Treatment Outcome of Adherent Placenta: An Experience at Tertiary Care Hospital

Abstract

Objective: The objective of this study was to see treatment outcome of morbidly adherent Placenta. Methodology: This descriptive case series was carried out in Obstetrics and Gynae Unit-2 Lady Willingdon Hospital Lahore from January 2013 to December 2014. In this period 127 females between 20 to 45 years with any parity were enrolled in this study. All the patients were diagnosed for Placenta Accreta, Increta and Percreta by color flow Doppler. Operative delivery was carried out in all. Cesarean Hysterectomy with or without Placental separation, conservative measures (uterine artery ligation, tamponade and hemostatic sutures) and Internal iliac ligation were used. The outcome measures recorded were total blood loss, neonatal birth weight, mean gestational age at delivery, neonatal Apgar score, intra and postoperative complications and maternal mortality. Non-probability, sampling technique was used. The results were analyzed using SPSS version 20. Results: The mean age of subjects in this study was 26.77 ± 3.17 years. Gestational age at diagnosis and at surgery was 34.83 ± 1.94 weeks and 36.19 ± 1.557 weeks respectively. According to previous history of cesarean section, 60 (47.3%) had 1 previous C-section, 38 (29.9%) had 2 previous C-section and rest of 29 (22.9%) had ≥ 3 C-section. The diagnosis was made on Doppler Ultrasonography (USG) and the patients had surgery under emergency as well as elective conditions. We found that 96 (75.5%) females had Accreta, 27 (21.26%) had Increta and only 4 (3.15%) females had Percreta. Placental separation was done in 63 (49.6%) followed by Cesarean Hysterectomy were done in 36 (57%), and conservative measures like tamponade, haemostatic sutures in Placental bed and Uterine artery ligation in the rest i.e. 27 (43%). Non-separation of Placenta followed by direct Cesarean Hysterectomy was done in 64 (50.3%), and Internal iliac ligation was done in 30 (23%). During surgery the average blood loss was 2.97 ± 1.36 L. According to neonatal outcome Apgar score at 5 minutes was 5.69 ± 1.446 and weight of new baby was 2.85±0.30 kg. According to final outcome 83 (65.35%) females were successfully discharged, 29 (22.83%) had bladder rupture occurred in 29 (22.83%) while maternal mortality occurred in 15 (11.81%) only. Conclusion: An increasing number of patients with morbidly adherent Placenta is coming up along with the rising incidence of C-Section. The key to the management of this condition is prompt diagnosis and referral to well-equipped hospitals having multidisciplinary input. Conservative measures with uterine sparing are worth trying in selected cases.