Uzma Shabab, Zehra Naqvi.
Maternal Factors and Complications Associated with Morbidly Adherent Placenta.
J Surg Pak Jan ;22(3):105-8.

Objective: To determine, the frequency of maternal factors and complications associated with morbidly adherent placenta (MAP). Study design: Retrospective review of records. Place & Duration of study: Department of Obstetrics and Gynaecology, Liaquat National Hospital Karachi, from January 2014 to December 2016. Methodology: All cases of morbidly adherent placenta managed during the study period were included. Information was retrieved from the case notes and operation theatre register. The data was analyzed with descriptive statistics. Results: During the study period the total number of deliveries conducted was 5515; among these 46 women had morbidly adherent placenta. The frequency of MAP about 0.83 %. Of the total cases, 22 (47.8%) women had placenta acreta, 9 (19%) increta and 15 (32%) percreta. Mean age of the women was 30.78 ± 5.08 year and the mean parity was 2.76 ± 1.50. The mean gestational age was 33.63 ±4.69 weeks. Forty-five (97.8%) women had previous caesarean section scar, twelve (26.1%) had undergone prior curettage, but they all had history of caesarean section also. Placenta previa was associated in 32 (69.5%) cases. Two (4.3%) women had no risk factors. Methotrexate was used in five (10.9%) women. Thirty patients underwent hysterectomy with additional bilateral internal iliac artery ligation in two women due to excessive bleeding. Caesarean section with delivery of placenta and closure of of placental sinuses done in thirteen (28.3%) women where placenta acreta was present. Massive blood loss was important observation. Three (6.5%) women died in this series. Conclusion: Early diagnosis and planned management can go a long way to reduce morbidity and mortality associated with MAP. Medical management has limited role and multidisciplinary approach helps in achieving better outcome.

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