Evaluation of pregnancy outcomes & different management options used in Morbid Adherent placenta

Gobran, Mai Ahmed; Hafeez, Abeer; ElShafie, Rofiada M; Ibrahim, Safaa A; Ramadan, Mohamed SH

doi:10.21608/zumj.2021.75640.2226

Evaluation of pregnancy outcomes & different management options used in Morbid Adherent placenta

Document Type : Original Article

Authors

¹ Academic building -fourth floor Zagazig University hospitals

² Stem cell Sharqia

³ Obstetrics and gynecology , Faculty of medicine, Zagazig university,Egypt

⁴ Obstetrics and gynecology Department Zagazig University hospitals

10.21608/zumj.2021.75640.2226

Abstract

Morobidly Adherent Placenta is defined as invasion of the placental chronic villi in to the myometrium, either invading myometrium superficially (accreta), or deeply (increta), or fully and or neighbouring organs (percreta) .The management of MAP is caesarean hysterectomy. Conservative uterine sparing approaches are performed in patients with strong desire for future fertility& hemodynamic stability.
The aim of this work is the evaluation of different management options for MAP & its effect on pregnancy outcomes to find the best approach to decrease MAP associated morbidity & mortality.
Methods:
Study included 42 MAP Previa patients Who underwent history taking, examination, investigations, different management operative options. Maternal and fetal outcome were recorded.
Results: The postoperative complications are DIC, reoperations, postpartum collapse in 2 patients (4.8%), ICU admission in 5 cases (11.9%), wound infection, retained products of conception, chorioamnionitis & pulmonary embolism in 1 patient .

Discussion: Biler A, et al., 2016 found in accordance with our results that, there is no significant difference (P: 0.64) between elective & urgent surgery as regard blood loss, while Eller et al., 2009 reported that scheduled surgery associated with reduced maternal morbidity. In agreement with our study, Fitzpatrick et al.,2015 reported that, there is highly significant increase in blood loss, hospital stay & amount of blood transfusion in cases performed hysterectomy after trial placental removal when compared to patients performed CS hysterectomy without trial placental removal. Management of MAP may be individualized, according to the hemodynamic stability & desire for future fertility.

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