Maternal and Fetal Outcomes of Morbidly Adherent Placenta Cases in Beni-Suef University Hospital

Document Type : Original Article

Authors

1 Assistant Professor of Obstetrics& Gynecology, Faculty of Medicine, Beni-Suef University

2 Resident of Obstetrics and Gynecology, Etsaa Hospital, Egypt

3 Lecturer of Obstetrics& Gynecology, Faculty of Medicine, Beni-Suef University

Abstract

The aim of current Case-Control study is to evaluate maternal and fetal outcomes among women with morbidly adherent placenta (MAP) in Beni-Suef university hospital and to quantify the predisposing risk factors. The study was conducted from January 2020 to December 2020 in the out-patient and emergency Gynecology and Obstetrics department at Beni-Suef University Hospital. This study included a total of (30) MAP patients and an equal number (30) of matched pregnant females without MAP as a control group. At study inclusion, baseline demographic, past obstetric and medical history were collected first from all participants included in the study, then obstetric ultrasonography (USG) was done to determine position of placenta and type of placenta previa. Parity was significantly higher among women with MAP as compared with women with normal placenta. Number of previous CS was significantly higher among women with MAP. Incidence of antepartum hemorrhage was significantly higher among studied cases with MAP as compared with women with normal placenta with a statistically significant difference. Estimated blood loss (L), incidence of blood transfusion, number of transfused units, and fresh frozen plasma (FFP) transfusion were significantly higher among MAP group. Neonatal weight was significantly lower in MAP women, no statistically significant differences in Apgar score at 1st minute and after 5 minutes in both groups. NICU admission was significantly higher among MAP neonates. In conclusion, Morbidly adherent placenta is associated with several adverse maternal and fetal outcomes. It is a life-threatening hemorrhagic condition associated with high fetal and maternal morbidities and mortalities.

