Maternal and Foetal Outcome in Cases of Placenta Previa, Accreta and Increta

Abstract

Objective: To evaluate the maternal and foetal outcome in cases of placenta previa, placenta accrete and placenta increta. Methods: Medical records of patients from 1 Feb 2014 to 28 Feb 2015 were checked and patients who underwent caesarean section with a diagnosis of placenta previa types III and IV (and placenta accreta, increta and percreta) were identified. Their medical record files were retrieved and data collected regarding patients age, parity, previous LSCS, D&C, blood loss, bladder injury, hysterectomy and use of B-lynch technique were recorded. Neonatal statistics were also recorded regarding birth weight, gender, APGAR score and need for admission in NICU. Results: In total 37 cases of major placenta previa were identified. These included 8 cases with placenta accrete including 2 cases of placenta increta. No maternal death occurred amongst the studied cases. Only one case of IUFD was identified. The incidence of placenta previa (major) was 29.95/1000 births. Average parity of patients with placenta accreta (PA) was significantly higher than cases of placenta previa (PP) (2.75 vs. 1.55, p = 0.04). Similarly average number of LSCS in cases of PA was significantly higher than cases of PP (2.25 vs. 0.86, p = 0.02). PA cases were delivered at a significantly earlier gestational age as compared to cases with PP (34.5 weeks vs. 37 weeks, p = 0.01). Hysterectomy was done in 6 (75%) cases of PA but in none with PP. Bladder injury occurred in 2(25%) cases of PA but in none with PP. Blood loss was also significantly higher in PA cases than PP cases (3975 ml vs. 1196 ml, p = 0.006). Conclusion: At tertiary care hospitals, maternal and foetal outcomes for placenta previa and placenta accreta have improved owing to improved surgical techniques and better understanding of these conditions.

Fetomaternal outcome in patients with placenta previa

“…Similar results with high morbidity and low mortality have been reported in a study from Lahore but number of patients was less. 18 High maternal mortality has been reported from Tanzania and India mainly due to lack of antenatal care. 9 , 20 …”

“…Similar morbidity is reported from all studies worldwide. [2][3][4][5][11][12][13][14][17][18][19] We had low case fatality of 3% as only two patients died. Antenatal care played an important part in improved outcome of these patients as 86.1% of our patients were booked.…”

“…Similar results with high morbidity and low mortality have been reported in a study from Lahore but number of patients was less. 18 High maternal mortality has been reported from Tanzania and India mainly due to lack of antenatal care. 9,20 Fetal outcome was good in patients with MAP and placenta previa in our study with majority (73.2% vs 65.6%) delivering after 36 weeks, with good APGAR and babies having birth weight ≥2.5kg and only three neonatal deaths due to prematurity (p>0.05).Some studies have reported adverse neonatal outcomes in these patients in terms of lower birth weight and preterm birth [3][4][5]16 while others have reported term deliveries with good perinatal outcome.…”

Morbidly Adherent Placenta: Management options

“…Similar results were found by Memon E and et al [10] . Another study reported comparative findings but their sample size was small [24] . Su HW in Taiwan had less successful results with conservative management of abnormally invasive placenta to save the uterus and had more morbidity [16] .…”

Exactitud de los hallazgos ecográficos 2D más ecografía Doppler para el diagnóstico de acretismo placentario clínico en gestantes con factores de riesgo

“…Placenta accreta is the abnormal insertion of the placenta to the uterine wall beyond the fibrin layer or Nitabuch layer (1), secondary to total or partial decidual absence (2), with trophoblast villi penetration into the myometrium and even into the serosa or adjacent organs (3,4). Three variants of placenta accreta have been proposed according to the degree of trophoblast invasion: accreta, increta and percreta (5).…”