Main Article Content
Uterine surgeries, Adherent placenta, Frequency
A placenta that adheres abnormally to the uterine wall, either partially or completely, is known as an adherent placenta. Because of the significant morbidity and mortality linked to this disease and the possibility of a massive haemorrhage after birth, it is a potentially fatal pregnancy complication.
Objective: To determine the frequency of adherent placenta in pregnant women with history of uterine surgeries.
Place and Duration: This Cross-Sectional study was held in the department of obstetrics and gynecology of Nishtar Hospital Multan from 1st April 2016 to 30th September 2016.
Methods: A total of 170 pregnant females with singleton gravida with gestational age 28-36 weeks with history of ≥ 1 D&C or ≥ 1 C-Section or ≥ 1 Hysterotomy or ≥ 1 open abdominal myomectomy > 6 months passed and parity ≥ 1 were selected for the study. Patients with history of diabetes mellitus, hypertension and Hyperlipidemia were excluded. Color Doppler Ultrasound examination for exact placental localization and adherence of placenta was done to all patients. Ultrasound examination was done under the supervision of consultant gynecologist having 3 years post fellowship experience. Data was noted for adherence of placenta and recorded on especially designed proforma.
Results: This study age range was from 25-40 years with 32.911± 3.01 years of mean age, 32.305 ± 2.22 weeks was the mean gestational age, 74.100± 13.87 Kg was the mean weight, mean height was1.701± 0.10 meters, mean BMI was 27.378 ± 1.78 Kg/m2 and mean previous uterine surgeries was 1.747± 0.62. Majority of patients were of age group 31-40 years (81.2%). As far as type of previous uterine surgeries, 79.4% had C-section, 12.9% D&C and 7.6% had myomectomy. Adherent Placenta was seen in 5.9% patients.
Conclusion: My study has concluded that, no incidence of adherent placenta in women with a prior myomectomy. However, the rates of adherent placenta are high in females with prior cesarean section.
2. Demirci O, Tugrul AS, Yilmaz E, Tosun O, Demirci E, Eren YS. Emergency peripartum hysterectomy in a tertiary obstetric center: nine years evaluation. Obstet Gynaecol Res. 2011;37(8):1054-60.
3. ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77:77-8.
4. Chen CH, Wang PH, Lin JY, Chiu YH, Wu HM, Liu WM. Uterine rupture secondary to placenta percreta in a near-term pregnant woman with a history of hysterectomy. J Obstet Gynaecol Res. 2011;37:71-4.
5. Aguilar-Hernandez OF, Renan-Riveroy-Coronado C, Sanchez- Garcia JF, Bolio-Bolio MA. Uterine rupture of placenta accreta. Ginecol Obstet Mex. 2010;78:250-3.
6. Royal College of Obstetricians and Gynaecologists. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management (Green-top Guideline No. 27) [Internet]. RCOG; [cited 2015 Feb 26]. Available from:https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg27/.
7. Spong CY, Mercer BM, D’Alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late preterm and early-term birth. Obstet Gynecol. 2011;118:323–33.
8. Landon MB, Lynch CD. Optimal timing and mode of delivery after cesarean with previous classical incision or myomectomy: a review of the data. Semin Perinatol. 2011;35:257–61.
9. Gyamfi-Bannerman C, Gilbert S, Landon MB, Spong CY, Rouse DJ, Varner MW. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol. 2012 Dec;120(6):1332–37.
10. Richa A, Amita S, Bala VN, Ponam Y, Abha S, Kiran M. Morbidly adherent placenta: a critical review. J Obstet Gynecol India. 2012 Jan-Feb;62(1):57–61.
11. Burton GJ, Fowden AL. The placenta: a multifaceted, transient organ. Philos Trans R Soc Lond B Biol Sci. 2015;370(1663):20140066.
12. Daltveit AK, Tollånes MC, Pihlstrøm H, Irgens LM. Cesarean delivery and subsequent pregnancies. Obstetrics and gynecology. 2008;111(6).
13. Barber EL, Lundsberg LS, Belanger K, et al. Indications contributing to the increasing cesarean delivery rate. Obstetrics and gynecology. 2011;118(1).
14. ACOG Committee opinion. Number 266, January 2002 : placenta accreta. Obstetrics and gynecology. 2002;99(1).
15. Read JA, Cotton DB, Miller FC. Placenta accreta: changing clinical aspects and outcome. Obstetrics and gynecology. 1980;56(1).
16. Fox H, Sebire N. Pathology of the Placenta. 3rd ed. Elsevier Limited; 2007:1-16, 80- 84.
17. Nguyen D, Nguyen C, Yacobozzi M, Bsat F, Rakita D. Imaging of the placenta with pathologic correlation. Seminars in ultrasound, CT, and MR. 2012;33(1).
18. Hutton L, Yang SS, Bernstein J. Placenta accreta. A 26-year clinicopathologic review (1956-1981). New York state journal of medicine. 1983;83(6).
19. Irving F, Hertig A. A Study of Placenta Accreta. Surg. Gynec. Obstet. 1937;64:178.
20. Jacques SM, Qureshi F, Trent VS, Ramirez NC. Placenta accreta: mild cases diagnosed by placental examination. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists. 1996;15(1).
21. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstetrics and gynecology. 2006;107(4).
22. Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol 2008;61:1243-1246.
23. Tantbirojn P, Crum CP, Parast MM. Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta. 2008;29(7).
24. Strickland S, Richards WG. Invasion of the trophoblasts. Cell. 1992;71(3).
25. Wehrum MJ, Buhimschi IA, Salafia C, et al. Accreta complicating complete placenta previa is characterized by reduced systemic levels of vascular endothelial growth factor and by epithelial-to-mesenchymal transition of the invasive trophoblast. Am J Obstet Gynecol 2011;204(5).