Placenta accreta spectrum: risk factors and fetomaternal outcome after multidisciplinary team approach

Abstract

Background: Placenta accreta spectrum (PAS) is an entity where abnormal trophoblastic invasion of placenta occurs into myometrium of uterine wall either partially or totally. Maternal and perinatal morbidity and mortality is increased in PAS due to severe hemorrhage, requirement of blood transfusion and need for peripartum hysterectomy. Objective: To find out risk factors and fetomaternal outcome after multidisciplinary team approach in cases of placenta accreta spectrum. Material and methods: All case records were obtained from medical record section and carefully analyzed to find out risk factors and primary and secondary outcome measures. Results: Maximum patients were in age group of 30-34 years (48.83%) and were third gravida (39.53%). 34.88 % cases had history of previous 2 LSCS (lower segment caesarian section) and in 67.44% it was associated with placenta previa. 67.44% had postpartum haemorrhage (PPH) with 48.83% unbooked cases. 41.18% cases went into hemorrhagic shock with 34.38 % falling into unbooked category. 69.76% had intensive care unit (ICU) admission due to various indications out of which 83.33% were unbooked and 16.67% were booked. 69.44% baby of unregistered pregnancy went to neonatal intensive care unit (NICU) in comparison to 30.56% of registered cases. Conclusion: Placenta accreta spectrum is associated with adverse maternal and perinatal outcome. Prenatal diagnosis and multidisciplinary team management can improve prognosis of both fetal and maternal outcome.

Keywords

• placenta accreta
• postpartum hemorrhage
• conservative treatment
• peripartum
• hysterectomy