Abstract
Objective. To determine maternal morbidity in women with placenta previa managed with prediction of morbidly adherent placenta (MAP) by ultrasonography. Methods. A retrospective cohort study was undertaken comprising forty-one women who had placenta previa with or without risk factors for MAP. Women who had all three findings (bladder line interruption, placental lacunae, and absence of the retroplacental clear zone) were regarded as high suspicion for MAP and underwent cesarean section followed by hysterectomy. We attempted placental removal for women having two findings or less. Results. Among 28 women with risk, nine with high suspicion underwent hysterectomy and were diagnosed with MAP. Three of 19 women with two findings or less eventually underwent hysterectomy and were diagnosed with MAP. The sensitivity and positive predictive value for the detection of MAP were 64% and 100%. The pathological severity of MAP was significantly correlated with the cumulative number of findings. There were no cases of MAP among 13 women without risk. There was no difference of blood loss between women with high suspicion and those without risk (2186 ± 1438 ml versus 1656 ± 848 ml, resp.; p = 0.34). Conclusion. Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.
Highlights
Adherent placenta (MAP) is one of a number of risk factors related to maternal death [1]
Comstock et al [3] introduced an approach for the detection of Morbidly adherent placenta (MAP) in the second and third trimesters of pregnancy by ultrasonography, where the presence of bladder line interruption, absence of the retroplacental clear zone, and presence of placental lacunae were regarded as criteria for the prediction of MAP
In women with risk for MAP (n = 28), nine with three findings comprising bladder line interruption, absence of the retroplacental clear zone, and placental lacunae were regarded as highly suspicious for MAP and underwent cesarean section followed by hysterectomy
Summary
Adherent placenta (MAP) is one of a number of risk factors related to maternal death [1]. Comstock et al [3] introduced an approach for the detection of MAP in the second and third trimesters of pregnancy by ultrasonography, where the presence of bladder line interruption, absence of the retroplacental clear zone, and presence of placental lacunae were regarded as criteria for the prediction of MAP. There were various advantages and disadvantages concerning the impact of current obstetrical practices on the outcome of MAP predicted by ultrasonography. Shamshirsaz et al [7] conducted a historical cohort study to investigate the impact of a multidisciplinary protocol on the outcome of MAP compared with a nonmultidisciplinary protocol. The multidisciplinary protocol was superior to the nonmultidisciplinary protocol in terms of reduction of both emergency surgery and blood loss during the perioperative period, that cohort study included only confirmed cases of MAP determined by histological examination after delivery
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