Abstract
Objective
To determine the frequency of placenta accreta spectrum (PAS) disorders and to study
the demographic profile, risk factors and maternal and fetal outcomes in women with
antepartum diagnosis of PAS as compared to women with diagnosis made in the intrapartum
period.
Study design
Retrospective analysis over a 3-year period of all patients who delivered with PAS.
The cases were divided into 2 groups. Group 1 consisted of the patients who were diagnosed
during the intra partum period and Group 2 was those diagnosed as PAS by ultrasound
in the antepartum period. Maternal and fetal outcomes were compared between the 2
groups. The cases that underwent conservative management were also analyzed for need
of secondary hysterectomy/placental resolution
Results
There were 81,480 deliveries conducted during the study period of which 74 were identified
as PAS. Hence PAS was seen in 1:1101 deliveries (0.09%). The estimated blood loss
and number of units of blood products required were significantly higher in Group
1 (2.36 ± 0.77 l vs 1.8 ± 0.91 L, p = 0.002; and 10.17 ± 5.12 vs 6.77 ± 4.22, p = 0.005)
compared to Group 2. The ICU stay was also more common in Group 1 (p = 0.01). The
perinatal mortality was significantly higher in Group 1(45.71% vs 23.08%, p = 0.040).
79.7% women underwent primary cesarean hysterectomy while others were managed conservatively.
In conservatively managed group, placental resolution took place in 60% and 40% required
secondary hysterectomy.
Conclusion
Antenatal diagnosis of placenta accreta spectrum disorders decreases the maternal
morbidity and perinatal mortality.
Keywords
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References
- Maternal morbidity associated with multiple repeat cesarean deliveries.Obstet Gynecol. 2006; 107: 1226-1232
- Clinical risk factors for placenta previa-placenta accreta.Am J Obstet Gynecol. 1997; 177 (177): 210-214
- Abnormal placentation: twenty-year analysis.Am J Obstet Gynecol. 2005; 192: 1458-1461
- Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage.Obstet Gynecol. 2015; 125: 814-821
- Always be vigilant for placenta accreta.Am J Obstet Gynecol. 2014; 211: 87-88
- Cesarean scar pregnancy is a precursor of morbidly adherent placenta.Ultrasound Obstet Gynecol. 2014; 44: 346-353
- Center of excellence for placenta accreta.Am J Obstet Gynecol. 2015; 212: 561-568
- Cryopreserved embryo transfer is an independent risk factor for placenta accrete.Fertil Steril. 2015; 103: 1176-1184
- Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study.PLoS One. 2012; 7: e52893
- Placenta accreta is associated with IVF pregnancies: a retrospective chart review.BJOG. 2011; 118: 1084-1089
- The management of placenta percreta: conservative and operative strategies.Am J Obstet Gynecol. 1996; 175: 1632-1638
- Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in low resource setting.Niger J Med. 2012; 21: 359-360
- The diagnosis and management of morbidly adherent placenta.Semin Perinatol. 2018; 42: 49-58
- Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta.Obstet Gynaecol. 2010; 115: 65-69
- Morbidly adherent placenta: a critical review.J Obstet Gynaecol India. 2012; 62: 57-61
- Levels and trends in caesarean birth in the developing world.Stud Fam Plann. 2006; 37: 41-48
- The increasing trend in caesarean section rates: global regional and national estimates: 1990–2014.PLoS One. 2016; 11: e0148343https://doi.org/10.1371/journal.pone.0148343
- Accuracy of ultrasound for the prediction of placenta accreta.AJOG. 2014; 211 (177e 1-e 7)
- Committee opinion.ACOG. 2012; 529 (Reaffirmed 2017)
- Maternal outcome after conservative management of abnormally invasive placenta.Taiwan J Obstet Gynecol. 2017; 56: 353-357
- Management of placenta accreta: morbidity and outcome.Eur J Obstet Gynecol Reprod Biol. 2007; 133: 34-39
Article info
Publication history
Published online: March 06, 2019
Accepted:
March 2,
2019
Received in revised form:
March 1,
2019
Received:
October 7,
2018
Identification
Copyright
© 2019 Published by Elsevier B.V.
