Indra Bhati, Pukhraj Choudhary
Abstract: Background: Morbidly adherent placenta, a grave complication of pregnancy is becoming an emerging cause of increased maternal morbidity and mortality. Objectives of present study were to evaluate the etiopathogenesis of MAP, its demography and clinical mode of presentation and maternal and foetal outcome with the aim to reduce maternal morbidity and mortality. Methods: It was a retrospective and prospective study at Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur in which data of patients with clinical diagnosis of MAP were reviewed from March 2017 to September 2019. Result: There were 21 cases of morbidly adherent placenta during the study period. The incidence was 0.037 % (1/2661 delivery). The mean age of presentation was 27.76 year, 66.66 % cases were un-booked and 33.33 % cases were booked with regular ANC visit. 65 % cases presented with bleeding per vagina as a chief complaint and 33 % cases were admitted for elective LSCS. 33.33 %cases were already diagnosed case of placenta praevia. 95.238 % cases had a history of previous LSCS. 95.238 % cases were given BT intraoperatively and postoperatively. 38.1 % cases underwent caesarean hysterectomy, 42.85 % fulfil the criteria of WHO near miss, and there was one maternal death. Conclusion: The incidence of MAP is increasing due to higher caesarean section (C/S) rate. Antenatal diagnosis via USG and colour-doppler imaging, preoperative counselling, planning and multidisciplinary approach is necessary to reduce morbidity and mortality associated with MAP.
Keywords: Caesarean hysterectomy, Increta, Percreta, Placenta accreta