scholarly journals Late Complication Due to Placenta Increta Left In Situ and Management Options

2011 ◽  
Vol 51 (184) ◽  
Author(s):  
S Zulfikir ◽  
M Al Bash ◽  
A Kakaria ◽  
V Gowri ◽  
A Saparamandu ◽  
...  
Keyword(s):  
Antenatal Diagnosis ◽  
Post Partum ◽  
Late Complication ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Management Options ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

With the rising incidence of caesarean sections, the number of cases of placenta praevia and morbidly adherent placenta is increasing. Antenatal diagnosis and management in a tertiary care centre helps to reduce maternal and neonatal morbidity and mortality. We present a patient in whom the antenatal diagnosis of morbidly adherent placenta was missed due to late booking. In spite of the conservative approach at the time of caesarean section in the secondary care hospital, the patient presented with delayed complications and a total hysterectomy was performed. Keywords: adherent placenta, hysterectomy, methotrexate, post partum haemorrhage.

scholarly journals Conservative management options for morbidly adherent placenta

2017 ◽  
Vol 6 (3) ◽  
pp. 1057
Author(s):  
Meena N. Satia ◽  
Animesh Gandhi ◽  
Manali P. Shilotri
Keyword(s):  
Caesarean Section ◽  
Conservative Management ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Care Hospital ◽  
Management Options ◽  
Morbidly Adherent Placenta ◽  
Balloon Catheters ◽  
Adherent Placenta ◽  
Internal Iliac

Background: Morbidly adherent placenta is still a very significant cause of obstetric hemorrhage.Methods: A retrospective, descriptive study was undertaken over a period of one and a half year in a tertiary care hospital of all diagnosed cases of morbidly adherent placenta which were managed conservatively and the maternal and perinatal outcomes were noted. Preparation for conservative management of cases of adherent placenta in the antenatal period included informing interventional radiologists and placement of internal iliac balloon catheters just before classical caesarean section. Post-operative methotrexate was used in a few patients.Results: 11 cases of morbidly adherent placenta diagnosed on Doppler ultrasound scan, and confirmed by MRI were identified. All patients underwent classical caesarean section. 9 patients had internal iliac balloon placement. 5 patients received methotrexate. 3 patients required obstetric hysterectomy. 1 maternal and 2 perinatal mortalities were noted.Conclusions: Interventional radiology and methotrexate can be used to avoid peripartum hysterectomy and to optimize maternal and perinatal outcome.

scholarly journals Morbidly Adherent Placenta: Management options

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.  

scholarly journals Analysis of obstetrics hysterectomy in tertiary care centre

2018 ◽  
Vol 7 (6) ◽  
pp. 2192
Author(s):  
Neetu Ahirwar ◽  
Rekha Wadhwani
Keyword(s):  
Maternal Mortality ◽  
Post Partum ◽  
Tertiary Care ◽  
Haemorrhagic Shock ◽  
Gravid Uterus ◽  
Tertiary Care Centre ◽  
Morbidly Adherent Placenta ◽  
Common Indication ◽  
Adherent Placenta ◽  
Gandhi Medical College

Background: Emergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. Obstetrics hysterectomy is performed on gravid uterus during pregnancy labor puerperium. It is a catastrophic inevitable lifesaving emergency procedure in cases of rupture uterus, uncontrollable post-partum haemorrhage, morbidly adherent placenta, and some cases of trauma, sever infection of pregnant uterus. Newer drug like prostaglandins, antibiotics and blood transfusion has brought down the incidence of obstetric hysterectomy.Methods: This retrospective study is performed in department of obstetrics and gynaecology SZH Gandhi medical college Bhopal. Retrospective analysis of record done.Results: In this study there were 51867 deliveries and 99 0bstetric hysterectomy giving the incidence as 1 in 524 deliveries. There were 17113 cesarean section performed hence the incidence as 1 in 173 cesaren section. Majority of patient belong to group para 4 and above i.e. 32.32%. Least incidence is among nullipara patient i.e. 2.02%. The most common indication of obstetric hysterectomy in this study was morbidly adherent placenta, 52 cases i.e. 52.52%% Rupture uterus was second common indication accounting for 36.36% of cases. Most common additional surgical procedure done during obstetric hysterectomy was repair of bladder tear and salpingoophrectomy done in 7 cases i.e. 7.07% of each. Repair of bowel injury done in 1 case i.e. 1.01%.Conclusions: Incidence of maternal mortality in cases of obstetric hysterectomy was 9.09%. most common cause of maternal mortality was haemorrhagic shock accounting for 55.55.

scholarly journals Instrumental delivery: a comparative study in a tertiary care hospital

