Materno-fetal Outcomes in Patients with Abnormally Invasive Placenta: A 14 Year Experience

Objectives: To establish the incidence of abnormally invasive placenta (AIP); determine trends in the diagnosis and management; and assess maternal and neonatal morbidity associated with AIP. Methods: Women were identified from a tertiary care referral hospital perinatal database (2000-2013) and crosschecked with confirmed histopathology. Verification of undetected cases using perinatal ultrasound database was performed. Risk factors, antenatal suspicion, hospital course, intrapartum management, maternal and neonatal outcomes were obtained from medical records. Results: Thirty eight women had AIP confirmed providing an incidence of 1 per 1420 deliveries. The incidence rose by 55% (95% Confidence interval (CI) 37% - 279%) over the 14 year period (Poisson regression). An antenatal diagnosis of AIP was made in 63% (95% CI 46% - 78%). Excluding women with placenta percreta, there was a significantly higher blood loss in women in whom an attempt was made at placental removal compared to women in whom there was no attempt (median 3.5 liters versus 1.5 L, p=0.002). Conclusion: AIP was associated with significant maternal and neonatal morbidity. A significantly higher blood loss ensued in women with AIP in whom an attempt was made at placental separation. A dedicated multidisciplinary team and a standardized pathway can potentially reduce morbidity.