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Main Subjects

References

  1. Ernst, L. M., Linn, R. L., Minturn, L., & Miller, E. S. (2017). Placental pathologic associations with morbidly adherent placenta: potential insights into pathogenesis. Pediatric and Developmental Pathology, 20(5), 387-393.‏
  2. Miller, R., Timor-Tritsch, I. E., Bannerman, C. G., & Society for Maternal-Fetal Medicine (SMFM. (2020). Society for Maternal-Fetal Medicine (SMFM) Consult Series# 49: Cesarean scar pregnancy. American Journal of Obstetrics and Gynecology.‏
  3. Collins, S. L., Chantraine, F., Morgan, T. K., & Jauniaux, E. (2018). Abnormally adherent and invasive placenta: a spectrum disorder in need of a name. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 51(2), 165.‏
  4. Narava, S., Pokhriyal, S. C., Singh, S. B., Barpanda, S., & Bricker, L. (2020). Outcome of multiple cesarean sections in a tertiary maternity hospital in the United Arab Emirates: A retrospective analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 247, 143-148.‏
  5. Tovbin, J., Melcer, Y., Shor, S., Pekar‐Zlotin, M., Mendlovic, S., Svirsky, R., & Maymon, R. (2016). Prediction of morbidly adherent placenta using a scoring system. Ultrasound in Obstetrics & Gynecology, 48(4), 504-510.‏
  6. Ahmed Gharib, M., Mohamed El-Nagar, W., El-Bakry Lashin, M., & Mohammed Elaweel, M. (2019). Evaluation of Protocol of Management of Morbidly Adherent Placenta in Maternity Zagazig University Hospital. Zagazig University Medical Journal, 25(3), 481-489.‏
  7. Zhang, H., Dou, R., Yang, H., Zhao, X., Chen, D., Ding, Y., ... & Gu, W. (2019). Maternal and neonatal outcomes of placenta increta and percreta from a multicenter study in China. The Journal of Maternal-Fetal & Neonatal Medicine, 32(16), 2622-2627.‏
  8. Bhide, A., Sebire, N., Abuhamad, A., Acharya, G., & Silver, R. (2017). Morbidly adherent placenta: the need for standardization. Ultrasound in Obstetrics & Gynecology, 49(5), 559-563.‏
  9. Rac, M. W., Moschos, E., Wells, C. E., McIntire, D. D., Dashe, J. S., & Twickler, D. M. (2016). Sonographic findings of morbidly adherent placenta in the first trimester. Journal of Ultrasound in Medicine, 35(2), 263-269.‏
  10. Hecht, J. L., Baergen, R., Ernst, L. M., Katzman, P. J., Jacques, S. M., Jauniaux, E., ... & Heller, D. S. (2020). Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Modern Pathology, 33(12), 2382-2396.‏
  11. Morlando, M., & Collins, S. (2020). Placenta Accreta Spectrum Disorders: Challenges, Risks, and Management Strategies. International Journal of Women's Health, 12, 1033.‏
  12. Saad, S. A., Mahmoud, M. A., Bayoumi, A. M., & Sallam, M. A. (2020). Role of Color Doppler Ultrasound in Antenatal Diagnosis of Placenta Accreta in Patients with Previous Cesarean Scar. Benha Journal of Applied Sciences, 5(3 part (1)), 1-5.‏
  13. Chahal, H. S., Juneja, S. K., Kaur, S., Kochar, B., Sharma, S., & Makkar, V. (2020). Pregnancy-related acute kidney injury and urological comorbidities in morbidly adherent placenta: A potential challenge to AKI-0by25. Saudi Journal of Kidney Diseases and Transplantation, 31(2), 368.‏
  14. Pegu, B., Thiagaraju, C., Nayak, D., & Subbaiah, M. (2021). Placenta accreta spectrum-a catastrophic situation in obstetrics. Obstetrics & Gynecology Science, 64(3), 239-247.‏
  15. Fahmy, O. M., Aitallah, A. S., Abdelghafar, H. M., Abdelhafez, M. Y., & Khalifa, A. A. (2021). Fetal and Maternal Outcomes in Cases of Morbidly Adherent Placenta in Sohag University Hospital: Observational Study. The Egyptian Journal of Hospital Medicine, 83(1), 935-939.‏
  16. Thanawala, U., & Suchak, S. (2020). Placental Adhesive Disorders. In Labour Room Emergencies(pp. 371-380). Springer, Singapore.‏
  17. Fox, K. A., Shamshirsaz, A. A., & Belfort, M. A. (2017). Center of Excellence for morbidly adherent placenta. Placenta Accreta Syndrome, 113.‏
  18. Belfort, M. A., Shamshirsaz, A. A., & Fox, K. A. (2018, February). The diagnosis and management of morbidly adherent placenta. In Seminars in perinatology(Vol. 42, No. 1, pp. 49-58). WB Saunders.‏
  19. Kyozuka, H., Yamaguchi, A., Suzuki, D., Fujimori, K., Hosoya, M., Yasumura, S., ... & Hashimoto, K. (2019). Risk factors for placenta accreta spectrum: findings from the Japan environment and Children’s study. BMC pregnancy and childbirth, 19(1), 1-7.‏
  20. Matsuzaki, S., Nagase, Y., Takiuchi, T., Kakigano, A., Mimura, K., Lee, M., ... & Kimura, T. (2021). Antenatal diagnosis of placenta accreta spectrum after in vitro fertilization-embryo transfer: a systematic review and meta-analysis. Scientific reports, 11(1), 1-12.‏
  21. Anjali, K., & Rekha, S. (2013). Obstetric hysterectomy, A retrospective study at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol, 2(4), 562-65.‏
  22. Lazariu, V., Nguyen, T., McNutt, L. A., Jeffrey, J., & Kacica, M. (2017). Severe maternal morbidity: a population-based study of an expanded measure and associated factors. PloS one, 12(8), e0182343.‏
  23. Kakar, F., Shoaib, M., Saifullah, S., & Naeem, S. (2020). Determine the Complications Related to Placenta Previa and Compare the Findings in Patients With and Without Previous C-Sections.  J. Med. Health Sci, 14(2), 455-457.‏
