MANAGEMENT AND MATERNAL OUTCOME IN MORBIDLY ADHERENT PLACENTA
AbstractBackground: Morbidly adherent placenta (MAP) with its variants is one of the most fearedcomplications causing high morbidity and mortality in obstetrics. The objective of this study was toanalyse different management options and maternal outcome in diagnosed cases of morbidly adherentplacenta. Methods: Descriptive case series was carried out in Obstetrics and GynaecologyDepartment, Combined Military Hospital, Rawalpindi and one private hospital from Jan 2008 to Dec2010. During this period all cases of morbidly adherent placenta diagnosed by colour flow Dopplerand MRI were analysed. Operative delivery was carried out in all patients. Three different surgicalmanagements namely total abdominal hysterectomy with non separation of placenta, subtotalhysterectomy and trial haemostasis with uterine sparing surgery were carried out on when and whererequired basis. The outcome like total blood loss, blood transfused, Intensive unit care, postnatalcomplications 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 adherentplacenta found to be 1/274.8 deliveries and 1/122.6 caesarean sections. Initially total caesareanhysterectomy was performed in 16 patients, while subtotal hysterectomy in 9 and Trial haemostasiswith uterine sparing in 7 cases out of which two cases underwent total hysterectomy due to massivepostpartum haemorrhage same day. One case in subtotal hysterectomy for placenta percreta withbladder 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 uterinesparing group. One patient died in this study. Conclusion: Antenatal diagnosis of morbidly adherentplacenta followed by well-planned total abdominal hysterectomy with non-separation of placentaadapting 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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