2018 ◽  
Vol 7 (3) ◽  
pp. 1079
Author(s):  
Bhanu B. T. ◽  
Anitha G. S.
Keyword(s):  
Post Partum ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Fetal Distress ◽  
Care Hospital ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Maternal And Neonatal Outcomes ◽  
Vertex Presentation

Background: To compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery.Methods: Women in labor with vertex presentation were delivered by indicated/propylactic vacuum or forceps. A total of 500 cases were included in this retrospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, neonatal jaundice, perinatal mortality, NICU admissions etc. Chi square test was used to analyze the data.Results: Maternal morbidity was significant in the forceps group. With regards to neonatal morbidity, in NICU admissions, statistically significant difference was noted.Conclusions: Vacuum and forceps should remain appropriate tools in the modern obstetrics. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother and decrease NICU admissions.

scholarly journals Emergency peripartum hysterectomy: a retrospective analysis in a tertiary care hospital in Jharkhand, India

2018 ◽  
Vol 7 (8) ◽  
pp. 3179
Author(s):  
Megha Bhagat ◽  
Bratati Moitra
Keyword(s):  
Retrospective Analysis ◽  
Uterine Rupture ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Care Hospital ◽  
Peripartum Hysterectomy ◽  
Morbidly Adherent Placenta ◽  
Cesarean Deliveries ◽  
Adherent Placenta ◽  
Emergency Peripartum Hysterectomy

Background: Emergency peripartum hysterectomy (EPH) is a rare but a lifesaving procedure done as a last resort to save life of mother. We conducted this study to know the incidence, leading causes, and complications of obstetric hysterectomy.Methods: Authors conducted a retrospective analysis of all the patients who underwent emergency peripartum hysterectomy from January 2015 to December 2017 at RIMS, Ranchi.Results: There were 126 emergency peripartum hysterectomies, with deliveries during the same period being 21732 and the rate of EPH was 5.7 per 1000 deliveries. Most common indication for EPH was uterine rupture (54.6%), followed by uterine atony (18.2%) and morbidly adherent placenta (23.01%). Most of the patients (66.67%) had previous cesarean deliveries. EPH was done following cesarean in 66.67%. Subtotal hysterectomy was done in 88.09%. Intra-operative urinary bladder injury was seen in 11.11% of the patients.Conclusions: Uterine rupture and Morbidly adherent placenta continues to be the most common causes for EPH in our population. Multiparity is an important risk factor among patients with rupture uterus. Cesarean delivery and repeat cesarean deliveries are the likely risk factors for EPH.

scholarly journals Placenta praevia: percreta and accreta, our experience

2020 ◽  
Vol 9 (3) ◽  
pp. 928
Author(s):  
Preeti F. Lewis ◽  
Shreya Chinchoriya
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
History Of ◽  
Previous Cesarean

Background: morbidly adherent placenta has an increasing incidence over decades. The purpose of this study is to identify risk factors and etiology of placenta previa- accreta and percreta.Methods: A cross sectional observational study of patients with morbidly adherent placenta previa including placenta accreta and placenta percreta were studied over a period of three years from June 2017 to June 2019 in a tertiary care centre, Mumbai.Results: Cases showed a higher incidence in patients with previous cesarean delivery (CS), grandmultiparity, abortions without the history of check curettage and anterior/central placentae.Conclusions: History of uterine surgeries and previous cesarean are some important risk factors for accreta in placenta previa patients.

scholarly journals Morbidly adherent placenta –A burden on tertiary care centre.

2020 ◽  
Vol 27 (09) ◽  
pp. 1795-1798
Author(s):  
Zahra Safdar ◽  
Sumera Zaib ◽  
Sumera Fatima
Keyword(s):  
Caesarean Section ◽  
Hospital Stay ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Case Series ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Prolonged Stay ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

Objectives: To determine the burden of Morbidly Adherent Placenta on tertiary care centre in terms of prolonged hospital stay, multiple blood transfusions, Intensive care unit stay, involvement of surgical urological colleges. Study Design: Descriptive Case Series. Setting: Department of Obstetrics and Gynaecology, Unit I Lahore, General Hospital Lahore LGH. Period: 06 months (1st August 2017-28th February 2018). Material & Methods: Total Obstetrical patients admitted in this period were 2754 total births 2567, lower segment caesarean 1184 patients, with Morbidly Adherent Placenta were 28. Date was analysed regarding maternal age, parity, previous surgeries and diagnosis prior to admission. The complications analysed were hospital stay >10 days, multiple transfusions>04 days, ICU admission>72hours, requirement of surgical and urological colleges. Patients fulfilling inclusion and exclusion criteria were studied. Results: Morbidly Adherent Placenta results in patient’s prolonged stay in hospital and ICU which results in high consumption of hospital resources. Conclusion: Morbidly Adherent Placenta is directly related with caesarean section rate. Every effort should be made to reduce the %age of primary caesarean section so that incidence of Morbidly Adherent Placenta can be minimised.

