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Frequency of Morbid Adherence of Placenta[ORIGINAL ARTICLE]
Author(s) Name:

Nasira Naseem
Rukhsana Parveen


Address of Correspondence

Senior Registrar, Department of Gynecology & Obstetrics, Nishtar Hospital Multan

 

Objective: To determine the frequency, causes and outcome of patients with morbidly adherent pla­centa.
Study Design: Descriptive case series.
Place and Duration of Study: The study was conducted at Gynae unit I Nishtar Hospital Multan from April 2011 to Oct 2011.
Methodology: One hundred patients with previous uterine operations; like caesarean section, myomectomy, hysterotomy or diagnostic curettage patients with placenta praevia or those patients with retained placenta removed with difficulty under anesthesia; were included in the study. All the primigravidas and cases with retained placenta due to uterine abnormalities were excluded. The admitted patients meeting the inclusion criteria were registered for the study after taking informed consent. Patients were clinically examined and appropriate investigations were done. All relevant information was recorded in a proforma especially designed for this study. All the data was entered and analysed through SPSS version 10. 
Results: Only 6 patients out of 100 selected cases had morbidly adherent placenta, out of  whom 4 were booked and 2 were unbooked. Five cases were between 25-30 years and one was 20 years of age. Their parity ranged from 1-6. Five patients had previous history of caesarean section. Placenta was found in lower uterine segment in 5 cases. One patient presented with preterm labour and one with antepartum haemorrhage. Post partum haemorrhage occurred in two cases. One patient was delivered vaginally and five had caesarean section. Three of the latter had placenta accreta, 2 had placenta percreta and one had placenta increta. Placenta was removed piecemeal followed by caesarean hystrectomy in 5 cases. In one case a conservative trial, followed by postpartum hysterctomy, was done. Blood transfusions were required in all cases ranging from 3-5 units. Duration of hospital stay was 5 – 10 days and maternal mortality was nil.
Conclusions: Morbid adherence of placenta is an obstetrical emergency, which carries an increased risk of perinatal and maternal mortality and morbidity Antenatal care needs to be improved and morbid adherence of placenta should be diagnosed at the earliest possible time . Previous caesarean section and placenta previa in current pregnancy were the major risk factors observed in 5(83%) of the cases. Previous history of dilatation and curettage was present in 1(16.6%) case.
Keywords: Placenta praevia, Accreta, Increta, Percreta, Caesarean Section.

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