Management of Urinary Tract Involvement in Placenta Accreta: A Single Institution Experience of 10 Cases

Abstract

Objective:Placenta accreta spectrum (PAS), which occurs in ~1/500 deliveries, represents the disorders that arise due to adherent placenta, which may infiltrate adjacent organs, including the urinary tract. Recently, its incidence rate has increased because of increasing rate of cesarean deliveries worldwide.Materials and Methods:Case records of all institutional deliveries that took place at a single, tertiary care hospital within two years were reviewed to identify all patients with PAS. The case records of patients who required urological referral were studied.Results:In total, 80 patients were diagnosed with PAS. Ten patients (12.5%) required urological referral for urinary tract involvement. All (100%) patients showed bladder involvement. Two patients (2.5%) required ureteric reimplantation. One patient (1.2%) required bilateral ureterostomies as an urgent temporizing measure because the bladder was extensively infiltrated. All patients were discharged in a stable condition. There were no long-term urological complications observed in patients who followed up (90%).Conclusion:PAS is a condition with high mortality and morbidity rates and increasing incidence. The findings of this study correlate well with international series on PAS. A multidisciplinary management team is necessary to manage the myriad complications that may arise from PAS.

Keywords

• placenta accreta
• placenta percreta
• bladder injury