MANAGEMENT AND MATERNAL OUTCOME IN MORBIDLY ADHERENT PLACENTA

Authors

  • Nighat Sultana
  • Sobia Mohyuddin
  • Tahira Jabbar

Abstract

Background: Morbidly adherent placenta (MAP) with its variants is one of the most feared
complications causing high morbidity and mortality in obstetrics. The objective of this study was to
analyse different management options and maternal outcome in diagnosed cases of morbidly adherent
placenta. Methods: Descriptive case series was carried out in Obstetrics and Gynaecology
Department, Combined Military Hospital, Rawalpindi and one private hospital from Jan 2008 to Dec
2010. During this period all cases of morbidly adherent placenta diagnosed by colour flow Doppler
and MRI were analysed. Operative delivery was carried out in all patients. Three different surgical
managements namely total abdominal hysterectomy with non separation of placenta, subtotal
hysterectomy and trial haemostasis with uterine sparing surgery were carried out on when and where
required basis. The outcome like total blood loss, blood transfused, Intensive unit care, postnatal
complications including febrile morbidity, hospital stay and prolonged follow ups, were recorded.
Results: Total 32 cases of morbidly adherent placenta diagnosed by colour Doppler ultrasound/MRI
(magnetic resonance imaging) were identified. In this study the frequency of morbidly adherent
placenta found to be 1/274.8 deliveries and 1/122.6 caesarean sections. Initially total caesarean
hysterectomy was performed in 16 patients, while subtotal hysterectomy in 9 and Trial haemostasis
with uterine sparing in 7 cases out of which two cases underwent total hysterectomy due to massive
postpartum haemorrhage same day. One case in subtotal hysterectomy for placenta percreta with
bladder invasion had re-laparotomy for bladder fistula, while two for severe postpartum haemorrhage.
Two needed ventilator support. Maternal morbidity was greater in subtotal hysterectomy and uterine
sparing group. One patient died in this study. Conclusion: Antenatal diagnosis of morbidly adherent
placenta followed by well-planned total abdominal hysterectomy with non-separation of placenta
adapting multidisciplinary approach is the best surgical option to reduce maternal morbidity/mortality.
Keywords: morbidly adherent placenta, total abdominal hysterectomy, Trial haemostasis

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Published

2011-06-01

How to Cite

Sultana, N., Mohyuddin, S., & Jabbar, T. (2011). MANAGEMENT AND MATERNAL OUTCOME IN MORBIDLY ADHERENT PLACENTA. Journal of Ayub Medical College Abbottabad, 23(2), 93–96. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/2542

Issue

Vol. 23 No. 2 (2011): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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