Retrospective observational case series of management of placenta accreta at tertiary care institution

Abstract

Introduction: Placenta accreta is a general term, when part of the placenta or the entire placenta invades and is inseparable from the uterine wall. The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia, occurring in around 1 in every 20 such women. Resorption of the retained, poorly perfused placenta can be augmented by concurrent treatment with methotrexate when fertility is desired. In cases where operative measures are required, placement of Internal Iliac artery (IIA) balloons preoperatively and their inflation intraoperatively, reduces maternal morbidity and mortality. Materials and Methodology: We present a case series of 14 patients with placenta accreta diagnosed preoperatively, 7 of whom had IIA balloons placed before undergoing Caesarean section and 7 did not have such an intervention. The maternal and foetal morbidity and mortality were studied, including the need for blood and blood product transfusions. Results: Internal Iliac Balloon placements did not change the requirement for blood and blood product transfudion in both groups. The group who had IIA balloon placed preoperatively had better maternal and fetal outcome as compared to the group who had no such intervention.

Keywords

• internal iliac artery balloon
• obstetric hysterectomy
• placenta accreta
• post partum hemorrhage
• uterine artery embolization