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

Abstract

Background: Morbidly Adherent Placenta (MAP) 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 neighboring organs (percreta). The management of MAP is caesarean hysterectomy. Conservative uterine sparing approaches are performed in patients with strong desire for future fertility and hemodynamic stability. The aim of this work was to evaluate different management options for MAP and its effect on pregnancy outcomes to find the best approach to decrease MAP associated morbidity and mortality.

Methods: Study included 42 MAP Previa  patients who underwent history taking, examination, investigations, and 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 and pulmonary embolism in 1 patient  (2.4%).

Conclusions: Multidisciplinary approach individualized according to hemodynamic stability; future fertility desire may reduce  maternal morbidity and mortality in MAP patients. As CS hysterectomy, should be avoided in women with future fertility desire. Good anticipation and timely decision are the keys to success in this lifethreatening condition.