Objective: The aim of this study was to know the current practice in patients with abnormally invasive placenta in the context of a rising caesarean delivery rate, evaluate our antenatal and intraoperative management and see the maternal and perinatal outcome in these patients.
Material and Methods: A prospective study was carried out in 19 women with abnormally invasive placenta in the Department of Gynecology, PGIMER, Chandigarh, India between Jan 2015 – April 2016. The profile of these patients was recorded in a predesigned proforma and maternal and perinatal outcome analyzed in detail. A critical analysis for improvement for better outcome was done.
Results: All 19 patients who had antenatal diagnosis of abnormally invasive placenta had previous cesarean scar with co-existing placenta previa. Massive blood loss during cesarean section was the predominant feature in all patients. In these patients, performing a classical CS, not trying to remove the placenta and proceeding directly to hysterectomy resulted in reduced blood loss (1900±1057.7ml) compared to trying to remove the placenta and then proceeding to hysterectomy (2500±707ml). All patients had requirement of blood transfusion with minimum of single PRBC to maximum of 7 units. All patients antenatal diagnosis of abnormally invasive placenta was again confirmed during intra-operative period and ultimately all 19 of them had peripartum hysterectomy. No maternal mortality was recorded.
Conclusion: Abnormally invasive placenta has high maternal as well as neonatal morbidity. Previous caesarean section remains the major risk factors for abnormally invasive placenta. So, every effort should be made to avoid cesarean delivery which will further reduce the development of abnormally invasive placenta.