Abstract :
Introduction: Placenta accreta spectrum is a life-threatening condition caused due to abnormal placentation and decidualisation. The absence of nitabuch layer leads to abnormal trophoblastic invasion and thus forming a morbidly adherent placenta. This may result into life-threatening antepartum and post-partum haemorrhage and thus causing severe maternal morbidity and mortality. The incidence of placenta accreta spectrum has increased over the last decade, causes being increased rate of caesarean section, other uterine procedures like myomectomy, dilatation and curettage, manual removal of placenta, isthmocele, etc. There is not enough research and data regarding its management in a low resource set-up like our institute. This study aims at solving these doubts and acknowledging multiple surgical methods and complications during management of PAS at a tertiary care centre in a low resource set-up. Materials And Methods: A retrospective cross-sectional study was performed from the year 2022 to 2024. 32 cases were found to have PAS and were managed in our institute using various surgical methods which involved caesarean hysterectomy, leaving placenta in situ, myometrial segmental resection, complete removal of placenta. These methods were combined with bilateral internal iliac artery ligation in few cases. It also includes management of some rare cases of PAS which underwent obstetric hysterectomy with foetus in situ and management of placenta percreta in caesarean scar pregnancy with scar rupture. Observations and Results: It was observed that uterine conservative surgery was successful in 59.36 % and 40.62% patients underwent caesarean hysterectomy. All cases had history of uterine procedure in previous pregnancies. Foetal outcomes were good in 78.11 % cases. The overall incidence of PPH (primary and secondary) in entire study was 50 %. There was 1 maternal mortality (3.12%) due to PAS. Other maternal morbidities observed were prolonged hospitalisation due to intraoperative complications of bladder and ureter injury followed by repair and/ or DJ stenting in 21.87 % cases, post operative ICU admission in 25 % cases, post operative ventilatory support in 18.75 cases, intra- and /or post operative inotropic support in 18.75% cases, surgical site infection in 9.39 % cases. Conclusion: In a case of PAS, planned delivery at 35+0 to 36+6 weeks of gestation is recommended. Overall, all surgical methods in this study have good maternal outcomes but the choice of surgical method depends entirely on clinical judgement, surgical expertise, type of institution, availability of multidisciplinary team, pre-operative ultrasound findings, availability of resources to manage complications (i.e. blood and blood products, broad interventions and post operative care in ICU).
Keyword :
PAS (Placenta accreta spectrum), Antepartum and Post-partum haemorrhage.