Management Strategies and Maternal Outcome of Placenta Accreta

Abstract

Objectives: To find out the proportion and maternal outcome of placenta accreta.Materials and Methods: Total 10579 deliveries were served during January 2013 to 31st December 2013 in the Department of Obstetrics and Gynecology of Addin Women Medical College Hospital, Dhaka. All patients who needed postpartum or cesarean hysterectomy for postpartum hemorrhage and diagnosed as placenta accreta after postpartum hysterectomy were included for the study. Among them who were antentally diagnosed as placenta previa with having other risk factors of placenta accreta, were evaluated by Doppler Sonography. All these cases such as diagnosed, suspected or only had multiple risk factors of placenta accreta were managed by a team approach and proper counseling of the patient’s guardian about need of massive transfusion, hysterectomy, Intensive Care Unit (ICU) admission .Results: Among the total 10579 deliveries 22 cases were diagnosed as placenta accreta after postpartum hysterectomy. On histopathology 8 of these cases were placenta percreta, 7 cases were placenta increta and 7 cases were placenta accreta vera. Almost ninety one (90.90%) patient had placenta previa and 90.90% patient had past H/O one or two cesarean section. Placenta percreta cases were more common in patients with H/O two previous C/S or one C /S and dilatation & curettage (D&C). In all preoperatively diagnosed cases, Right lower paramedian incision was given and hysterectomy was done leaving the placenta in situ.Conclusion: Placenta accreta is associated with previous two or more cesarean deliveries, or multigravidae with past H/O repeated D&C or M/R or combined. History of of these operations are diagnosed as having anterior or central placenta previa.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(2) : 71-75

Maternal and fetal outcome of eclampsia in Dinajpur Medical College Hospital Dinajpur, Bangladesh

“…In this study common indications were previous section 16%, foetal distress 15%, obstructed labour 14%, pre-eclampsia and eclampsia 12%. Previous section constitute 20.41% in another study in our country Chowdhury and Begum et al [18] Present study findings correlate with it. Repeat sections constitute the commonest indication for LSCS in most other countries.…”

“…Begum et al [10] found that 77.0% came from low socioeconomic status. Begum et al; Rouf et al; Ara et al and Begum et al [15][16][17][18] ] mentioned that eclampsia is a disease of lower class who do not have basic education, do not receive ANC, do not seek health advice & present only in grave form of the disease. Yaqub et al [13] found in their study that 56% cases of eclampsia observed with women who conceived first time i.e.…”

Morbidly Adherent Placenta: A Cross-sectional Study in a Tertiary Care Hospital

“…Another study conducted at a local hospital in the same city quoted its incidence as 4.7 per 1000 deliveries 4 . Similar studies done in India and Bangladesh have shown its incidence of 1.2 and 2 per 1000 deliveries respectively 5,6 .…”

Outcome of Placenta Percreta Management by Planned Peripartum Hysterectomy in a Tertiary Level Hospital

“…Hysterectomy in a Tertiary Level Hospital In Bangladesh, haemorrhage is still the leading cause of maternal mortality [20][21][22] . The diagnosis of placenta accreta is made on obstetric ultrasonography, usually in the second and third trimester of pregnancy 23 . Sometimes, patients present with acute emergency that is mild to severe antepartum haemorrhage with features of shock without having any investigations.…”