Table of Content Details

Abstract

Objective: There are many centres in India, in which advanced services like Magnetic
resonance imaging (MRI), uterine artery embolization (UAE) for diagnosis and management
are not accessible. So, we have conducted this study in the resource limited setting to see the
risk factors associated, trends in its diagnosis and its outcome.
Method: The cross-sectional study was conducted from January to December 2020 in
limited resource private hospital located in eastern India. A predesigned and pretested
questionnaire was used to record history, which included women demographic details, risk
factors, ultrasound findings, intra- and post-operative events were recorded. Also, whether
PAS was diagnosed pre operative on USG or intraoperatively. The outcome measure was
patient morbidity or mortality. We have used part of Severe maternal morbidity (SMM)
list of US Centers for Disease control and prevention, list of surgical morbidity given by
Matsuzaki et al.
Result: Of the 4125 total deliveries, 17 patients had PAS, i.e., the prevalence was 0.41%.
Placenta previa was present in 15 (88.23%) of patients. There are 15 (88.23%) patients
with previous caesarean section and 9 (52.94%) with previous history of dilatation and
evacuation (D&E). USG was not conclusive in any of the case. Caesarean hysterectomy
had been done in 13 (76.47%) patients, in other 4 patients there was focal placenta accreta
which was left in situ and haemostatic suture taken. 88.23% women need transfusion.
35.29% had bladder injuries.88.23% women needed ICU care
Conclusion: There is high incidence of PAS in previous caesarean with placenta previa
and ultrasound is not conclusive in its diagnosis. So, high index of suspicion and proper
arrangement is necessary in every placenta previa with previous caesarean section.
Conservative approach is feasible with focal excision, haemostatic sutures but when it is a
major degree, early recourse to hysterectomy is essential.

Click Here For Reading Continue

Download Journal