Assessment of different management options used in morbidly adherent placenta and pregnancy outcomes

Abstract

The aim of this work is evaluation of different management options for patients with morbidly adherent placenta and its effect on pregnancy outcomes to find the best method of management to decrease morbidity and mortality. In this prospective study, there were 42 patients diagnosed as having morbidly adherent placenta previa and hospitalized between January 2019 to February 2020. Different management options performed to patients with morbidly adherent placenta previa were recorded, blood loss was estimated for each patient, operative procedures, maternal and fetal outcome was recorded. The results showed the following: Different methods were tried to preserve the uterus including bilateral uterine artery ligation in 13 (59%) cases, bilateral ovarian artery ligation in 3 (13.6%) cases, bilateral internal iliac artery ligation in 3 (13.6%) cases, intrauterine tamponade in 4 (18.1%) cases and hemostatic sutures in placental bed in 11(50%) cases, while B-lynch suture was not done, while procedures which were performed to control pelvic hemorrhage after hysterectomy included internal iliac artery ligation in 8 (27.5%) cases, pelvic packing in 5 (17.2%) cases and internal iliac balloon inflation to control hemorrhage in 1 (3.4%) case. The postoperative complications were DIC occurred in 2 patients (4.8%), ICU admission occurred in 5 cases (11.9%), two cases required reoperations, one patient (2.4%) had wound infection, Postpartum collapse occurred in 2 case (4.8%). Pulmonary embolism occurred in 1 case (2.4%), Median duration of hospital stay was 4 days (range: 2-25).