Abstract
Introduction: Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups; Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum hysterectomy<span
Highlights
Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta
An efficient team capable for managing possible complicated situations will reduce mortality and morbidity to the least possible [1] [4]. This is comparable to a previous review in King Abdul-Aziz University Hospital analyzing placenta previa cases from the period to 2013, reported 11.3% hypovolemic shock with massive blood transfusion, admission to I.C.U and 6.5% hysterectomy
We considered the occurrence of intra partum hypovolemic shock, surgical complications e.g. urologic injuries, peripartum hysterectomy or need for postnatal
Summary
Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta, with the various grades of severity according to depth of penetration, constitutes a serious and possibly a life threatening complication during pregnancy It could present with massive intrapartum hemorrhage either spontaneously or during trials to separate the placenta during caesarian section [2] [3]. An efficient team capable for managing possible complicated situations will reduce mortality and morbidity to the least possible [1] [4] This is comparable to a previous review in King Abdul-Aziz University Hospital analyzing placenta previa cases from the period to 2013, reported 11.3% hypovolemic shock with massive blood transfusion, admission to I.C.U and 6.5% hysterectomy. Their cases were 82% unbooked patients compared to 52% in our study
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