RISK FACTORS AND OUTCOME OF MORBIDLY ADHERENT PLACENTA IN SULAYMANIYAH MATERNITY TEACHING HOSPITAL
Huda Muhaddien Muhammad a
a College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 6/10/2020; Accepted: 24/4/2021; Published: 21/9/2021
DOI Link: https://doi.org/10.17656/jsmc.10323
Over the last three decades, the incidence of placenta accreta has increased dramatically in concert with the increase in cesarean delivery rate. Moreover, placenta previa has been reported to be associated with a high rate of placenta accreta, which is mainly responsible for direct maternal mortality and morbidity.
The present study aimed to determine the risk factors of the morbidly adherent placenta and their outcomes.
Patients and Methods
The present cross-sectional study was carried out from May 1, 2018, to May 1, 2019. For this purpose, a total number of 38 pregnant women with morbidly adherent placenta above 20 weeks’ gestations were selected. Afterwards, the patients were interviewed using a constructed questionnaire. The data were analyzed using the Chi-square test by Statistical Package for Social Science (version 24). P-values of less than 0.05 were regarded as significant.
Approximately 63% of patients did not report a previous history of previous surgical evacuation, and more than half of them did not have a history of previous abortions. More than 88% of cases of placenta accreta were reported among those with late gestational age. In more than 76% of the patients, the placental position was in an anterior position. Cesarean hysterectomy was the most commonly used surgical intervention. Also, more than two-thirds of them needed a blood transfusion. Furthermore, 75% of placenta increta occurred among anterior placental positions.
The morbidly adherent placenta is common in patients with repeated cesarean section. Cesarean hysterectomy is the traditional method of managing mean arterial pressure (MAP) to prevent severe blood loss and other maternal morbidities.
Placenta Accreta, Morbidly, Risk Factor, Sulaymaniyah.
1. Aggarwal R, Suneja A, Vaid NB, Yadav P, Sharma A, et al. Morbidly Adherent Placenta: A Critical Review. J Obstet Gynaecol India. 2012; 62(1): 57–61. DOI: 10.1007/s13224-012-0149-5.
2. ACOG Committee on Obstetric Practice. ACOG Committee Opinion. Number 266, January 2002: placenta accreta. Obstet Gynecol. 2002;99(1):169-70. DOI: 10.1016/s0029- 844(01)01748-3.
3. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192(5):1458-61. DOI: 10.1016/j.ajog.2004.12.074.
4. Benirschke K, Burton GJ, Baergen RN. Pathology of the human placenta, 6th ed. Berlin: Springer Verlag; 2012. ISBN 978-3-642-23941-0. DOI: https://doi.org/10.1007/978-1-4757-4199-5
5. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107(4):927-41. DOI: 10.1097/01.AOG.0000207559.15715.98.
6. Happe SK, Rac MWF, Moschos E, Wells CE, Dashe JS, et al. Prospective assessment of morbidly adherent placenta with first-trimester ultrasound. American Journal of Obstetrics and Gynecology. 2018; 218(1): S281-S282. DOI: 10.1016/j.ajog.2017.10.404.
7. Silver RM. Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta. Obstet Gynecol. 2015;126(3):654-68. DOI: 10.1097/AOG.0000000000001005.
8. Belfort MA. Placenta accreta. Am J Obstet Gynecol. 2010; 203:430-9. DOI: https://doi.org/10.1016/j.ajog.2010.09.013.
9. O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol. 1996;175(6):1632-8. DOI: 10.1016/s0002-9378(96)70117-5.
10. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, et al. CHAPTER 41: Obstetrical Hemorrhage. Williams Obstetrics, 25e. New York, NY: McGraw-Hill Education. 2018.
11. Benirschke K, Burton GJ, Baergen R. Pathology of the human placenta, sixth edition. Berlin, Springer Verlag. 2012; DOI: 10.1007/978-3-642-23941-0. ISBN: 978-3-642-23940-3.
