Impact of Antenatal Diagnosis and Management Strategies in Morbidly Adherent Placenta

To study the pattern, demography and management options in placenta accreta in a tertiary care centre. 1st January 2004 to 15 August 2008 at Military Hospital, Rawalpindi and between 1st Sep 2008 to 30th Oct 2009 at Combined Military Hospital, Multan. All cases of placenta accreta seen during the study period were included in the study. Placenta accreta was defined as placenta being adherent to uterine wall without easy separation. Patient's demography, presence or absence of prenatal diagnosis and the management strategy i.e. conservative or otherwise was documented on a proforma. Success or failure of surgical approach used was noted. Assessment of maternal morbidity in the form of amount of blood/blood product transfused and early and late complications was made and compared with other cases that were antenatally diagnosed or were undiagnosed. A total of 28 cases were analyzed during study period. The incidence of placenta accreta was 6.3/10000. Mean maternal age was 30.7 years. Placenta praevia obstetrical hysterectomy was performed in 17(61%) cases and had to be backed up by internal iliac artery ligation in 7(25%) Requirement for blood transfusion in antenatally diagnosed cases was almost 50% less than those of undiagnosed cases and the same was true for fresh frozen plasma (3.75 ± 4.18 versus 6.75±5.41) , platelet transfusion (P=0.04), stay in intensive care unit (1.56±1.82 versus3.41±3.28)and use of mechanical ventilation (7% versus 11%). There was no mortality in this series. Intra-operative internal iliac artery ligation reduces blood loss before and after hysterectomy and should be done in cases with placents accreta to reduce morbidity and mortality.