The Surgical Management and Outcome In 36 Cases Of Morbidly Adherent Placenta.
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 8
Abstract
Background : The morbidly adherent placenta (MAP), once a rare occurrence, is now an increasingly common complication of pregnancy secondary to the increase in cesarean delivery rates. The massive haemorrhage associated with this condition leads to severe maternal morbidity and mortality.There are various surgical methods in use to control bleeding from the placental bed,but MAP has replaced atonic post partum haemorrhage as the leading cause of Cesarean hysterectomy. Aim : to analyse the surgical management of the morbidly adherent placenta with the objective of reducing maternal morbidity and mortality ,by studying the various surgical methods used to achieve haemostasis. Results : 36 cases of MAP managed between January to December 2017 were analysed.The average age of the cases was 24 years,with average gravidity 2.All patients had undergone previous cesaerean delivery with average of 2 previous LSCS.22 cases were diagnosed in the antenatal period and the rest during cesaerean section. 17 cases were delivered between 32 to 38 weeks of gestation. 3 cases were managed by hysterectomy with placenta insitu. In the18 cases where uterine sparing surgery was undertaken 10 cases had to undergo hysterectomy and bilateral hypogastric artery ligation for control of bleeding.Average blood and component therapy was 6 and 8 units.Ionotropic support was required in 13 cases and ventilator support in 9 cases.Bladder injury occurred in 6 cases and ureteric injury in 2.There was maternal mortality in 3 cases -8.3%. Conclusion: Patients diagnosed in the antenatal period undergoing planned surgery had better outcomes with fewer blood transfusions and shorter hospital stay. Uterine sparing surgery was associated with significant maternal morbidity and was not successful in 54 % of cases.Compression sutures ,with bilateral hypogatic artery ligation was the most common surgical technique used to control bleeding from the placental bed.
Authors and Affiliations
Rani Reddy, L. Lavanaya
Keywords
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