Menoufia University Hospital experience in management of the patients with morbidly adherent placenta

Abstract

Objective To determine the outcome of management of placenta accreta when the policy of hysterectomy was adopted without attempt of manual separation of placenta. Background Placenta accreta occurs when the chorionic villi invade the myometrium abnormally. The incidence of placenta accreta has been steadily increasing, attributed to the increasing prevalence of cesarean delivery in recent years. Patients and methods A retrospective randomized study was conducted on 70 cases of morbidly adherent placenta accreta attending the Obstetrics and Gynecology Outpatient Clinic at Menoufia Teaching Hospital over a 4-year interval, during the period between January 2015 and December 2018. Results The incidence of placenta accreta was 1.67% of cesarean deliveries. The ultrasonography was suggestive of morbid adherent in only 32 (45.7%) cases. ICU admission occurred in eight (11.4%) cases. Two (2.8%) patients had wound infection. One (1.4%) case needed reoperation. Postpartum pyrexia occurred in one (1.4%) case. Median duration of hospital stay was 5 days (range, 3–35 days). The mean gestational age at delivery was 36.87 weeks (range, 32–39 weeks), and 11 (15.7%) infants were admitted to neonatal ICU. Conclusion Placenta accreta is highly associated with placenta previa, especially in cases with previous cesarean section. When placenta accreta is diagnosed or suspected antenatally, the patient must be referred to tertiary center. Generally, the recommended management is cesarean hysterectomy with placenta left in situ after bilateral clamping of uterine artery below insertion of placenta with blunt dissection of urinary bladder from lateral to medial.