Outcomes of Patients with Morbidly Adherent Placenta in Ain Shams Maternity Hospital: A Retrospective Study

Abstract

he incidence of placenta accreta has been steadily increasing, mirroring increased rates of caesarean delivery. The most important risk factor for placenta accreta is placenta preavia after a prior cesarean delivery. Other predisposing factors have been identified including: multiparity, previous uterine surgery, advanced maternal age and previous uterine curettage. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage that occurs at the time of attempted manual placental separation. Part or the entire placenta remains strongly adherent to the uterine cavity, and no plane of separation can be developed. The severe uterine hemorrhage may lead to the need of extensive life-saving surgical interventions such as Hysterectomy and Ligation of major pelvic vessels. Placenta accreta has become the leading cause of emergency hysterectomy. s a consequence of placental invasion to adjacent organs, reconstruction of the urinary bladder or bowel may be necessary. Massive blood and blood products transfusions are the rule in these dramatic cases. Other complications include: neonatal death, infection, fistula formation & ureteral damage. Accordingly, it is important to recognize the risk factors and attempt to make a prenatal diagnosis. Prenatal diagnosis of placenta accreta is based upon the presence of characteristic findings on ultrasound examination. Color flow Doppler can help support a sonographic diagnosis. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because removal of the placenta associated with significant hemorrhagic morbidity. However, surgical management of placenta accreta may be individualized. Conservative approach should be considered only when the patient has a strong desire for future fertility as well as haemo-dynamic stability, normal coagulation status, and is willing to accept the risks involved in this conservative approach. The patient should be counseled that the outcome of this approach is unpredictable and that there is an increased risk of significant complications as well as the need for later hysterectomy. The aim of this study was to determine the incidence, risk factors, and outcome of management of patients with Placenta accreta at Ain Shams Maternity Hospital during the past five years. Neonatal morbidity and mortality rates in pregnancies complicated by placenta preavia have fallen over the past few decades because of improvements in obstetrical management (eg, antenatal corticosteroids, delayed delivery when possible), the liberal use of cesarean delivery, and improved neonatal care. It is critically important that obstetricians and