Psychological Outcome of Women with Morbidly Adherent Placenta Following Hystrectomy: Prospective Matched Case-control Study

Background Placenta accreta (Morbidly adherent placenta) is a condition in which all or part of the placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi. It may occur when there is either a primary deficiency of or a secondary damage to chorionic villi or Nitabuch’s layer. Women often consider the uterus to be a sexual organ, and the controller and regulator of important physiological functions in the body, as well as the source of youth, energy, activity, and a symbol of child-bearing capacity. Aim of the work The purpose of this study is to investigate the risk of postoperative psychiatric disorders of depression, anxiety outcomes and sexual dysfunctions and self esteem disturbance in women with morbidly adherent placenta following hysterectomy. Methods The study included 120 subjects divided into 3 groups including Group A which included 40 women who underwent caesarean hysterectomy, Group B which included women who underwent lower segment caesarean section and Group C which included 40 women who underwent spontaneous vaginal delivery with inclusion and exclusion criteria. All patients who delivered from 4 to 6 months ago, will be subjected to fulfill Questionnaire after obtaining informed consent from the patients who are invited to participate in the research. Results Self-esteem was statistically signifciantly highest in cases underwent CS with no statistical significant difference between CH and VD. Anxiety was non- statistically significantly most frequent in CH and least frequent in VD. Depression was non- statistically signifciantly most frequent in CH and least frequent in VD. Severe depression was statistically signifciantly most frequent in VD and least frequent in CH. Different dysfunctions were statistically significantly highest in CH research group. Desire, Arousal, Lubrication and pain dysfunctions were statistically significantly lowest in VD group. Orgasm and Satisfaction dysfunctions were signifciantly lowest in CS group. Analyzing the current research data results and considering previous research efforts in female sexual dysfunctions in correlation to obstetric clinical scenarios reveal that the female sexual normal activity is a critical issue when affected could result in serious sequale not only affecting the female as regards self-esteem and psychiatric health status but could affect the male partner due to reduced sexual functional capacity, future research efforts are recommended to be multi-centric in fashion taking in consideration more detailed aspects particularly the male partner satisfaction from sexual activities with his female counterpart after cesarean, vaginal deliveries. Conclusion Analyzing the current research data results and considering previous research efforts in female sexual dysfunctions in correlation to obstetric clinical scenarios reveal that the female sexual normal activity is a critical issue when affected could result in serious sequale not only affecting the female as regards self-esteem and psychiatric health status but could affect the male partner due to reduced sexual functional capacity, future research efforts ere recommended to be multicentric in fashion taking in consideration more detailed aspects particularly the male partner satisfaction from sexual activities with his female counterpart after cesarean, vaginal deliveries.

Placenta percreta presenting as uterine rupture following previous B-Lynch suture

Placenta accreta spectrum disorder varies from minimally adherent placenta to deeply invasive placenta. Placenta percreta is a rare cause for uterine rupture and the incidence of morbidly adherent placenta is on the rise due to increase in the rates of caesarean section. We report a case of a 32-year-old, G2P1L1 who presented to us at 27 weeks in a state of haemodynamic shock with intrauterine fetal death. She had a history of prior caesarean section complicated by postpartum haemorrhage requiring B-Lynch suturing. With an initial diagnosis of caesarean scar rupture, she underwent an emergency laparotomy. Intraoperatively, the caesarean scar was found to be intact and uterine fundal rupture with placental protrusion identified. She underwent caesarean hysterectomy and was discharged in a stable condition. The histopathology report confirmed the diagnosis of placenta percreta.

Alpha Feto-Protien as a Biochemical Marker in Prediction of Morbidly Adherent Placenta

Background Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Aim of the Work To compare between alpha-fetoproteine as biological marker & ultrasound & Doppler findings for prenatal predication of morbid adherent placentation in anterior placenta on scar of previous cesarean section. Patients and Methods The current study is a prospective cohort study, conducted at a tertiary center: Ain Shams University Maternity Hospital during the period between February 2018 and April 2019,where 150 pregnant women having placenta previa covering scar of previous uterine surgery had been recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service, but 50 patients were dropped out due to loss in follow up because of emergency antepartum haemorrhage & C.S., others escaped follow up. Results The results of the current study showed a significant association between all criteria of the 3DPD with multislice view and presence of placental adherence, need for added surgical steps, CS hysterectomy and bladder injury with sensitivity 83% & specificity 57%, PPV 76%, NPV 66%. Conclusion The current study suggests that AFP assay, it isn't good test alone as regards its sensitivity &specificity &its level of accuracy 55% as compared to 2D &3D power doppler with multislice view, so it is unreliable test alone for antenatal diagnosis of morbidly adherent placenta.

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

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.

The Zone II Aorta is not a Forbidden Zone for Occlusion in Women with Morbidly Adherent Placenta

Aim: To evaluate the safety and efficacy of balloon occlusion at the Zone II aorta for the management of morbidly adherent placenta.Methods: From September 2015 to October 2018, a total of 80 consecutive patients who were prenatally diagnosed with morbidly adherent placenta were assigned into two groups: the balloon occlusion group (n=40) and the non-balloon occlusion group (n=40). The intraoperative estimated blood loss, blood transfusion, urine output, serum creatinine (Scr), blood urea nitrogen (BUN) and hysterectomy rate were recorded and compared between the two groups.Results: The estimated blood loss in the balloon occlusion group was significantly lower than that in the non-balloon occlusion group (811.75±299.93 ml vs 1529.75±808.01 ml, P<0.001). The median amount of packed RBCs transfused in the balloon occlusion group and non-balloon occlusion group was 0 U and 2 U, respectively (P=0.001). The women in the former group had a lower blood transfusion rate than those in the latter group (30% vs 57.5%, P=0.013). Hysterectomy occurred in none in the balloon occlusion group but in 6 patients in the non-balloon occlusion group (P=0.011).Conclusion: The middle abdominal aorta (Zone II) is not a forbidden zone for occlusion as long as the single occlusion time is limited to 15 mins. Balloon occlusion at the Zone II aorta can effectively reduce blood loss, transfusion requirements and hysterectomy rates in patients with morbidly adherent placenta.