MATERNAL AND FOETAL OUTCOME IN CESAREAN HYSTERECTOMIES PERFORMED FOR PLACENTA INCRETA
AbstractBackground: Placenta accreta is a serious obstetrical complication and is currently a very important indication for peripartum hysterectomy. The purpose of this study is to review the frequency of Caesarean hysterectomies performed for placenta accreta and maternal, foetal outcome of these patient. Methods: In this cross-sectional study all the patients who underwent emergency hysterectomies for different obstetrical indications during this one year were included in this study. Among them the hysterectomies performed for massive antepartum haemorrhage due to placenta increta were reviewed in detail and risk factors were identified. Results: Caesarean hysterectomies performed for different obstetrical indications were 47 and 10 were due to placenta previa increta (21.2%). The mean age of the patients was 30±5.5 years. Majority of the patients were multigravidas between 26 and 35 years of age. 30% of patients were Para-3 and 70% of patients were Para–4 and above. 01 patient (10%) had previous one Caesarean section with placenta previa increta, 02 patients (20%) had previous 02 C-Sections and low-lying placenta adherent to it and 04 patients (40%) had previous 03 C-Sections and major degree placenta previa and 03 patients (30%) had 04 C-Sections with placenta increta. Among the foetal outcome 04 babies (40%) were delivered between 28–32 weeks of gestation. 05 foetuses (50%) were delivered between 33–36 weeks of gestation and one foetus (10%) was delivered at term. 02 babies delivered at 28 weeks of gestation had early neonatal death due to prematurity. There were no maternal deaths in this time period. Conclusion: placenta previa increta is a major obstetrical complication. Timely recognition and delivery in a tertiary care hospital with surgical expertise, blood bank facilities and intensive care facilities both for the mother and the baby are needed to improve maternal and foetal outcome. Keywords: Placenta previa; Placenta accrete; Placenta increta; Hysterectomy, Maternal mortality, Maternal morbidity
Frederiksen MR, Glassenberg R, Stika CS. Placenta previa. A 22 years analysis. Am J Obstet Gynaecol 1999;18(6):1432–73.
Zhang J, Sanitz DA. Maternal age and placenta previa: A population based, case control study. Am J Obstet Gynaecol 1993;168(2):641–5.
Haider G, Zehra N, Munir AA, Hairder A. A frequency and indications of caesarean section in tertiary care hospital. Pak J Med Sci 2009;25(5):791–6.
Rose GL, Chaman MG. Aetiological factors in placenta privia. A case controlled study. Br J Obstet Gynaecol 1986;93:586–8.
Morken NH, Henriksen H. Placenta Percreta two cases and review of literature. Eur J Obstet Gynaecol Reprod Biol 2001;100(1):112–5.
Abu-Heija AT, EL-Jallad F, Ziadeh S. Placenta Previa: effects of age, gravidity, parity and previous Caesarean Section. Gynaecol Obstet Invest 1999;47(1):6–8.
Memon S, Kumari K, Yasmin H, Bhutta S. Is it possible to reduce the rates of placenta previa? J Pak Med Assoc 2010;60(7):566–9.
Johnson LG, Mueller BA, Daling JR. The relationship of Placenta previa and history of induced abortion. Int J Gynaecol Obstet 2003;81(2):191–8.
Faiz AS, Ananth CV. Eitiology and risk factors for placenta previa; an over view and meta analysis of observational studies. J Matern Fetal Neonatal Med 2003;13(3):175–90.
Nasreen F. Incidence, causes and outcome of placenta previa. J Postgrad Med Inst 2003;17(1):99–104.
Clark SL, Koonings RP, Phelan JP. Placenta previa accreta and prior Caesarean Section. Obstet Gynaecol 1985;66(1):89–92.
Yazdani T, Islam A, Nadeem G, Hayat T, Mushtaq M. Frequency of abnormal placentation in patients with previous Caesarean section. J Rawal Med Coll 2007;11(1):39–41.
Placenta Previa and Placenta Accreta. Diagnosis and management. Green-top Guideline No. 27. Royal Coll Obstet Gynaecol 2011;1–26.
Silver L, Hobel C, Lagasse L, Luttrull J, Platt L. Placenta previa percreta with bladder involvement: new considerations and review of the literature. J Int Soc Ultrasound Obstet Gynecol 1997;9(2):131–8.
Comstock CH, Love JJ Jr, Bronsteen RA, Lee W, Vettraino IM, Huang RR, et al. Sonographic detection of placenta accreta in the second and third trimester of pregnancy. Am J Obstet Gynaecol 2004;190(4):1135–40.
Twicker DM, Lucas MJ, Balis AB, Santos-Ramous R, Martin L, Malone S, et al. Color flow mapping for myometrial invasion in the women with prior Caesarean delivery. J Matern Fetal Med 2000;9(6):330–5.
Wong HS, Chung YK, Strand L, Carryer P, Parker S, Tait J, et al. Specific Sonographic features of placenta accreta. Tissue interface description on gray scale imaging and evidence of vessels crossing interface disruption sites on Doppler ultrasound. Ultrasound Obstet Gynaecol 2007;29(2):239–41.
Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, et al. Accuracy of Ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynaecol 2006;108(3 Pt 1):573–81.
Wong HS, Zuccollo J, Straw L, Tait J, Pringle KC. The use of ultrasound in assessing the extent of myometrial involvement in partial placenta accreta. Ultrasound Obstet Gynaecol 2007;30(2):277–80.
Ramos GA, Kelly TF, Move TR. Importance of preoperative evolution in patients with risk factors for placenta accreta. Obstet Gynaecol 2007;109:75.
Shukenami K, Hottori K, Nishijima K, Kotsuji F. Transverse fundal uterine incision in a patient with placenta accreta. J Matern Fetal Neonatal Med 2004;16(6):335–6.
Yap YY, Pervin LC, Pain SR, Wong SF, Chan FY. Manual removal of suspected placenta accreta at Caesarean Hysterectomy. Int J Gynaecol Obstet 2008;100(2):186–7.
Ojala Y, Perala J, Karinuemi J, Ranta P, Raudaskoski T, Tekay A. Arterial embolization and prophylactic Catherization for the treatment of severe obstetric hemorrhage. Acta Obstet Gynaecol Scand 2005;84(11):1075–80.
Arukumaran S, Ng CS, Ingemasson I, Ratnam SS. Medical treatment of placenta accreta with methotrexate. Acta Obstet Gynaecol Scand 1986;65(3):285–6.