Obstetrical Hysterectomy In Patients Having Morbidly Adherent Placenta With Previous Cesarean Delivery

Nasreen Fatima

Abstract

Objective 

To find out the frequency of obstetrical hysterectomy in patients having morbidly adherent placenta with previous cesarean delivery.

Study design 

Cross sectional study.

Place & Duration of study

Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from January 2019 to December, 2019.

Methodology•

All women irrespective of age admitted with morbidly adherent placenta diagnosed on Doppler ultrasound were enrolled. Brief history and detailed physical examination were done. Women with previous cesarean section > 28 weeks gestation with morbidly adherent placenta were included. Primigravida and women with previous all vaginal deliveries, pre eclampsia, diabetes mellitus and those with chronic illnesses were excluded. Patients were followed up from admission till discharge from hospital after surgery. Morbidly adherent placenta was classified on the basis of per operative findings and confirmed by histopathology. Data were collected on pre structured questionnaire.

Results

Total of 72 women were included.  Mean age of patients was 30.83 ± 4.44 year, mean gestational age 34.72 ± 2.91 weeks, mean parity 2.81 ± 1.28 and mean previous numbers of cesarean section 2.41 ± 1.07. Eight (11.11%) patients diagnosed as having placenta increta, 45 (62.5%) placenta accreta and 19 (26.39%) placenta percreta. Thirty-four (47%) patients had obstetrical hysterectomy while 38 (53%) patients were managed by conservative surgery. Gravadity, parity, duration of hospital stay and previous number of cesarean section were significantly high in patients who had obstetrical hysterectomy. One (1.4%) patient expired due to disseminated intravascular coagulation.

Conclusions

High maternal morbidity was associated with morbidly adherent placenta in women who underwent previous cesarean section. Obstetrical hysterectomy was required in 47% women. Reduction in the rate of cesarean section is essential for prevention of morbidly adherent placenta.

Key words 

Obstetrical hysterectomy, Morbidly adherent placenta, Postpartum hemorrhage, Previous cesarean section, Placenta percreta.