Characteristics, Outcomes and Prevalence of Pregnant Women with Placenta Accreta Spectrum in Black Lion Hospital - Five years retrospective study , Addis Ababa, Ethiopia, 2023

Abstract

Background Placenta accreta spectrum is known to be associated with significant maternal morbidity and mortality usually because of catastrophic hemorrhage during delivery. The Prevalence rates ranged from 0.01 to 1.1% with an overall pooled prevalence of 0.17% (95% confidence interval, 0.14–0.19). The aim of this study was to determine the prevalence, characteristics and outcome of pregnant mothers with placenta accreta spectrum in black lion hospital. Methodology: An institution based cross-sectional study from January 1, 2018 to December 31, 2022. FIGO classification system for the clinical diagnosis of placenta accreta spectrum disorder were used to define cases and enroll the participants. Data was cleaned, entered and analyzed using SPSS version 26.0 statistical software and MS excel. Descriptive statistics were used to describe baseline characteristics. Result From the 24,844 deliveries, prevalence of cesarean delivery- 37.3%; prevalence of placenta accreta spectrum to be 0.1% (1 out of 994) and of which, 16 (64%)- abnormally adherent type (grade 1) and 9 (36%)-abnormally invasive type [grade 2 (24%) and grade 3 (12%)]. Placenta accreta spectrum was suspected prenatally in 28% of the mothers. Risk factors identified in 92% (23 out of 25) of the mothers were either placenta previa or cesarean delivery; in 60% (15 out of 25) of the mothers both placenta previa and prior cesarean delivery. Average estimated blood loss of 1568 (± 849) ml and 17 out of 25 (68%) were transfused. There was no maternal death and intensive care unit admission. Conclusion and Recommendations: The prevalence of cesarean delivery is very high as compared to the national figure. Antenatal suspicion or prenatal diagnosis of placenta accreta spectrum is very low thus all pregnant mothers with risk factors especially mothers with cesarean delivery and placenta previa should be screened for placenta accreta spectrum. Mothers with suspected placenta accreta spectrum should be managed with optimal preparation as possible.