Abstract
Objective:To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes.Material and Methods:This was a retrospective cohort study conducted from January 2017 to December 2018. Women with PAS diagnosed antenatally were designated as group A and those where diagnosis was suspected during operation and confirmed on histopathology (PAS diagnosed perioperatively) were designated as group B. Outcome in terms of uterine conservation, maternal death, admission of mother to intensive care unit (ICU), perinatal death and neonatal ICU (NICU) admission were recorded.Results:During the study, PAS was confirmed in 96 cases which were included. Out of these, 34 (35.4%) cases were included in group A while 62 (64.6%) were diagnosed intraoperatively (group B). The median number of units of blood transfused was lower in group A compared to group B (4 vs 6, p<0.001). The uterus was conserved more often in group A compared with group B (67.6% vs 43.5%, p=0.024) while admission to ICU occurred significantly more often in group B (26.5% vs 59.7%, p=0.002). Maternal death (p=0.038) and perinatal death (p=0.008) were also significantly higher in group B. More neonates delivered to mothers in group B were admitted to NICU (85.7% vs 24%, p=0.033). Survival analysis showed a statistically significant increase in uterine conservation rate in group A compared with group B (log rank, p=0.04).Conclusion:PAS diagnosed antenatally has better fetomaternal outcome than intraoperative detection of PAS. Diagnosing PAS antenatally is therefore crucial to improve management and achieve a better outcome.
Highlights
Placenta accreta spectrum (PAS) is a well-known entity that has become far more common than previously reported [1]
Consent for the use of hospital records was obtained from the department head
There was no difference between the groups in terms of risk factors including the median number of cesarean sections (p=0.304), history of bleeding (p=0.703) and history of prior dilatation and curretage (p=0.427)
Summary
Placenta accreta spectrum (PAS) is a well-known entity that has become far more common than previously reported [1]. This is partly due to the rising cesarean section rates in the region. It was previously believed that the final diagnosis could only be confirmed retrospectively by histological examination of the specimen. This position is in doubt and studies have reported that novel techniques such as power Doppler and magnetic resonance imaging have up to 100% sensitivity in diagnosing PAS cases [3].
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