Reflective practice in management of morbidly adherent placenta: A four year comparative retrospective study

Abstract

Objectives: To analyze trends in management of morbidly adherent placenta and their impact on pregnancy outcomes over a four-year period at a tertiary care hospital center.

Methodology: This retrospective cross-sectional study, was conducted in obstetrics and gynecology unit, from September 2018 to August 2022. It included women with singleton pregnancies complicated by Morbidly adherent placenta (MAP), diagnosed either prenatally by ultrasound / Magnetic resonance imaging, or intraoperatively based on failure of placental separation following delivery after 28 weeks of gestation. Pregnancy outcomes, analyzed over four years and compared between two groups defined by time interval: A (2018 – 2020) and B (2020 – 2022) to assess evolving trends in the management and care of MAP over time.

Results: A total of 47 women were included with MAP. Preterm delivery (<37 weeks) was more frequent 25(53.2%) in MAP. Uterine conservation was achieved in 27.7% of patients. Blood loss >1500 ml was observed in 85.1% of cases, 57.4% required ≥4 units of intraoperative red blood cell (RBC) transfusion. Postoperative ICU admission was more common with placenta percreta(PPC). A significant association for surgical techniques was seen between Group-A and B: p-value 0.02. Surgical techniques were less frequent in Group-A as compared to Group-B. (B = -1.08, p = 0.052).

Conclusion: Morbidly adherent placenta (MAP) is frequently associated with type four placenta previa(PP) and preterm delivery. Cesarean hysterectomy remains the most frequently performed surgical intervention; uterine conservation was feasible in less invasive forms. Multidisciplinary approach and advanced surgical techniques, may contribute to less blood loss and the preservation of future fertility.