PLACENTA PREVIA AND PLACENTA ACCRETA SPECTRUM (PAS) DISORDER: INCIDENCE, RISK FACTOR AND FETOMATERNAL OUTCOME IN A TERTIARY CARE CENTER

2021 ◽  
pp. 15-17
Author(s):  
Ramona Perhar ◽  
Rubi Devi ◽  
Ruchi Patel ◽  
Jagriti Jagriti
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Adherent Placenta ◽  
Placenta Accreta Spectrum

Introduction: Placenta Previa is characterised by Placental implantation into the lower uterine segment covering whole or part of the cervix . It complicates 0.4% of pregnancy at term The average incidence is 0.3% or 1 case per 300 to 400 deliveries. The presence of placenta previa can also increase a woman's risk for placenta accreta spectrum (PAS). This spectrum of conditions includes placenta accreta, increta, and percreta. Uncontrolled postpartum hemorrhage from placenta previa or PAS may necessitate a blood transfusion, hysterectomy thus leaving the patient infertile, admission to the ICU, or even death. Material and method: Study was conducted in department of obstetrics & gynecology , swaroop rani hospital, Allahabad for 1 year . A total of 102 pregnant women presenting to antenatal OPD or admitted in IPD with history of antepartum hemorrhage and conrmed case of PP or MAP in Ultrasonography were selected. The follow up till the fetomaternal outcome was done and risk factors were evaluated for 102 cases. Result: Out of the total 2342 deliveries in one year 95 patients had PP and the incidence was 4.04% and 7 patients had morbidily adherent Placenta which accounts to an incidence of 0.29%. Previous LSCS, Multiparity, increase maternal age, Dialatation and curettage were risk factors in both Placenta Previa and Morbidily Adherent Placenta. Antenatal complication were antepartum hemmorrhage , Anemia, preterm labor. Emergency LSCS is more common mode of delivery in cases of Placenta previa. Caesarean hysterectomy were done in 3.2% cases of Placenta Previa and all cases of Morbidily adherent placenta . Most common perinatal complications in both groups were prematurity and low birth weight. Conclusion: Now a days Placenta previa and Morbidily adherent placenta are very common. Incidence increases as the rate of cesaerean section or abdominal surgery were increases.Earlydiagnosis and pre plan mode of delivery will decrease the risk of prematurity and low birth weight.

scholarly journals Evaluation of outcome of pregnancy in placenta accreta spectrum

2021 ◽  
Vol 10 (9) ◽  
pp. 3331
Author(s):  
Uma Veludandi ◽  
B. Aruna Suman ◽  
S. Nagamani ◽  
Medha Hothur
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Placenta Accreta ◽  
Intrauterine Device ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Background: Aim of the study was to evaluate the outcome of pregnancy in placenta accrete spectrum in third trimester pregnancy at tertiary care centreMethods: This hospital based retrospective study was carried out from 2017 to 2019.  The case records of all women identified as placenta accrete spectrum from the hospital registers were retrieved. A total of 166 patients with the diagnosis of placenta accrete spectrum were included in the study.Results: The incidence of morbidly adherent placenta is 5 per 10,000 deliveries with mean age being 32.4±4.2 (23-39) years. and showed its relation with risk factors such as previous caesarean section (CS), placenta praevia and multiparity. The mean duration of MICU stay in placenta previa was 6.7±1.9 days (range 2-12 days). With complications in 18 cases of which urinary bladder injury (3%), infection (9%), PPH and coagulopathy (4.2%). The placenta was removed successfully in 141 while 25 cases had caesarean hysterectomy (2.4%). In total 166 cases 26 (16.8%) cases are intrauterine device (IUD) and still births. 5 (3%) cases are very low birth weight, 24 cases (14.5%) are low birth weight babies, 76 (45.8%) cases had neonatal intensive care unit (NICU) admissions followed by 10 (6%) cases with <5 APGAR score.Conclusions: Placenta accreta spectrum can be identified antenatally with a high index of suspicion in the presence of known risk factors and proper radiological studies, allowing for planned attempts to avoid life-threatening haemorrhage and caesarean hysterectomy.

