litres. The mean intraoperative blood transfusions were 3 units of PRBC, 3 units of FFP and 1.4 units of platelet. There was no maternal mortality. The average total hospital stay was 20.46 days. 11 neonates were preterm (61%) and 5 neonates were term (27.74%). FGR was seen in 2 preterm neonates (12.5%). The NICU admission rate was 81% (n=13). The perinatal mortality rate was 31.25% (n=5).
Conclusions: As most of the women ended up in caesarean hysterectomy, early diagnosis will enable appropriate planning for blood components, anaesthetic and surgical resources, thereby reducing adverse fetomaternal outcomes. This will also allow adequate preoperative counselling of the women involved.
References
Cheng KK, Lee MM. Rising incidence of morbidly adherent placenta and its association with previous caesarean section: a 15-year analysis in a tertiary hospital in Hong Kong. Hong Kong Med J. 2015;21(6):511-7.
Aggarwal R, Suneja A, Vaid NB, Yadav P, Sharma A, Mishra K. Morbidly adherent placenta: a critical review. J Obstet Gynecol India. 2012;62(1):57-61.
Benirschke K, Burton J, Baergen RN. Non-villous parts and trophoblast invasion. In: Pathology of the Human Placenta, 6th ed. New York, Springer; 2012: 154-240.
Cunningham, Leveno, Bloom, Spong, Dashe, Hoffman, Casey, Spong. Obstetrical Haemorrhage. In: Williams Obstetrics, 25th ed. New York, NY: McGraw-Hill; 2018:777-779.
Wong HS, Cheung YK, Zuccollo J, Tait J, Pringle KC. Evaluation of sonographic diagnostic criteria for placenta accreta. J Clinic Ultrasound. 2008;36(9):551-9.
Committee Opinion No. 529. American College of Obstetricians and Gynecologists. Placenta accreta. Obstet Gynecol. 2012;120:207-11.
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: Twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458-61.
Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta: Summary of 10 years: A survey of 310 cases. Placenta 2002;23:210-4.
Hung TH, Shau WY, Hsieh CC, Chiu TH, Hsujj, Hsieh TT. Risk factors for placenta accrete. Obstet Gynecol. 1999;93:545-50.
Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. Am J Obstet Gynecol. 1997;177:210-6.
Bencaiova G, Burkhardt T, Beinder E. Abnormal placental invasion experience at 1 center. J Reprod Med. 2007;52(8):709-14.
Clark SL, Koonings PP, Phelan JP. Placenta previa/accrete and prior cesarean section. Obstet Gynecol. 1985;66:89.
Chattopadhyay SK, Kharif H, Sherbeeni MM. Placenta praevia and accreta after previous caesarean section. Eur J Obstet Gynecol Reprod Biol. 1993;52(3):151-6.
Garmi G, Goldman S, Shalev E, Salim R. The effects of decidual injury on the invasion potential of trophoblastic cells. Obstet Gynecol. 2011;117:55.
Aitken K, Allen L, Pantazi S, Kingdom J, Keating S, Pollard L, et al. MRI significantly improves disease staging to direct surgical planning for abnormal invasive placentation: a single centre experience. J Obstet Gynaecol Canada. 2016;38(3):246-51.
Alagebally AM, Yosef RR, Padr SS, AlObeidly A, Szmigielski W, Al Ibrahim AA. The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation. Pol J Radiol. 2014;79:409-6.
Jauniaux E, Jurkovic D. Placenta accreta: pathogenesis of a 20th century iatrogenic uterine disease. Placenta. 2012;33:244-51.
Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. Br J Obstet Gynecol. 2009;116:648-54.
Balayla J, Bondarenko HD. Placenta accrete and the risk of adverse maternal and neonatal outcomes. J Perinat Med. 2013;41:141-9.
Harper LM, Odibo AO, Macones GA, Crane JP, Cahill AG. Effect of placenta pevia on fetal growth. Am J Obstet Gynecol. 2010;203:330-e1.
