Placenta accreta is a significant obstetric complication in which the placenta is completely or focally adherent to the myometrium. The worldwide incidence of placenta accreta spectrum (PAS) is increasing day by day, mostly due to the increasing trends in cesarean section rates. The accurate and timely diagnosis of placenta accreta is important to improve the fetomaternal outcome. Although standard ultrasound is a reliable and primary tool for the diagnosis of placenta accreta, the absence of ultrasound findings does not preclude the diagnosis of placenta accreta. Therefore, clinical evaluation of risk factors is equally essential for the prediction of abnormal placental invasion. Pregnant women with a high impression or established diagnosis of placenta accreta should be managed by a multidisciplinary team in a specialist center. Traditionally, PAS has been managed by an emergency obstetric hysterectomy. Previously, few studies suggested a satisfactory success rate of conservative management in well-chosen cases, whereas few studies recommended delayed hysterectomy to reduce the amount of bleeding. The continuously increasing trends of PAS and the challenges for its routine management are the main motives behind this literature review.

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Introduction Women undergoing instrumental delivery are known to be at higher risk of urinary retention, which can lead to long‐term complications such as voiding dysfunction. Nulliparous women undergo a pronounced and sudden change in the perineum due to stretching during delivery, which may add to the perineal trauma from an episiotomy, increasing the risk of urinary retention. We aim to study the incidence and risk factors associated with postpartum urinary retention in women undergoing instrumental delivery. Material and methods Pregnant women who had an instrumental delivery after 37 weeks of gestation at JIPMER, Puducherry, India, between January 2017 and June 2017 were included in the study. Postpartum urinary retention was defined as the inability to void spontaneously or ultrasonographic documentation of post‐void residual volume of >150 mL, 6 hours after delivery. Demographic factors, clinical profile and follow‐up of these patients were noted. Multivariate logistic regression analysis was performed to assess the risk factors associated with urinary retention and was presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results Postpartum urinary retention was noted in 124 (20.6%) women undergoing instrumental delivery. Overt and covert urinary retention occurred in 2.3% and 18.3%, respectively. After adjusting for other risk factors, nulliparity (adjusted OR = 4.05, 95% CI 2.02‐8.12 compared with multiparity) and prolonged second stage (OR = 3.96, 95% CI 1.53‐10.25) compared with suspected fetal compromise as an indication for instrumental delivery was associated with increased risk of postpartum urinary retention. Interaction was noted between parity and episiotomy on the occurrence of postpartum urinary retention (P = .010). Among nulliparous women, those with episiotomy (adjusted OR = 6.10, 95% CI 2.65‐14.04) have higher odds of developing postpartum urinary retention compared with those without episiotomy. Conclusions Approximately one of five (20.6%) women undergoing instrumental delivery developed postpartum urinary retention. Among women undergoing instrumental delivery, episiotomy increased the chances of developing postpartum retention in nulliparous but not multiparous women. Prolonged second stage as an indication for instrumental delivery also increased the chances of retention. Future studies are needed to define the cutoff for diagnosis and to evaluate the long‐term effects of covert postpartum urinary retention, as well to study the effect of episiotomy on development of postpartum urinary retention in women undergoing instrumental delivery.

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Objective To assess the incidence of postpartum depression (PPD) and its risk factors in women with potentially life‐threatening complications. Methods Eight hundred and ninety women admitted to a tertiary center in South India with potentially life‐threatening complications were recruited for the study. Within seven days of delivery, women underwent mental health assessments using the EPDS and PHQ‐9 scale. Counseling was provided and follow‐up assessment carried out at 3 months postpartum. Bivariate and multivariate analysis was done to assess the association of risk factors to depression. Results PPD was observed in 21% of the study cohort. Women with no formal education (OR −2.66, 95% CI: 1.10– 6.40) and those who had a stillbirth (OR 2.48, 95%CI: 1.57–3.93) were found to be associated with PPD after adjusting for other factors. Occurrence of an obstetric near‐miss event did not increase the risk of depression. Most women recovered with postnatal counseling, with only three requiring medication at the end of 3 months. Conclusion One in five women who develop potentially life‐threatening complications developed PPD. A strategy of screening focused on this high‐risk group, especially in low resource settings, can lead to early recognition and treatment. This in turn can lead to a reduction in the long‐term morbidity associated with PPD.