Abstract: Background: Placenta accrete spectrum disorders refer to the penetration of the trophoblastic tissue through the decidua basalis into the underlying myometrium, the uterine serosa or even beyond extending into the pelvic organs. The presence of risk factors such as one or more previous caesarean section, uterine surgery, manual removal of placenta, recurrent miscarriages managed surgically should trigger an even more detailed examination of the placental bed during ultrasound examination. Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of placenta accreta spectrum; thus, clinical risk factors remain equally important as predictors of placenta accrete spectrum by ultrasound findings.
Material & Methods: Retrospective, observational and analytical study from March 2013 to February 2018. All women who had vaginal or cesarean delivery in district hospital Samba were included in the study.
Results: There were total of 7800 deliveries, out of these 2100 were cesarean section deliveries. Emergency Obstetric Hysterectomies were done in four cases for intra-operative diagnosis of PAS after the delivery of baby and verification that placenta will not spontaneously deliver. The incidence of abnormal invasion of placenta is 1 in 1950 pregnancies.
Conclusion: Women with suspected placenta accreta spectrum diagnosed in the antenatal period based on clinical history and on imaging should be delivered at tertiary institute. Early ultrasound examination for at risk patients is important to ensure accurate dating and enable early diagnosis. If the placenta accreta spectrum is diagnosed after the birth of baby on delivery table, attempt should not be made for manual removal of placenta as it can lead to profuse hemorrhage and maternal morbidity and mortality. One should proceed for emergency obstetric hysterectomy after written consent
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