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J Obstet Gynaecol India. 2012 Feb;62(1):57-61. doi: 10.1007/s13224-012-0149-5. Epub 2012 Apr 20.

Morbidly adherent placenta: a critical review.

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1
Department of Obstetrics & Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, 110095 India ; KL-99, Kavi Nagar, Ghaziabad, UP 201002 India.

Abstract

OBJECTIVE:

To evaluate the demographic profile, high risk factors, fetomaternal outcome and management options in morbidly adherent placenta (MAP).

STUDY DESIGN:

Retrospective analysis.

METHODOLOGY:

Review of 20 case records of women with MAP during year 2001-2006.

RESULTS:

The mean age and parity of the women was 27.7 ± 4.2 years and 2.5 respectively. 70 % women had previous uterine scar, and similar number had placenta previa. 60 % women presented with antepartum hemorrhage and 20 % with retained placenta. 85 % women underwent hysterectomy with 5 % requiring internal iliac artery ligation, another 5 % partial cystectomy and 15 % bladder repair. Blood loss was between one and nine litres requiring an average of six units whole blood and 4 units FFP. There were six (30 %) maternal deaths. 55 % of the newborns were preterm and the perinatal mortality was 33.3 %.

CONCLUSION:

Cesarean section and placenta previa are significant risk factors. MAP is associated with high fetomaternal morbidity and mortality.

KEYWORDS:

Internal iliac artery ligation; Morbidly adherent placenta; Placenta accreta; Placenta increta; Placenta percreta

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