Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre

Abstract

Objectives: The aim of this study was to evaluate the demographic profile, risk factors, management strategies in women with placenta accrete spectrum and also to see the feto-maternal outcome of these women. Study design- Prospective Analysis Methods: This study was conducted in the Department of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana from January 2017 to December 2018. All the women who were diagnosed as placenta accrete spectrum (PAS) either on ultrasonography, magnetic resonance imaging or intra-operatively were included in the study.Results: During the two year study period, there were 22745 deliveries, out of which 22 patients were diagnosed to have placenta accrete spectrum, therefore, the incidence was 0.09%. The majority (41%) of the women in study belonged to the age group of 30-35 years. Most of the women (77%) were unbooked and 80% were from rural background. None of the women in our study were primiparous. The risk factors for PAS in our study included history of one caesarean section in 11(50%) patients, two caesarean section in 4 (18%) patients and history of three caesarean section in 2 (9%) patients. Co-existing placenta previa was present in 17 (77%) of the women with placenta accrete spectrum. Eight women (36%) had placenta accrete, one (5%) had placenta increta and rest of the 59% were diagnosed as placenta percreta. The maternal complications encountered in the study were post-partum haemorrhage (95%), bladder injury (59%), DIC (9%) and sepsis (5%). Maternal mortality rate was 9%. The most common neonatal complication was prematurity and low birth weight.Conclusion: The rising rates of caesarean sections is an important factor behind increase in incidence of placenta accrete spectrum. Early diagnosis in antenatal period, timely intervention, multi-disciplinary team approach and adequate arrangement of blood and blood products is a key for successful management of PAS, thereby, reducing maternal and neonatal morbidity and mortality.