Morbidly adherent placenta and it’s maternal and fetal outcome

Background: Morbidly adherent placenta, a grave complication of pregnancy is becoming an emerging cause of increased maternal morbidity and mortality. Objectives of present study are to evaluate the etiopathogenesis of MAP, its clinical mode of presentation and maternal and fetal outcome with the aim to reduce maternal morbidity and mortality.Methods: It was a retrospective and prospective study at Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur in which data of patients with clinical diagnosis of MAP were reviewed from October 2014 to January 2016.Results: In this study of 10 cases of morbidly adherent placenta of Umaid hospital from October-2014 to January 2016 were studied, it was found that the mean age of presentation was 30.2 year. 60% cases were unbooked and 40% cases were booked with regular ANC visit. 60% cases presented with bleeding per vagina as a chief complaint and 30% cases were admitted for elective LSCS. 60% cases were already diagnosed case of placenta praevia. 90% cases had a history of previous LSCS. 80% cases were given BT intraoperatively and postoperatively. 60% cases underwent caesarean hysterectomy, 80% cases were shifted to ICU, and there was one maternal death.Conclusions: The incidence of MAP is increasing due to higher cesarean section (C/S) rate. Antenatal diagnosis via USG and color-doppler imaging, preoperative counseling, planning and multidisciplinary approach is necessary to reduce morbidity and mortality associated with MAP.

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Efficacy of colour doppler imaging in prediction of placenta accrete

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174408 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4377

Author(s):

Rachna Agarwal ◽

Sruthi Bhaskaran ◽

Esha Gupta ◽

Dipanvita Dutta ◽

Anupama Tandon

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Color Doppler ◽

Color Doppler Imaging ◽

Final Diagnosis ◽

Doppler Imaging ◽

Colour Doppler ◽

Grey Scale ◽

Transfusion Requirements ◽

Caesarean Hysterectomy

Background: In present scenario of increasing cases of previous caesarean section the diagnosis of Placenta accreta preoperatively is of great value to the attending obstetrician. This helps in preparing, counselling the patient and also in assembling a multidisciplinary team for effective peripartum clinical management of these patients to prevent maternal morbidity and mortality.Methods: One hundred patient with persistent placenta previa after 28 weeks gestation were screened by grey scale B mode sonography. In suspicious cases of placenta accreta, further assessment by colour Doppler ultrasound was done. The color doppler imaging (CDI) criteria used were - diffuse intra parenchymal placental lacunar flow, focal intra parenchymal placental lacunar flow, bladder-uterine serosa interphase hypervascularity, prominent sub-placental venous complex and loss of sub-placental vascular signal in areas lacking peripheral sub-placental hypoechoic zone. Patients were prospectively followed up till delivery and the CDI findings were analysed with reference to final diagnosis made during caesarean section.Results: Six of hundred patients exhibited characteristic CDI patterns highly specific for placenta accreta according to the criteria used. In all 6 patients, morbidly adherent placenta was present intraoperatively. The sensitivity and specificity of CDI in the diagnosis of placenta accreta in presentstudy was 100%. Caesarean hysterectomy was required in five patients. Patients with CDI features of lacunar flow had higher incidence of blood loss, transfusion requirements and need for caesarean hysterectomy compared to patients with nonlacunar flow. The remaining 94 patients with placenta previa, not suspicious for placenta accreta on sonography underwent uncomplicated caesarean section.Conclusions: The use of CDI along with conventional grey-scale sonography improves the diagnostic accuracy for prediction of placenta accreta in patients with persistent placenta previa.

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Color Doppler imaging of placental masses: differential diagnosis and fetal outcome

Ultrasound in Obstetrics and Gynecology ◽

10.1046/j.1469-0705.2000.00324.x ◽

2000 ◽

Vol 16 (6) ◽

pp. 559-563 ◽

Cited By ~ 28

Author(s):

N. Prapas ◽

R.-I. Liang ◽

D. Hunter ◽

J. A. Copel ◽

L.-C. Lu ◽

...

Keyword(s):

Differential Diagnosis ◽

Color Doppler ◽

Color Doppler Imaging ◽

Fetal Outcome ◽

Doppler Imaging

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Use of a Fibrin Sealant Patch at Cesarean for Conservative Management of Morbidly Adherent Placenta

American Journal of Perinatology Reports ◽

10.1055/s-0038-1675848 ◽

2018 ◽

Vol 08 (04) ◽

pp. e325-e327 ◽

Cited By ~ 1

Author(s):

James Greenberg ◽

Julian Robinson ◽

Jean Carabuena ◽

Michaela Farber ◽

Daniela Carusi

Keyword(s):

Cesarean Delivery ◽

Fibrin Sealant ◽

Maternal Morbidity ◽

Placenta Previa ◽

Morbidity And Mortality ◽

Artery Embolization ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Maternal Morbidity And Mortality ◽

Repeat Cesarean Delivery

Background Morbidly adherent placenta represents a surgical challenge and source of maternal morbidity and mortality. We report the use of a fibrin sealant patch to address hemorrhage associated with a morbidly adherent placenta during cesarean delivery. Case A patient underwent repeat cesarean delivery with complete anterior placenta previa and anticipated morbidly adherent placenta. Bleeding persisted following delivery and removal of the placenta, despite uterine artery embolization. A fibrin sealant patch was applied as an adjuvant intervention to the placental bed and hemostasis was achieved without resorting to a hysterectomy. Conclusion Postpartum hemorrhage is an ongoing leading source of maternal morbidity and mortality. A case is presented in which a fibrin sealant patch provided control of focal placental bed bleeding, allowing removal of a focal morbidly adherent placenta and avoidance of hysterectomy.

