Fetal and Maternal Outcomes in Cases of Morbidly Adherent Placenta in Sohag University Hospital: Observational Study

摘要

Background: Morbidly Adherent Placenta (MAP) is the greatest challenge in modern obstetrics. It is associated with massive obstetrical hemorrhage and high maternal mortality. Antenatal diagnosis and meticulous multidisciplinary planning at delivery is crucial for optimal outcome. Objective: To study the maternal and fetal outcomes in cases of morbidly adherent placenta for better management of these cases and to know our local practices toward these cases in Sohag University Hospital. Patients and Methods: 132 cases of pregnant women who had placenta previa with previous cesarean section scar were studied. This observational study was conducted at a Tertiary Care Hospital at Sohag University Hospital, Obstetrics & Gynecology Department (Inpatient and Emergency Sectors) from September 2017 to September 2018. All cases were subjected to complete history taking, complete physical examination, complete investigations, obstetric 2D U.S, color Doppler and MRI in some cases. Elective delivery was planned at 37-38 weeks or earlier in case of any complication. Results: 3664 were delivered, 2138 cesarean deliveries (58.3%) were performed. The percentage of these cases found to be 3.6% of deliveries and 6.17% of cesareans. The frequency of MAP in our study is 1 in 27.8 deliveries. There was one mortality in our study. Conclusion: High caesarean section (C.S) rate is the leading cause of MAP. Antenatal diagnosis of morbidly adherent placenta through color Doppler and MRI allows for multidisciplinary planning to minimize potential maternal or neonatal morbidity and mortality. Keywords: Morbidly adherent placenta, Intensive care unit, Cesarean section, Internal iliac artery, Intra-uterine catheter.