scholarly journals Retrospective review of maternal deaths and maternal near misses due to major obstetric haemorrhage at a tertiary care centre in India

2019 ◽  
Vol 8 (8) ◽  
pp. 3431 ◽  
Author(s):  
Swati Agrawal ◽  
Anuradha Singh ◽  
Ratna Biswas ◽  
Abha Singh
Keyword(s):  
Cesarean Section ◽  
Maternal Death ◽  
Tertiary Care ◽  
Near Miss ◽  
Tertiary Care Centre ◽  
Maternal Deaths ◽  
Near Misses ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Obstetric Haemorrhage

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani  Hospital over a period of 12 months (April 2016-March 2017), of  all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was  2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor  for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH. 

IMPACT OF OBSTETRIC HEMORRHAGE ON "NEAR MISS" MORBIDITY IN A TERTIARY CARE HOSPITAL-... 'LEADING INDICATOR IN EVERY HUMANITARIAN CRISIS'

2021 ◽  
pp. 5-7
Author(s):  
Priyanka Kesharwan ◽  
Prashant Bhingare ◽  
Shrinivas Gadappa ◽  
Ashwini N Hotkar ◽  
Sasireka Sasireka
Keyword(s):  
Hospital Admissions ◽  
Post Partum ◽  
Tertiary Care ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Common Cause ◽  
Obstetric Haemorrhage ◽  
Prospective Study Design

Background:To assess risk factors, and “near-miss” morbidity in Obstetric haemorrhage. Methods: This was a tertiary care based Observational Prospective Study design conducted between October 2018 to September 2020 to nd magnitude, morbidity associated with Obstetric haemorrhage. To study various Maternal outcomes and intervention for management of maternal near miss cases. Total 350 samples were selected by using concurrent sampling method for maternal near miss cases at tertiary care centre and who met the designed set of criteria. Result: Most common cause of MNM observed was Atonic PPH 224 (64%). 242 (69.14%) cases required blood transfusion and mean and SD of blood transfused was 10.98 ± 1.04. In our study, hemodynamic compromise was common cause of Systemic dysfunction, most common system involve in MNM observed was haematological 185 (52.86%). Overall, 218 (62.28%) cases required ICU monitoring. 166 (47.42%) cases needed emergency LSCS, Obstetric hysterectomy was performed on 56 (16%) of cases whereas 47 (13.43%) cases undergone Exploratory Laparotomy. The most common problem encountered by patients prior to hospital admissions was the unavailability of treatment at lower-level health facilities, affecting 248 out of 350 of study participants. Conclusion: Concluded from this study that Post-Partum Haemorrhage were the most common cause maternal morbidity in the study group. “Near-Miss” morbidity in PPH reect the level of obstetric care in the developing world. These need to be reduced by strengthening peripheral delivery facilities, active 3rd stage management and early referral.

Frequency of factors leading to acute renal failure in obstetric patients.

2021 ◽  
Vol 28 (05) ◽  
pp. 640-646
Author(s):  
Shaheena Zafar ◽  
Riffat Jaleeel ◽  
Kouser Karim Lodhani
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Placental Abruption ◽  
Post Partum ◽  
Common Factor ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Cross Sectional

Objective: To determine the frequency of factors leading to acute renal failure in obstetric patients. Study Design: Cross Sectional study. Setting: Department of Obstetrics and Gynecology, Civil Hospital Karachi, Tertiary Care Hospital. Period: July 2015- Jan 2016. Material & Methods: Total 250 women during pregnancy and within 42 days after delivery who were diagnosed as ARF were included. Serum creatinine was done on admission and then after 24 hours of delievery. Those with urine output < 30ml / hour and serum creatinine > 1.5 mg / dl were recruited. All data was recorded on proforma. Results: The average age of the women was 29.36±5.87 years. Post-partum hemorrhage was the important and common factor i.e. 40.4%, followed by placental abruption 25.6%, Severe pre-eclampsia 18.4%, puerperal sepsis 8.4% and eclampsia 7.2%. Conclusion: Ante partum hemorrhage like placental abruption, eclampsia and preeclampsia, and postpartum hemorrhages’ are the major causes of obstetrical ARF. Good antenatal care and provision of universal health facility can prevent this dangerous condition. Though it is a treatable and curable complication, but if not diagnosed and treated timely, it can lead to significant maternal morbidity and mortality.

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