Maternal Factors and Complications Associated with Morbidly Adherent Placenta: An Experience at a Tertiary Care Hospital in Pakistan

Article Information

Title: Maternal Factors and Complications Associated with Morbidly Adherent Placenta: An Experience at a Tertiary Care Hospital in Pakistan

Authors: Samina Rehan, Humaira Tabassum, Shazia Tufail, Qudsia Nawaz, Nazia Mushtaq, Adnan Aqil Khan

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 3

Language: English

DOI: 10.51253/pafmj.v73i3.9113

Keywords: Cesarean SectionPlacenta accretaplacenta previaplacenta incretaplacenta percreta

Abstract

Objective: To identify the risk factors predisposing to the Morbidly Adherent Placenta and to evaluate maternal outcomes in those patients.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Obstetrics &amp; Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2021.
Methodology: A total of 18 females with a clinical diagnosis of the morbidly adherent placenta, irrespective of age and several previous scars, having singleton foetuses with more than 26 weeks gestational age, were included in the study. Patients’ particulars including demographic data, gestational age, number of previous uterine scars, type of placenta, treatment option and the outcome, were collected.
Results: The frequency of morbidly adherent placenta was 4.06 per 1000 deliveries. The mean age of patients was 31.06±2.48 years, whereas the mean gestational age was 35.5±1.15 weeks. The mean parity was 3.5±0.71. Out of 18 patients with morbidly adherent placenta, 3(16.7%) had four caesarean scars, 8(44.4%) had three previous caesarean scars, and 7(38.9%) had two previous caesarean scars. Associated placenta previa was present in 14(77.8%) patients. Hysterectomy was done in 15(83.3%) patients, while in 3(16.6%) patients uterus was preserved. The bladder was repaired in 12(66.6%) patients with post-op catheterisation for three weeks. There was no maternal mortality.
Conclusion: Previous caesarean scar and placenta previa are major risk factors for the morbidly adherent placenta. Wellestablished antenatal diagnosis with timely surgical intervention can prevent long-term complications.Keywords: Caesarean section, Placenta previa, Placenta accreta, Placenta increta, Placenta percreta.

Disclaimer: The following sections are produced through an intensive multi-stage analytical pipeline developed by DefinePK, utilizing advanced natural-language processing, domain-specific knowledge models, and automated cross-referencing systems. Despite the rigor and computational effort involved, the generated summary may still contain inaccuracies or incomplete interpretations. Users are strongly advised to verify all critical information against the original paper and its authoritative sources.

Research Objective

To identify the risk factors predisposing to the Morbidly Adherent Placenta (MAP) and to evaluate maternal outcomes in patients with MAP.

Methodology

Cross-sectional study conducted at the Department of Obstetrics & Gynaecology, Combined Military Hospital, Lahore, Pakistan, from January to December 2021. 18 female patients with a clinical diagnosis of MAP, singleton fetuses, and gestational age >26 weeks were included. Data collected included demographic data, gestational age, number of previous uterine scars, type of placenta, treatment option, and outcome. Statistical analysis was performed using SPSS version 24.0.

Methodology Flowchart

                        graph TD
    A["Patient Recruitment 18 females with MAP"] --> B["Data Collection: Demographics, Gestational Age, Previous Scars, Placenta Type, Treatment, Outcome"]
    B --> C["Data Analysis using SPSS v24.0"]
    C --> D["Results Interpretation"]
    D --> E["Discussion of Findings"]
    E --> F["Conclusion and Implications"]

Discussion

The study highlights previous caesarean scars and placenta previa as significant risk factors for MAP. The observed frequency of MAP in this tertiary care hospital setting was higher than in some other studies, potentially due to the hospital's role in managing complicated obstetric cases. The findings underscore the importance of antenatal diagnosis and timely surgical intervention to mitigate maternal morbidity and mortality associated with MAP.

Key Findings

The frequency of MAP was 4.06 per 1000 deliveries. The mean age of patients was 31.06±2.48 years, and the mean gestational age was 35.5±1.15 weeks. The mean parity was 3.5±0.71. Among the 18 patients, 77.8% had placenta previa. Previous caesarean scars were prevalent: 38.9% had two, 44.4% had three, and 16.7% had four. Hysterectomy was performed in 83.3% of patients, while the uterus was preserved in 16.7%. Bladder repair was necessary in 66.6% of patients. There was no maternal mortality.

Conclusion

Previous caesarean section and placenta previa are major risk factors for morbidly adherent placenta. Well-established antenatal diagnosis with timely surgical intervention is crucial for reducing morbidity and mortality in patients with MAP.

Fact Check

- Frequency of MAP: 4.06 per 1000 deliveries.
- Hysterectomy performed in: 15 (83.3%) patients.
- Bladder repaired in: 12 (66.6%) patients.

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