Placenta Accreta - Still a Dilemma

Abstract

Objectives:  To determine the etiological risk factors and outcomes of placenta accreta.

Study Design:  Descriptive study.

Setting:  Gynae Unit III Jinnah Hospital, Lahore.

Duration of Study:  Two years from 1^st Sept 2009 to 31^st Aug 2011.

Materials and Methods:  All the patients who pre-sented with suspected placenta previa, previous cesa-rean section or myomectomy scar and previous D&C in OPD and emergency department were included in the study. Trans-abdominal ultrasound was carried out in all the patients when diagnosed or had suspicion of placenta accrete it was confirmed by color Doppler.

      MRI was carried out in those patients who had anterior placenta previa along with placenta accreta. Data regarding age, parity, booking status and previ-ous obstetric history were recorded and analyzed.

Results:  During the study period there were 9046 deliveries and 13 patients presented with placenta acc-reta giving the incidence of 1 in 695 deliveries. Majo-rity of all patients (84.61%) with placenta accreta were between 31 – 35 years of age. Seventy seven percent were multi gravidae and 23% were grand multi gravi-dae. More than 2/3^rd of the patients were booked. Forty six percent of the patients had previous 2 C/S, 38.5% had previous 3 C/S and 15.5% had H/O D&C. In 77% placenta previa was present along with placenta acc-reta. All the patients with placenta accreta were opera-ted under General anaesthesia and had hysterectomy. There was no maternal deaths.

Conclusion:  Placenta accreta is an obstetric catastro-phe associated with high maternal and perinatal morbi-dity and mortality in developing countries. Antenatal care should be improved and all patients with previous C/S should have USG to diagnose placenta previa and accreta. This study showed a strong association of pla-centa accrete with previous C/S, placenta previa and previous D&C.