Morbidly Adherent Placenta (MAP): Lessons learnt

Leena Wadhwa, Sangeeta Gupta, Pratibha Gupta, Bhawna Satija, Rupali Khanna

Department of Obstetrics & Gynecology, ESI-PGIMSR, Basaidarapur, Delhi.
Department of Radiology ESI-PGIMSR, Basaidarapur, Delhi.

DOI: 10.4236/ojog.2013.31A040                

Abstract

Context: Once a rare occurrence, MAP is becoming an increasing threat to maternal lives. Aims: To summarize our experience in the management of patients with morbidly adherent placenta. Introduction: MAP is a potentially life threatening hemorrhagic condition responsible for 7% - 10% maternal mortality. Settings and Design: Tertiary care center. Methods and Material: Retrospective study in which data of twelve patients with clinical diagnosis of morbidly adherent placenta was reviewed from Jan 2009 till Sept 2012. Results: The incidence of placenta accreta was found to be increasing every year. Out of twelve cases with clinical diagnosis of MAP, placenta previa was present in 10/12 patients with MAP. All patients had history of previous section. Two patients with preoperative diagnosis of MAP on USG/MRI were found to be normal intra-operative and in one patient focal accreta was diagnosed intraoperatively. Nine patients of MAP underwent caesarean hysterectomy due to excessive bleeding during placental separation and were confirmed histo-pathologically (3 accreta vera, 3 increta and 3 percreta). Internal iliac artery ligation was done in 2 patients. Two patients with placenta percreta had bladder rupture which was repaired and these two patients subsequently expired. Conclusions: The incidence of placenta accreta is increasing due to higher cesarean section (C/S) rate. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary approach.

Keywords

Placenta Accreta; Morbidly Adherent Placenta; Cesarean Section; Hemorrhage; Maternal Mortality

Conflicts of Interest

The authors declare no conflicts of interest.

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