  24. Wasim, T., Bushra, N., Riaz, S., & Iqbal, H. I. (2020). Fetomaternal outcome in patients with placenta previa. Pakistan Journal of Medical Sciences, 36(5), 952.‏
  25. Eliwa, S., Abdel Fatah, M., El Noury, M., & El Sayed, M. (2021). Uterine Artery Doppler and Placental Morphological Features as Predictors of Peripartum Complications in Placenta Previa and Placenta Previa Accreta. Benha Medical Journal.‏
  26. Khanum, T., Ara, G., Begum, S., Miah, M. Z., & Akter, S. (2020). Morbid Adherent Placenta among Pregnant Women prior to Cesarean Delivery: Experience of 15 Cases at a Tertiary care Hospital in Bangladesh. Journal of National Institute of Neurosciences Bangladesh, 6(1), 33-37.‏
  27. Sajid, A., Sajid, A. S. A., Sajid, A. S. A., & Abid, M. A. M. (2020). Morbidly Adherent Placenta: Management options. Pakistan Postgraduate Medical Journal, 31(01), 3-7.‏
  28. Mushtaq, R., Abbas, A., & Ahmed, W. (2019). Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in Central Punjab. The Professional Medical Journal, 26(10), 1645-1650.‏
  29. Fan, D., Wu, S., Liu, L., Xia, Q., Wang, W., Guo, X., & Liu, Z. (2017). Prevalence of antepartum hemorrhage in women with placenta previa: a systematic review and meta-analysis. Scientific reports, 7(1), 1-9.‏
  30. Afzal, S., Akram, R., Fatima, T., Aslam, M., Zafar, A., & Iqbal, S. (2020). Fetomaternal Outcome with Placenta Previa and Morbidly Adherent Placenta, A Cross Sectional Study.‏
  31. Nasrullah, F. D., Khan, A., Haque, S., & Mubeen, S. (2016). Review of cases of morbidly adharent placenta in a tertiary care unit. Parity, 3, 1-6.‏
  32. Nieto-Calvache, A. J., López-Girón, M. C., Messa-Bryon, A., Ceballos-Posada, M. L., Duque-Galán, M., Ríos-Posada, J. G. D., ... & Chancy-Castaño, M. M. (2019). Urinary tract injuries during treatment of patients with morbidly adherent placenta. The Journal of Maternal-Fetal & Neonatal Medicine, 1-7.‏
  33. Kandil, M. A., Sayyeda, T. M., Salaha, A., & Al Gilanyb, N. M. (2019). Maternal and neonatal outcomes of placenta accreta: a descriptive case series study. Menoufia Medical Journal, 32(1), 368.‏
  34. Wright, J. D., Pri-Paz, S., Herzog, T. J., Shah, M., Bonanno, C., Lewin, S. N., ... & Devine, P. (2012). Predictors of Massive Blood Loss in Women With Placenta Accreta. Obstetric Anesthesia Digest, 32(2), 115.‏
  35. Yasmeen, N., Ahmad, S., & Bashir, A. (2019). Association of an Increase Incidence of Morbidly Adherent Placenta with Previous Caesarean Section and Its Outcomes: A 3 Years Analysis in a Tertiary Care Hospital. Journal of University Medical & Dental College, 10(3),
  36. Furuta, K., Furukawa, S., Hirotoshi, U., Michikata, K., Kai, K., & Sameshima, H. (2014). Differences in maternal morbidity concerning risk factors for obstetric hemorrhage. Austin Journal of Obstetrics and Gynecology, 1(5), 5.‏
  37. Dwivedi, S., Dwivedi, G. N., Kumar, A., Gupta, N., Malhotra, V., & Singh, N. (2016). Placenta accreta: the silent invader. Int J Reprod Contracept Obstet Gynecol, 5(5), 1501-1505.‏
  38. Aggarwal, R., Suneja, A., Vaid, N. B., Yadav, P., Sharma, A., & Mishra, K. (2012). Morbidly adherent placenta: a critical review. The Journal of Obstetrics and Gynecology of India, 62(1), 57-61.‏
  39. Vinas, M. T., Belli, A. M., Arulkumaran, S., & Chandraharan, E. (2015). Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple‐P procedure. Ultrasound in Obstetrics & Gynecology, 46(3), 350-355.‏
  40. Shamshirsaz, A. A., Fox, K. A., Salmanian, B., Diaz-Arrastia, C. R., Lee, W., Baker, B. W., ... & Belfort, M. A. (2016). Maternal Morbidity in Patients With Morbidly Adherent Placenta Treated With and Without a Standardized Multidisciplinary Approach. Obstetric Anesthesia Digest, 36(1), 31-32.‏
  41. Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., ... & Lin, H. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ open, 7(8), e017173.‏
  42. Zhou, M., Chen, M., Zhang, L., He, G. L., He, L., Wei, Q., ... & Liu, X. H. (2017). Severe adverse pregnancy outcomes in placenta previa and prior cesarean delivery. Sichuan da xue xue bao. Yi xue ban= Journal of Sichuan University. Medical science edition, 48(5), 783-787.‏
  43. Cheng, K. K., & Lee, M. M. (2015). Rising incidence of morbidly adherent placenta and its association with previous caesarean section: a 15-year analysis in a tertiary hospital in Hong Kong. Hong Kong Med J, 21(6), 511-517.‏
  44. Weiner, E., Miremberg, H., Grinstein, E., Mizrachi, Y., Schreiber, L., Bar, J., & Kovo, M. (2016). The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. Journal of Perinatology, 36(12), 1073-1078.‏
  45. Silver, R. M., & Barbour, K. D. (2015). Placenta accreta spectrum: accreta, increta, and percreta. Obstetrics and Gynecology Clinics, 42(2), 381-402.‏
  46. Chaudhari, H. K., Shah, P. K., & D’Souza, N. (2017). Morbidly adherent placenta: its management and maternal and perinatal outcome. The Journal of Obstetrics and Gynecology of India, 67(1), 42-47.‏

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