Frequency of Morbid Adherence of Placenta

Abstract

Objective: To determine the frequency, causes and outcome of patients with morbidly adherent placenta. Study Design: Descriptive case series. Place and Duration of Study: The study was conducted at Gynae Unit-I of Aziz Fatima Medical And Dental College from March 2012 to March 2013. Methodology: One hundred patients with previous uterine operations; like caesarean section, myomectomy, hysterotomy or diagnostic curettage, patients with placenta praevia or those patients with retained placenta removed with difficulty under anesthesia; were included in the study. All the primigravidas and cases with retained placenta due to uterine abnormalities were excluded. The admitted patients meeting the inclusion criteria were registered for the study after taking informed consent. Patients were clinically examined and appropriate investigations were done. All relevant information was recorded on a proforma especially designed for this study. All the data was entered and analysed through SPSS version 10. Results: Only 6 patients out of 100 selected cases had morbidly adherent placenta, all cases were booked. Five cases were between 25-30 years and one was 20 years of age. Their parity range from 1-6. Five patients had previous history of caesarean sectionPlacenta was found in lower uterine segment in all cases. One patient presented with preterm labour and one with antepartum haemorrhage. Prior to surgical intervention, proper work up of the patients was done. Colour Doppler of all the patients was done. All the patients had caesarean section done. Three of the latter had placenta accreta, 2 had placenta percreta and one had placenta increta. The placenta was removed piece meal in 4 cases. In one case a conservative approach i.e (segmental resection of the portion of the lower uterine segment where placenta was adherent) was done. In one case, caesarean hysterectomy was done. Blood transfusion was required in all cases ranging from 3-8units. Duration of hospital stay was 5-10 days and maternal mortality was nil. Conclusion: Morbid Adherence of placenta is an obstetrical emergency, which carries an increased risk of perinatal and maternal mortality and morbidity. Antenatal care needs to be improved and morbid adherence of placenta should be diagnosed at the earliest possible time. Previous caesarean section and placenta previa in current pregnancy were the major risk factors observed in 5(83%) of the cases. Previous history of dilatation and curettage was present in 1(16.6%) case.