Morbidly adherent placenta: a critical review

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.