Morbidly Adherent Placenta: A Cross-sectional Study in a Tertiary Care Hospital

Primary Amenorrhea :An Approach to Diagnosis and Management

Abstract

Background: Morbidly adherent placenta (MAP) is one of the most dreaded antenatal complications leading to massive hemorrhage, immense blood transfusion, hysterectomy, intensive care unit admission, mechanical ventilation, multi-organ failure and maternal mortality. The study aimed to determine the maternal outcome in terms of complications, interventions, and mortality in patients with MAP in a tertiary care hospital.

Methods: During the study period of one year (2020-2021) a total of 68 patients with MAP were studied. Demographic profiles including age, parity, gestational age and history of previous cesarean sections were recorded. Other complications and interventions were also noted. Data was analyzed by using SPSS version 23 and a t-test was applied for comparison between the two groups. p-value <0.05 was considered statistically significant.

Results: Total number of deliveries during the study period was 20971. Among these 7183 women had a cesarian section (CS). The total number of CS done due to placenta previa was 319, out of which a total of 68(21.3%) patients were diagnosed with MAP. It was further observed that 0.6% of patients had no history of a previous uterine scar, 39.0% of patients with previous 1 scar and 80% with 4 scars (p>0.05). Peripartum hysterectomy was performed in 48.5% of patients. The complications noted were bladder injury 17.6%, ICU admission 45.5% and maternal mortality 4.4%.

Conclusion: Morbidly adherent placenta (MAP) was found directly related to cesarean section (p>0.05). Appropriate measures should be taken to reduce the primary scars to reduce the incidence of repeat scars and ultimately MAP related severe maternal outcomes.

Keywords: Morbidly Adherent Placenta (MAP); Caesarean Section; Placenta Previa.