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

scholarly journals A retrospective analysis on placenta previa in a tertiary care center of Jharkhand

2021 ◽  
Vol 10 (9) ◽  
pp. 3389
Author(s):  
Tanu Sharma
Keyword(s):  
Risk Factors ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Adherent Placenta ◽  
History Of ◽  
Nicu Admission

Background: When the placenta is implanted partially or completely in the lower uterine segment, it is called placenta previa. Previa is a Latin word means going before. About one-third of APH belongs to placenta previa and now a day’s incidence is increasing in primigravida patients. The objective of this study was to analyze the incidence, risk factors, maternal morbidity, mortality and perinatal outcome in women with placenta previa in a tertiary care center of Jharkhand.Methods: Total 193 cases of placenta previa were studied between September 2018 to August 2019 in the department of obstetrics and gynecology, RIMS, Ranchi with respect to their age, parity, gestational age, clinical presentation, previous history of curettage/hysterotomy/caesarean, ICU admission, need for NICU admission, maternal morbidity and mortality and perinatal outcome.Results: In this study, 1.94% of the deliveries were complicated with placenta previa. 31.6% were above 30 years, 87% were multigravida, 122, i.e.; 62.7% were having history of curettage or previous caesarean or hysterotomy. 49.7% had prior caesarean deliveries, 21.5% had prior abortion with history of D and C. 49.2% had true placenta previa. 68.4% had preterm delivery. 11.9% patients presented in shock and maximum i.e.; 184 (95.3%) out of 193 presented with painless bleeding per vaginum and 9 cases with no complaints. Malpresentation seen in 16.6% cases and 8.3% had adherent placenta previa. There were 45.6% ICU admission and 54.9% NICU admission, 2.5% maternal mortality and 32.6% perinatal mortality.Conclusions: Advanced maternal age, multiparty, scarred uterus as in prior CS or D and C are independent risk factors for placenta previa. Also, it remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa and associated adherent placenta should encourage a careful evaluation, timely diagnosis and delivery to reduce associated maternal and perinatal complications.

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 PLACENTA ACCRETA SPECTRUM - A CASE SERIES

2020 ◽  
pp. 1-4
Author(s):  
Medha Dadaji Davile ◽  
Anil Charandas Humane ◽  
Ashwini Kuchnur
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Obstetric Hemorrhage ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
Placenta Accreta Spectrum

Morbidly adherent placenta is a major cause for massive obstetric hemorrhage, which leads to maternal morbidity and mortality. Most accepted hypothesis for etiology of placenta accreta spectrum is defect in the endometrial–myometrial interface which leads to failure of normal decidualization in the uterine scar, which allows abnormal deep infiltration of placental anchoring villi and trophoblast. Maternal morbidity and mortality can occur as a result of massive and sometimes life-threatening obstetric hemorrhage which often requires blood transfusion. It becomes exponential and life threatening when placenta previa is associated with placenta accreta spectrum. There are several risk factors for placenta accreta spectrum, most common being previous caesarian section. Antenatal diagnosis of placenta accreta is highly desirable as outcomes are optimized when timely delivery occurs at a tertiary care facility accustomed to handle such cases. Here we are reporting six cases of placenta accreta spectrum managed by conventional and expectant way at our tertiary care hospital. Methods: Study was carried out in Government Medical College & Hospital, Nagpur. Case records of patients with placenta accreta syndrome between December 2019 and March 2020 were reviewed and analysed. Results: Six cases of placenta accreta syndrome were studied.100% patients had history of previous caesarean section, 5 patients had associated placenta previa. One out of six patients one had history of dilatation and evacuation for missed abortion.4 out of six underwent caesarean hysterectomy and 2 underwent conservative management with uterine preservation. Average blood loss was 2500 ml. Conservative management was successful in two patients. There was no maternal mortality in series. Conclusion : Among many risk factors, previous caesarean section is the most common. Therefore reducing rate of caesarean deliveries can reduce the prevalence of placenta accreta syndromes. Adherent placenta should be suspected in cases of previous caesarean with placenta previa, high parity, uterine curettage, and uterine surgeries.Conservative management should be reserved for selected patients. MRI is not mandatory for diagnosis of the condition.

