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Placenta Accreta Spectrum Disorder: A Retrospective Study of 78 Cases | ||
| Al- Anbar Medical Journal | ||
| Volume 20, Issue 1, June 2024, Pages 80-85 PDF (303.24 K) | ||
| Document Type: Original articles | ||
| DOI: 10.33091/amj.2024.144565.1446 | ||
| Authors | ||
| Raida Al-Wazzan* 1; Luma Ibraheem Al-Najafi2 | ||
| 1Department of Obstetrics and Gynecology, College of Medicine, University of Mosul, Mosul, Iraq. | ||
| 2Department of Obstetrics and Gynecology, Al-Khansaa Teaching Hospital, Nineveh Health Directorate, Mosul, Iraq. | ||
| Abstract | ||
| Background: Placenta accreta spectrum (PAS) disorder is a potentially near-miss life-threatening hemorrhagic obstetrical condition causing maternal complications and death. As there was no unique method recommended for the treatment of PAS all over the world until now, an analysis of the treatment of these cases in the study’s locality was needed. Objectives: To analyze the management of cases with a diagnosis of PAS and study the maternal outcome. Materials and Methods: A descriptive observational retrospective case series study included 78 consecutive pregnant women with a diagnosis of PAS who were managed at Al-Khanssa Teaching Hospital in Mosul/Iraq from June 1st , 2017 to May 31st , 2020. The grade of PAS, time of diagnosis, treatment modalities, and complications were studied and analyzed. Results: In these 3 years, 78 patients met the diagnostic criteria of PAS. Overall, 21.8% of patients had an antenatal diagnosis and had a scheduled Caesarean section. About half of cases (48.72%) had placenta increta. In 33.33% of patients, preservation of the uterus after removal of the placenta with good hemostasis was successful. Hysterectomy was needed in 66.67% of cases. Maternal complications were reported in 16.67% of cases, and fortunately, no maternal death was reported. Conclusion: In a limited resource clinical setting, hysterectomy and preservation of the uterus after removal of the placenta with a low threshold to hysterectomy were two methods appropriate to treat PAS cases. Both these methods were effective with low complications by an experienced obstetrician. | ||
| Keywords | ||
| Placenta accreta spectrum (PAS); Morbidly adherent placenta; Placenta accreta; Hysterectomy; Uterine preservation | ||
| References | ||
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[1] R. Ramli et al., “Morbidly adherent placenta: One-year case series in a tertiary hospital,” Medical Journal of Malaysia, vol. 74, no. 2, pp. 128–132, 2019. [2] A. Naser, V. Praveen, S. Kurian, and S. Ajith, “Study of maternal and neonatal outcomes of placenta accreta spectrum in a tertiary care hospital,” vol. 14, no. 5, pp. 108–115, 2023. [3] A. Slaoui et al., “Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: Case series and review of the literature,” Pan African Medical Journal, vol. 33, pp. 1–12, 2019. [4] W. Pan et al., “Uterus-preserving surgical management of placenta accreta spectrum disorder : a large retrospective study,” pp. 1–9, 2023. [5] D. K. Chan and A. B. Olawaiye, “Clinics in Mother and Child Health Management of the Morbidly Adherent Placenta,” vol. 16, no. 1000323, pp. 1–3, 2019. [6] C. Dane, E. Kızıldag, S. Güleç, and B. Dane, “Five cases of placenta previa accreta : the maternal and fetal outcome from a tertiary center,” vol. 5, no. 1, pp. 24–27, 2023. [7] A. M. Maged et al., “Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum : systematic review and meta ‑ analysis,” pp. 1–18, 2023. [8] A. Kansouh and E. Serag Eldin, “Maternal outcomes after different surgical techniques in placenta accreta: