Obstetric Hysterectomy versus Conservative Surgery for Management of Patients with Placenta Accreta as Regard Maternal Morbidity and Mortality: A Retrospective Study for the last 5 Years and a Prospective Study for the Next 6 Months

Abstract

lacenta accreta is described as deep adherence of placental villi to the myometrium. . It is caused by a defect in decidua basalis resulting in an abnormally invasive placental implantation. According to an epidemiological review, cases of placenta accreta have increased because of higher cesarean rates due to a greater number of accepted indications for cesarean sections, including maternal request. Strong risk factors for abnormal placentation include previous caesarean scars and placenta previa. Other known risk factors are multi-parity, advanced maternal age, previous dilatation and curettage, a history of manual placenta removal, sub-mucous myoma resulting in atrophy of the endometrium, gestational products implanted in the uterine diverticulum, and previous radium insertion. The main danger and most common complication of abnormal placentation is massive bleeding. Abnormal invasive placentation cause elevated maternal morbidity and mortality. Placental invasion abnormalities are classified according to the depth of penetration by the chorionic villi as placenta accreta, -increta, and -percreta. Placenta accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intra-partum and postpartum hemorrhage.