scholarly journals Anaesthetic Practices and Maternal Outcome in Rising Placenta Accreta Spectrum in Tertiary Care Hospital

2020 ◽  
Vol 24 (2) ◽  
pp. 108-111
Author(s):  
Sumbal Rana ◽  
Ali Arslan Munir ◽  
Qudsia Anjum Quraishi ◽  
Amim Muhammad Akhtar ◽  
Erum Pervaiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multidisciplinary Team ◽  
Maternal Age ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Care Hospital ◽  
Placenta Accreta Spectrum ◽  
Team Interventions ◽  
Previous Cesarean

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

scholarly journals Clinical profile and factors determining outcome of intramural very low birth weight babies in a tertiary care centre: a retrospective study

2017 ◽  
Vol 5 (2) ◽  
pp. 520
Author(s):  
Devi Meenakshi K. ◽  
Arasar Seeralar A. T. ◽  
Srinivasan Padmanaban
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Logistic Regression Analysis ◽  
Very Low Birth Weight ◽  
Tertiary Care ◽  
P Value ◽  
Increased Risk

Background: Very low birth weight (VLBW) babies are at increased risk of a number of complications both immediate and late. Worldwide it has been observed that these babies contribute to a significant extent to neonatal mortality and morbidity. Aim of the study was to study the risk factors contributing to mortality in VLBW babies and to evaluate the morbidity pattern in these infants.Methods: A retrospective analysis of data retrieved from the case records of VLBW babies admitted in the NICU of Kilpauk Medical College between January 2015 to December 2015. Out of the 2360 intramural babies admitted during the study period, 99 babies were less than 1500 gms. The risk factors for these babies were analyzed for their association with the outcome. Data were statistically analyzed.Results: In present study, we found that sex of the baby, gestational age, obstetric score, birth asphyxia, pulmonary haemorrhage, ROP and presence of shock were found to be associated with increased mortality. By logistic regression analysis it was observed that birth weight of the baby (p value 0.002), duration of stay (p value 0.0006), presence of shock (p<0.0001), were the risk factors significantly associated with poor outcome.Conclusions: Among the maternal and neonatal factors analyzed in the study using logistic regression analysis, birth weight, duration of hospital stay and presence of shock were significantly related to poor outcome. Of these presence of shock was the single most important factor that predicted increased mortality.

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

scholarly journals Clinico-Demographic Profile and Pregnancy Outcome in Placenta Previa: A Study from Tertiary Care Hospital

2017 ◽  
Vol 15 (1) ◽  
pp. 2-4
Author(s):  
Husneyara Haque ◽  
Upendra Pandit
Keyword(s):  
Birth Weight ◽  
Blood Transfusion ◽  
Low Birth Weight ◽  
Pregnancy Outcome ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
College Teaching ◽  
Morbidity And Mortality ◽  
Care Hospital

Introduction: Placenta previa is an obstetric complication which causes considerable maternal and fetal morbidity and mortality during pregnancy. This study is done with the objective to find out the clinico-demographic factors associated with placenta previa and to analyze maternal and perinatal outcome in these cases. Methods: This was a retrospective study done in the department of Obstetrics and Gynecology of Nepalgunj Medical College Teaching Hospital, Nepalgunj, a tertiary care hospital from Midwestern Nepal. Relevant data were retrieved from maternity register from June 2015 to May 2017. All women who had undergone caesarean section for placenta previa were included in this study. Result: Out of total 5812 deliveries during the study period there were 50 caesarian sections done for placenta previa which is 0.86% of total deliveries. Maximum number of mothers belonged to 26- 30 years of age group. Commonest type of placenta previa was minor type. About 72% were multiparous. 20% had previous LSCS and 24% had previous abortion. Postpartum hemorrhage was present in 36% mothers and 32% received blood transfusion. About 64% new born were preterm and low birth weight. 34% babies had less than 7 apgar score at 5 min. Still births were 6%. Conclusion: Placenta previa poses greater risk and need of blood transfusion to mother as well as birth of preterm and low birth weight babies which leads to perinatal morbidity and mortality. Timely diagnosis, regular antenatal check up and effective management may improve pregnancy outcome.

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