Conservative Versus Radical Management of Morbidly Adherent Placenta (Cohort study)

Abstract

ABSTRACT Background: Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality, postpartum hysterectomy, admission to ICU, and an inadvertent laceration to intestine or bladder during cesarean section. Aim: To compare between outcome of conservative management of morbidly adherent placenta and caesarean hysterectomy. Methods: This study included 90 pregnant females diagnosed by ultrasound to have morbidly adherent placenta (MAP). Maternal history, intraoperative data about placental location, estimated blood loss, units of blood transfusion required and surgical procedure carried out to control bleeding was retrieved. Post-operative need for intensive care unit (ICU) admission and other maternal complications were recorded. Perinatal mortality and neonatal outcomes for birth weights, neonatal ICU admission, and neonatal ICU stay in both groups was also noted. Results: There was no significant difference between the two groups as regards Blood Volume, and although actual blood loss was higher in group 2 than group 1 but the difference wasn't significant. ICU admission and duration mean were significant higher in group 2 where 21(42.9%) females were admitted to ICU for duration mean ±SD equals 2.29±1.189 days versus 5(16.1%) females and duration mean ±SD equals 1.40±0.548 in group 1. Operation time and post operation stay were significant higher in group 2 than group 1. There was no significant difference between the two groups as regards blood transfusion intra and post-operative time. Conclusion: Conservative management of morbidly adherent placenta is associated with lower maternal morbidities and mortalities as compared with radical surgical management in patients who fits the inclusion criteria and wants to preserve their fertility.