Incidence of Placenta Accreta and Its Complications in Cases of Previous Cesearean Sections with Placenta Praevia Anterior at El-Sayed Galal Hospital

Abstract

Background: due to the increasing rate of cesarean delivery, there has been a 10-fold rise in the incidence of placenta accreta since the 1970. In a recent survey, placenta accreta was even found to become the leading cause of emergency peripartum hysterectomy which represented 40–60% of cases. Aim of the Work: the purpose of this study was to determine the incidence of placenta accreta and its complications in cases of previous cesarean sections with placenta praevia anterior at El-Sayed Galal Univerity Hospital. Patients and Methods: this prospective study was done at El-Sayed Galal Maternal Unevirsity Hospital during the period from March 2017 to March 2018 on 100 pregnant women diagnosed by ultrasound as placenta praevia or low lying placenta anterior with previous cesarean section, they were selected from Outpatient Clinic, Ultrasound Unit and women admitted in El-Sayed Galal Maternal University Hospital Departments. Results: the incidence of placenta accreta in cases of previous cesarean section with placenta praevia anterior were 63%. Risk factors of placenta accreta were: 1) Placenta praevia with prior cesarean section. All cases had placenta praevia and had at least one previous CS, 2) Increased maternal age (the mean age 32.60±5.018 years in cases of placenta accrete ), and 29.14±4.889 years in cases with normal placenta. 3) Multiparity [the median parity was 3 (range: 1-6). The ultrasonography and Doppler was suggestive of morbid adherence in 60 cases (95.2%)of cases approved with placenta accreta, with accuracy 96, sensiyivity 95.24, specificity 97.3, +ve predictive value 98.36, and -ve predictive value 92.31. The intraoperative data were:, - Cesarean hysterectomy performed in all cases of placenta accrete (63 cases), and 2 cases (5.4%) of normal placenta due to severe bleeding from placental ped and uterine atony. , - Bladder injury occured in 31 cases(49.2%) all of them approved placenta accreta, all of them do C.S hystrectomy and performed bladder repair. Bowel injury in 2 cases (3.2%) all of them have placenta accreta and C.S hysterectomy done. All cases of placenta accreta received intra operative blood transfusion. Uterine preserving procedures (Bakry balloon) done in one case after spontaneous separation of the placenta. The postoperative data were:, - ICU admission occurred in 40 cases (63.5%) of cases with placenta accrete, and in 2 cases (5.4%) of cases with normal placenta. 61 cases (96.8%) of cases with placenta accreta received postoperative blood transfusion. -No cases complicated with DIC or death. Conclusion: from the above our results showed that the incidence, risk factors and Feto-maternal outcome of management of Patients with placenta accreta at El-Sayed Galal University Maternity Hospital are comparable with those in the previous literatures.