a prospective study,” Journal of Medicine in Scientific Research, vol. 1, no. 4, p. 306, 2018. [9] E. Jauniaux et al., “FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction,” International Journal of Gynecology and Obstetrics, vol. 140, no. 3, pp. 261–264, 2018. [10] A. Shehata, N. Hussein, A. El-Halwagy, and A. El Gergawy, “Could Simple Procedures Minimize Hysterectomy in Management of Placenta Accreta?,” Indian Journal of Obstetrics and Gynecology Research, vol. 2, no. 4, p. 213, 2015. [11] A. Richa, S. Amita, and V. Neelam, “Morbidly Adherent Placenta : A Critical Review,” vol. 62, no. February, pp. 57–61, 2012. [12] M. Kasraeian et al., “A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women,” BMC Women’s Health, vol. 21, no. 1, pp. 1–6, 2021. [13] N. Tahir, M. Adil, B. Afzal, S. Kiani, R. Kiani, S. Khan. Definitive Management of Morbidly Adhernt Placenta: Analysis of Maternal Outcomes. Pakistan Armed Forces Medical Journal, 68 (5): 1156-60, 2018. [14] R. Wajid, S. Bashir, and A. Hanif, “Treatment Outcome of Adherent Placenta: An Experience at Tertiary Care Hospital,” Annals of King Edward Medical University, vol. 23, no. 1, pp. 23–28, 2017. [15] S. Gupta, N. P. Jain, S. K. Singla, S. K. Juneja, R. Aggarwal, and L. Khanna, “Clinical Profile of Morbidly Adherent Placenta.,” National Journal of Integrated Research in Medicine, vol. 8, no. 3, pp. 36–40, 2017. [16] H. Zhao et al., “Risk factors of emergency cesarean section in pregnant women with severe placenta accreta spectrum : a retrospective cohort study, Frontiers in Medicine” vol. 10, no. July, pp. 1–9, 2023. [17] S. Takeda, J. Takeda, and Y. Murayama, “Placenta Previa Accreta Spectrum: Cesarean Hysterectomy,” The Surgery Journal, vol. 07, no. S 01, pp. S28–S37, 2021. [18] D. V. Rani, D. S. Jain, D. S. Nanda, D. V. M. D. M. B. Chauhanand, and D. N. Sangwan, “Placenta accrete spectrum-management and fetomaternal outcome at a tertiary care centre,” International Journal of Clinical Obstetrics and Gynaecology, vol. 3, no. 5, pp. 84–89, 2019. [19] J. L. Bailit et al., “Morbidly Adherent Placenta Treatments and Outcomes HHS Public Access Author manuscript,” Obstet Gynecol, vol. 125, no. 3, pp. 683–689, 2015. [20] V. Malhotra, V. Bhuria, S. Nanda, M. Chauhan, and A. Rani, “Placenta accreta: Five-year experience at a tertiary-care center,” Journal of Gynecologic Surgery, vol. 30, no. 2, pp. 91–95, 2014. [21] A. A. Hasan, J. A. Hasan, A. A. Khan.Management and Maternal Outcome in Morbidly Adhrent Placenta. Journal of Surgery Pakistan (International), 14 (4): 166-169,2009. [22] A. J. Nieto-Calvache et al., “Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings?,” Revista Brasileira de Ginecologia e Obstetricia, vol. 44, no. 9. pp. 838–844, 2022. [23] G. Kayem, C. Davy, F. Goffinet, C. Thomas, D. Cléent, and D. Cabrol, “Conservative versus extirpative management in cases of placenta accreta,” Obstetrics and Gynecology, vol. 104, no. 3, pp. 531–536, 2004. [24] N. Yasmeen, S. Ahmad, Z. Khanum, F. Khanum, and S. Khan, “Fetomaternal Out Come in Placenta Accreta Spectrum (Pas)in a Tertiary Care Teaching Hospital,” JAIMC: Journal of Allama Iqbal Medical College, vol. 21, no. 1, pp. 34–39, 2023. [25] S. Talib SalmanMBChB, C. Ali Hassan MohammedMBChB, C. Nadhim Ghazal NoamanMBChB, and H. Khaleel Ibrahim, “Prevalence of placenta accreta in Diyala governorate during 2010-2012 years,” Tikrit Medical Journal, vol. 19, no. 2, pp. 286–295, 2013. [26] C. R. Warshak et al., “Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta,” Obstetrics and Gynecology, vol. 115, no. 1, pp. 65–69, 2010. | ||
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