Publication

Abstract : Morbidly adherent placenta is a life threatening obstetric emergency. There is an increase in the incidence of adherent placenta . An important risk factor is the placenta previa in the presence of a uterine scar Ultrasound is the primary tool for diagnosis but MRI is helpful in cases of inconclusive or if placenta percreta is suspected.Methods: Review of case records (Retrospective case study) of women with adherent placenta during the years 2009 – 2015 at Amrita Institute Of Medical Sciences Research Centre, Kochi. To evaluate the high risk factors, management of morbidly adherent placenta and the maternal as well as fetal outcome in our institution.Results: Out of 17 cases the incidence of placenta accreta increased from 0.15% in 2009 to 0 .26% in 2015. Placenta previa and LSCS were the major risk factors. Ultrasound and MRI was done in the vast majority. The mean age of termination of pregnancy was 36.51 weeks. Elective surgery were done in 14 with Ceasarean hysterectomy in almost 50%. Haemostatic surgical measures were taken in all cases.The complications included bladder injury, DIC and wound dehiscence. Blood and blood products were replaced .The average time of surgery was 2.21hours and blood loss was 2.34L.. There was no maternal or perinatal mortality.Conclusion: In suspected cases, screening for placenta accrete should be done by 18- 24 weeks. Early admission, prophylactic corticosteroids, elective surgery around 36 -37 weeks in a tertiary care with multidisciplinary appproach helps to reduce the maternal and neonatal morbidity and mortality.