Outcomes of pregnancies with a morbid adherent placenta from a tertiary referral Centre in North India

Abstract

Morbid adherent placenta (MAP) is an abnormality of placental implantation that is an important cause of maternal and fetal mortality. The maternal mortality may reach up to 7% and is associated with multiple maternal morbidities e.g. massive transfusions, infections, urologic injuries and fistula formation. The present study was a retrospective observational study done to evaluate the profile and outcome of pregnancies diagnosed with MAP over three years. Forty nine patients were diagnosed with MAP. The incidence was 1.21 per 1000 pregnancies. A majority of patients were multi gravidas and had a history of previous caesarean section(CS). Placenta previa was present in 61.2% patients. Forty seven patients had to undergo a hysterectomy and 75% of patients had to undergo the internal iliac artery ligation to achieve hemostasis. 31 patients (63.2%) required intensive care admission and monitoring. There was one death in our cohort. MAP is an important cause of maternal morbidity and mortality and its incidence has been on the rise due to increased CS deliveries. CS and placenta previa are important risk factors for MAP. Early recognition of at risk pregnancies and subsequent risk based counselling and management can help optimise the outcomes in MAP.