12. Eniola AO, Bako AU, Selo-Ojeme DO. Risk factors for placenta previa in southern Nigeria. East Afr Med J. 2002; 79:535-8. DOI: 10.4314/eamj. v79i10.8816.
13. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol. 2006;107(4):771-8. DOI: 10.1097/01.AOG.0000206182.63788.80.
14. Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. International Journal of Gynecology & Obstetrics. 2006; 93(2):110-7. DOI: 10.1016/j.ijgo.2006.02.006.
15. Onwere Chidimma, Gurol-Urganci Ipek, Cromwell DA, Mahmood TA, Templeton A, et al. Maternal morbidity associated with placenta previa among women who had an elective cesarean section. Eur J Obstet Gynecol Reprod Biol. 2011;159(1):62-6. doi: 10.1016/j.ejogrb.2011.07.008.
16. Bennett MJ, Sen RC. 'Conservative' management of placenta previa percreta: report of two cases and discuss current management options. Aust N Z J Obstet Gynaecol. 2003;43(3):249-51. DOI: 10.1046/j.0004-8666.2003.00067. x.
17. Mussalli GM, Shah J, Berck DJ, Elimian A, Tejani N, et al. Placenta accreta and methotrexate therapy: three case reports. J Perinatol. 2000;20(5):331-4. DOI: 10.1038/sj.jp.7200373.
18. Eller AG, Bennett MA, Sharshiner M, Master C, Soisson AP, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol. 2011;117(2 Pt 1):331-7. DOI: 10.1097/aog.0b013e3182051db2.
19. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7(12): e52893. DOI: 10.1371/journal.pone.0052893.
20. Vijayasree M. Retrospective Analysis of Morbidly Adherent Placenta in a Tertiary Care Referral Centre - A Decade of Experience. SM J Gynecol Obstet. 2018; 4(2): 1031. ISSN: 2573-6744.
21. Duzyj CM, Barishansky S, Khan S, Berthiaume F, Heller D, et al. 147: Evidence of active wound remodelling at the site of trophoblast invasion in placenta accreta. Poster session. 2017; Volume 216, Issue 1, Supplement, S99-S100. DOI: https://doi.org/10.1016/j.ajog.2016.11.051.
22. Cramer S. F, Heller D. S. Placenta Accreta and Placenta Increta: An Approach to Pathogenesis Based on the Trophoblastic Differentiation Pathway. Pediatr Dev Pathol. 2016;19(4):320-33. DOI: 10.2350/15-05-1641-OA.1. Epub 2015 Oct 22.
23. Choudry A, Choudry H, Shukr I, Bano I, Ahmad S. Impact of Antenatal Diagnosis and Management Strategies in Morbidly Adherent Placenta. Pakistan Journal of Medical Research. 2011; ISSN 0030-9842, v. 50(1); p. 5-9.
24. Arduini M, Epicoco G, Clerici G, Bottaccioli E, Arena S, Affronti G. B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum haemorrhage due to placenta previa accreta. Int J Gynaecol Obstet. 2010; 108:191-3. DOI: 10.1016/j.ijgo.2009.10.007.
25. Ferrazzani S, Guariglia L, Triunfo S, Caforio L, Caruso A. Conservative management of placenta previa-accreta by prophylactic uterine arteries ligation and uterine tamponade. Fetal Diagn Ther. 2009; 25:400-3. DOI: 10.1159/000236154.
26. Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, et al. Placenta Previa, and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BLOG. 2019;126(1): e1-e48. DOI: 10.1111/1471-0528.15306. DOI: 10.1111/1471-0528.15306.
27-Royal College of Obstetrician and Gynaecology. Placenta previa and placenta praevia accreta: diagnosis and management (Green-top 27) [Internet]. 2011. [updated 2011 Apr 11].
© The Authors, published by University of Sulaimani, College of Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.