Abstract
Objective: To determine the fetomaternal out comes in placenta Accreta Spectrum (PAS) Study design: Descriptive study: Place and duration: Department of Obstetrics and Gynaecology unit-I1,FJMU /Sir Ganga Ram hospital Lahore. Patient and Methods: During this one years study a total of fifty pregnant women with placenta Accreta Spectrum(PAS) diagnosed on Doppler ultrasound , whether booked or un booked irrespective of number of caesarean scars with or without bleeding per vagina were included in the study. The number of caesarean section, treatment, complications maternal and fetal morbidity and mortality associated with PAS were described. Results: A total of 50 cases of PAS were studied over one year period. 35(70%) patients with placenta Accreta Spectrum (PAS) were unbooked.15(30%) were booked. 25 (50%) patients were the age group between 26-30 years. The average gestational age was between 32-36 weeks. In 35 (70%) type IV placenta previa was found. In 1o(20%) type III placenta previa was detected. In 5(10%) patient with placenta Accreta Spectrum (PAS)had previous once caesarean section while 45 (90% ) patients had two or more caesarean section. In 35 (70%) patients the presentation was bleeding per vagina while 15 (30%) patients were asymptomatic at presentation. In 15 (30%) patients placenta accreta was found while placenta increta and percreta were found in 35 (70%) patients.Total Caesarean hysterectomy done in 35 (70%) patients and Uterine sparing along with internal iliac artery, ligation was carried out in 10(20%). Bladder invasion which needed bladder repair was found in 5(10%) cases. 6(12%) maternal deaths were noted in this study. Mean Intraoperative blood loss was between 3 to 4 litres. Blood transfusion was needed in all 50 (100%) patients.Regarding perinatal out come Out of 50patients Intrauterine growth restriction. Prematurity and neonatal admission to ICU reported in 10(20%), 35(70%), and 15(30%) of the cases respectively. Conclusion: placents accreta spectrum (PAS) is a life threatening haemorrhagic condition associated with high rate of maternal and perinatal morbidity and mortality. Antenatal diagnosis by Doppler ultrasound, multi-disciplinary approach with involvement of senior obstetrician, anaesthetist and haematologist is pivotal to improve feto maternal out come.
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