A 5-years cross-sectional study of risk-factors and feto-maternal outcomes in Placenta Accreta Spectrum at single tertiary care centre, South India

• Shridevi Chidanand Metgud,*  
• Gauri Abhishek Prabhu,  
• Prasad Murigendrappa Renuka

Abstract

Placenta accrete spectrum (PAS) is an obstetric condition leading to severe maternal morbidity and mortality due to massive obstetric haemorrhage (MOH). The global incidence of PAS is on the rise due to increasing use of Caserean Section (CS) worldwide. This study aimed to assess the risk factors associated with PAS and to compare the elective and emergency delivery outcomes in PAS. This is a 5 years single centre observational study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included in the study. Total of 38 cases of PAS were included in the study. The placental location, presence of placenta previa and degree of placental adherence were documented on transabdominal and transvaginal ultrasound. Maternal and perinatal outcomes were analysed between elective and emergency delivery. Chi-square test and T-test were used to compare the categorical variables with p value 0f <0.05 as statistically significant. The incidence of PAS in our study was 1.85 per 1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors noted. There were no statistically significant difference in maternal and perinatal outcomes between elective and emergency groups. MOH was the commonest complication among both the groups. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Anterior and lateral placenta with placenta previa and bladder involvement were more difficult to operate. Prematurity and low birth weight were the most important perinatal outcomes. PAS needs early referral to reduce poor outcomes. There is a need for forming regional team to manage PAS. Adequate blood and blood products have to be arranged prior to surgery as even in expert hands blood loss can be massive. Future studies should emphasize on easy and early detection of PAS.

Keywords

Placenta Accreta Spectrum, placenta previa, massive obstetric haemorrhage, peripartum hysterectomy.