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An Ultrasound Scoring Model for the Prediction of Intrapartum Morbidly Adherent Placenta and Maternal Morbidity: A Cross-Sectional Study

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0891-0772 ◽

2019 ◽

Author(s):

Dahlia O. El-Haieg ◽

Nadia M. Madkour ◽

Mohammad Abd Alkhalik Basha ◽

Reda A. Ahmad ◽

Somayya M. Sadek ◽

...

Keyword(s):

Maternal Morbidity ◽

Color Doppler ◽

Bladder Wall ◽

Cross Sectional Study ◽

Perfect Agreement ◽

Cross Sectional ◽

Morbidly Adherent Placenta ◽

Scoring Model ◽

Adherent Placenta ◽

Placental Lacunae

Abstract Objective To design an ultrasound scoring model for the prediction of the intrapartum morbidly adherent placenta (MAP) and maternal morbidity. Patients and Methods 114 females with singleton pregnancies ≥ 28 weeks of gestation referred for suspicion of MAP were included. All patients underwent examination by two-dimensional ultrasound with the color Doppler setting. Five signs were evaluated: the retroplacental echolucent space, placental lacunae, the hyperechoic uterine-bladder interface, retroplacental myometrium thickness, and subplacental, uterine serosa-bladder wall, intraplacental and bladder wall vascularity. We designed a score ranging from 0 – 8.5 points, including the five signs according to their odds ratios and evaluated its prediction for MAP and maternal morbidity. Results Using multivariate logistic regression, all ultrasound signs were significant dependent predictors for both MAP and maternal morbidity (myometrium thickness < 1 mm followed by lacunae ≥ 4 and lost retroplacental echolucent space). The only independent predictors for MAP were myometrium thickness < 1 mm and lacunae ≥ 4, while myometrium thickness < 1 mm and lost retroplacental echolucent space were predictive for maternal morbidity. The score showed a perfect agreement with MAP and a good one for maternal morbidity. Conclusion Application of the score we designed can improve the ultrasound diagnosis of MAP and the maternal outcome.

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Morbidly Adherent Placenta: Management options

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i01.375 ◽

2021 ◽

Vol 31 (01) ◽

pp. 3-7

Author(s):

Abida Sajid ◽

Aqsam Sajid Aqsam Sajid ◽

Arham Sajid Arham Sajid ◽

Maham Abid Maham Abid

Keyword(s):

Maternal Morbidity ◽

Tertiary Care ◽

Case Series ◽

Morbidity And Mortality ◽

Care Hospital ◽

Management Options ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Vaginal Deliveries ◽

Maternal Morbidity And Mortality

Background Placenta previa with placenta accreta spectrum is one of the most feared complications responsible for increased maternal morbidity and mortality. This study aims to reduce maternal morbidity and mortality by detecting risk factors, performing relevant investigations, and deciding appropriate management options. Methods: The study design is a descriptive case series, carried out on 72 patients of MAP of a tertiary care hospital, in a 6-years duration from January 2014 to December 2019. Patients of OPD and the emergency department were diagnosed for MAP by using grayscale ultrasounds, color Doppler USG's (in most cases), and MRI's (in only a few cases). Different management options were studied and maternal morbidities were observed. In the majority of cases, patients had operative deliveries with planned/ emergency hysterectomies, except for some having conservative surgery. Results: In the period of 6 years, the total number of deliveries was 35940. Out of these, 22140 were spontaneous vaginal deliveries and 13800 were C-sections. The incidence of MAP was 1 per 499 normal deliveries and 1 per 192 in C-sections. The criteria for MAP was fulfilled by 72 patients. MAP diagnosed in the antenatal period was 43% while 57% were diagnosed in an emergency. The majority of patients had a history of C-sections and many underwent emergency obstetric hysterectomies. Blood transfusions were given to all patients in our study. Only 4(5.5%) patients died in our study. Conclusion: Antenatal diagnosis of morbidly adherent placenta, followed by a well-planned surgical management, avoidance of placental separation and early caesarean hysterectomy ultimately result in a better maternal outcome. Keywords: Morbidly Adherent Placenta, Maternal Morbidity, Massive Obstetric Hemorrhage, Obstetric Hysterectomy.

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Association of Implementing a Multidisciplinary Team Approach in the Management of Morbidly Adherent Placenta With Maternal Morbidity and Mortality

Obstetrics and Gynecology ◽

10.1097/aog.0000000000002865 ◽

2018 ◽

Vol 132 (5) ◽

pp. 1167-1176 ◽

Cited By ~ 8

Author(s):

Helena C. Bartels ◽

Ailin C. Rogers ◽

Donal O’Brien ◽

Ruaidhri McVey ◽

Jennifer Walsh ◽

...

Keyword(s):

Multidisciplinary Team ◽

Maternal Morbidity ◽

Morbidity And Mortality ◽

Team Approach ◽

Morbidly Adherent Placenta ◽

Multidisciplinary Team Approach ◽

Adherent Placenta ◽

Maternal Morbidity And Mortality

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Morbidly adherent placenta: management is real challenge

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190885 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1091

Author(s):

Rupa C. Vyas ◽

PrinceNrutik Amrut Patel ◽

Sapana Shah ◽

Shweta N. Vala ◽

Nidhi B. Patel

Keyword(s):

Placenta Previa ◽

Color Doppler ◽

Ventilatory Support ◽

Bladder Injury ◽

Ultrasound Scan ◽

Morbidly Adherent Placenta ◽

Total Hysterectomy ◽

Adherent Placenta ◽

Caesarean Hysterectomy ◽

Real Challenge

Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome.Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded.Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series.Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.

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