Clinical Profile of Morbidly Adherent Placenta
Clinical Profile of Morbidly Adherent Placenta
Keywords:
Caesarean, caesarean hysterectomy, conservative management, embolization, methotrexate, morbidly adherent placenta, placenta accreta, placenta percretaAbstract
Background & Objectives: To present our experience of antenatally diagnosed morbidly adherent placenta and the success of the conservative management of morbidly adherent placenta in preserving the uterus and also in decreasing the maternal morbidity. Methods: Morbidly adherent placenta was diagnosed antenatally by ultrasound doppler. The women were followed till delivery. Treatment strategies ranged from a caesarean hysterectomy to leaving the placenta in situ with or without internal artery ligation/uterine artery embolisation and/or methotrexate therapy. Eleven cases of morbidly adherent placenta were managed successfully conservatively by leaving the placenta in situ followed by uterine artery embolisation and methotrexate therapy. The patients were followed with ultrasound doppler examination and serum beta-human chorionic gonadotrophin (β-hCG) level. Evacuation was done with complete removal of the placental tissue. Results: Morbidly adherent placenta was diagnosed antenatally by ultrasound doppler in 29 patients. History of previous one caesarean was present in 16 (55.1%) and two or more in 7 (24.1%), previous abortion in 4 (13.7%) and previous vaginal delivery in 2 (6.8%) women. Placenta was partially separated in 10 (34.4%) and retained in 11 (37.9%). 8(27.5%) women underwent emergency obstetric hysterectomies in whom the histology confirmed the diagnosis. 11 (37.9%) cases were managed successfully conservatively by leaving the placenta in situ with uterine artery embolisation and methotrexate therapy. Conclusions: Prenatal imaging may be very useful in antenatal diagnosis of adherent placenta. Efforts to minimize blood loss, planning the type of surgery, selective arterial embolization and uterine and/or hypogastric artery ligation, leaving the placenta in situ without attempts to remove and postpartum management with methotrexate therapy is more acceptable option in selected cases. [Shweta G NJIRM 2017; 8(3):36-40]
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