Maternal Factors and Complications Associated with Morbidly Adherent Placenta: An Experience at a Tertiary Care Hospital in Pakistan

Abstract

Objective: To identify the risk factors predisposing to the Morbidly Adherent Placenta and to evaluate maternal outcomes in those patients.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Obstetrics & Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2021.
 Methodology: A total of 18 females with a clinical diagnosis of the morbidly adherent placenta, irrespective of age and several previous scars, having singleton foetuses with more than 26 weeks gestational age, were included in the study. Patients’ particulars including demographic data, gestational age, number of previous uterine scars, type of placenta, treatment option and the outcome, were collected.
 Results: The frequency of morbidly adherent placenta was 4.06 per 1000 deliveries. The mean age of patients was 31.06±2.48 years, whereas the mean gestational age was 35.5±1.15 weeks. The mean parity was 3.5±0.71. Out of 18 patients with morbidly adherent placenta, 3(16.7%) had four caesarean scars, 8(44.4%) had three previous caesarean scars, and 7(38.9%) had two previous caesarean scars. Associated placenta previa was present in 14(77.8%) patients. Hysterectomy was done in 15(83.3%) patients, while in 3(16.6%) patients uterus was preserved. The bladder was repaired in 12(66.6%) patients with post-op catheterisation for three weeks. There was no maternal mortality.
 Conclusion: Previous caesarean scar and placenta previa are major risk factors for the morbidly adherent placenta. Wellestablished antenatal diagnosis with timely surgical intervention can prevent long-term complications.Keywords: Caesarean section, Placenta previa, Placenta accreta, Placenta increta, Placenta percreta.