Placenta Accreta Syndrome- A Calamitous Diagnosis

Increasing incidence of Placenta accrete syndrome has become a worrisome issue due to its associated life-threatening complications for both the mother and the fetus. The ideal management for PAS disorder remains the matter of debate still. The critical step in its effective management being its suspicion knowing the underlying risk factors and its diagnosis in antenatal period. Still, cesarean hysterectomy remains the gold standard procedure with many newer conservative approaches under evaluation. Our basic aim behind writing this review is to highlight the recent changes in classifying and diagnosing PAS owing to the ever-increasing incidence of this catastrophic entity. Also, it will emphasize the well-established role of radical over conservative management and also all modalities used in conservative management so far.

Evaluation of outcome of pregnancy in placenta accreta spectrum

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.

Urinary Incontinence after Planned Cesarean Hysterectomy for Placenta Accreta

<b><i>Introduction:</i></b> Data regarding the risk of incontinence after cesarean hysterectomy are lacking. We aimed to assess the risk of urinary incontinence in women who underwent planned cesarean hysterectomy for placenta accreta. <b><i>Methods:</i></b> This was a retrospective study of women who underwent planned cesarean hysterectomy for placenta accreta. The primary outcome was the incidence of post-cesarean hysterectomy urinary incontinence, defined as involuntary loss of urine between 3 and 12 months after cesarean hysterectomy. Outcomes were compared in a cohort of women who underwent planned cesarean hysterectomy for placenta accreta with a control group of women who underwent scheduled cesarean section without hysterectomy. <b><i>Results:</i></b> Forty-seven singleton gestations who underwent planned cesarean hysterectomy for placenta accrete were included in the study and were compared with 100 controls. Eight cases of bladder injuries were reported, 7 in the planned cesarean hysterectomy group and one in the planned cesarean delivery group. Overall, urinary incontinence was reported in 10 women of the planned cesarean hysterectomy group and in 8 women of the planned cesarean section group (21.3% vs. 8.0%; <i>p</i> = 0.03). <b><i>Conclusion:</i></b> Planned cesarean hysterectomy for placenta accreta is a risk factor for urinary incontinence.

The maternal and fetal outcome of repeat previous one caesarean section

Background: The rates of adverse maternal and neonatal outcomes have increased significantly in the last decade. Patients with repeated caesarean deliveries also have a greater risk of placenta previa, placenta accrete, uterine rupture, bowel and bladder injury, and unplanned hysterectomy.Methods: This retrospective study was performed between 01 April 2017 to 31 March 2021, at a private hospital to know about the surgical difficulties and maternal and neonatal complications encountered in cases of repeated LSCS. The outcome of 1028 women admitted with a history of previous LSCS was studied.Results: The 613 patients were given a trial of labour. 40.07% of patients delivered normally. The most common indication for repeat LSCS was CPD in 20.94% and fetal distress 20.12%. The most common complication observed was adhesion in 37.65%. Scar dehiscence in 8.92 %, scar rupture in 0.64%, uterine atony in 4.8%, placenta previa in 3.57%, placenta accrete in 0.64%, injury to the bladder was seen in 0.97%, caesarean hysterectomy was done in only 2 cases and gaped wound was found in 1.13% of cases. 19.15% of neonates were admitted to NICU. Apgar score <7 at 5 minutes in 14.77%. premature neonates were 8.44% RDS was found in 7.62%, birth asphyxia was found in 2.92% cases and neonatal sepsis was found in 1.13%.Conclusions: The dramatic increase in caesarean section rates over the past three decades has been associated with a corresponding increase in maternal morbidity but there a continuous decrease in neonatal morbidity and mortality rates because of advances in neonatal medicine.

PLACENTA ACCRETA IN PRIMIGRAVIDA AT PERIPHERAL SETUP – A RARE CASE REPORT

One of the risk factors for maternal mortality is morbidly adherent placenta (MAP) and accounts for 7–10% of maternal mortality cases worldwide. Placenta accreta is the most common type of MAP, while the other two types are placenta increta and placenta percreta. Placenta accrete accounts for 75–80% of MAP. Here, we present a case of 22 years old, primigravida with no known antenatal risk factors, diagnosed to have placenta accreta intraoperatively after delivering health baby. It is extremely rare for MAP to occur in a patient with no prior risk factors in a primigravida. Peripartum hysterectomy is the only option in a limited care facility with a hemodynamically unstable patient without a proper full-fledged blood bank facility. It is once again reiterated that bleeding from the vagina that does not slow or stop, drop in blood pressure and signs of shock are early signs of blood loss and should be investigated with great concern.

Placenta accreta spectrum: Management and outcomes in a tertiary centre in India: An observational cross-sectional study

Our observational cross-sectional study looked at the risk factors, diagnosis, management and outcomes of placenta accrete spectrum at the Christian Medical College and Hospital, Vellore, India, between January 2013 and December 2018. A total of 21 cases of placenta accrete spectrum are described among whom a preop diagnosis was available in 14 cases. A previous history of Caesarean section and placenta previa was present in 90%. Caesarean hysterectomy was carried out in 80%, but none of those managed conservatively required interval hysterectomy. Urinary tract injury was the most common surgical complication, seen in over 50%. The mean blood loss was 3.5 l and 14 patients required intensive care unit admission, but no maternal mortality ensued. Thus, we conclude that the conservative management in carefully selected cases is feasible.

Hysteroscopic Evaluation of Uterine Cavity after Conservative Management of Placenta Accreta

Background: Placenta accrete occurs when there is abnormal attachment of the placenta to the uterine wall either partially or totally. Placenta accreta had many complications mainly intraoperative and postpartum including injury to local organs (e.g. bowel, bladder, ureters) and neurovascular structures in the retroperitoneum. The aim of the present study was to evaluate the uterine cavity after conservative management of placenta accreta by using hysteroscope. Materials and Methods: This is prospective study was carried on 40 pregnant at Tanta University Hospital with age >35 years, to detect Presence or absence of intra uterine changes after conservative management of placenta accrete by hysteroscopy, easiness of performing diagnostic hysteroscopy and Correlation between intrauterine changes and operative data. Results: Hysteroscopic examination of the participants showed that 30.0% with incidences of Cervical stenosis, 15.0% with uterine cavity irregularity, 15.0% with intrauterine adhesions, 10.0% with endometrial fibrosis, 5.0% with scar dehiscence and 5.0% with Remnant. There was a statistically significant positive correlation between development of cervical stenosis and endometrial thickness by US (correlation coefficient r = 0.323 with p value 0.042) .There was a statistically significant negative correlation between Endometrial fibrosis and scar thickness (correlation coefficient r = -0.538 with p value <0.001). There was a statistically significant negative correlation between Intra uterine adhesions and scar thickness (correlation coefficient r = -0.470 with p value 0.002). There was a statistically significant negative correlation between uterine cavity irregularity and duration of CS (correlation coefficient r = -0.320 with p value 0.044). Conclusion: The frequency of abnormal hysteroscopic findings after conservative management of placenta accreta is high, for at least several months after the procedure. The most frequently found abnormalities, associated with conservative treatment, are cervical stenosis, uterine cavity irregularity and Intrauterine adhesions.