INCIDENCE OF MORBIDLY ADHERENT PLACENTA AFTER PREVIOUS 1 SCAR REPORTED IN PEMH

Abstract

Objective: to determine the incidence of morbidly adherent placenta among women with one previous caesarean section, to identify the associated risk factors, and to highlight the need for early diagnosis and preventive strategies.

Study Design: Prospective cohort study

Place and duration: Pak Emirates Military Hospital, Rawalpindi over a period of six months, from January 2025 to June 2025

Methodology: This prospective cohort study was conducted at Pak Emirates Military Hospital, Rawalpindi, over six months from January to June 2025, including thirty-three pregnant women with one previous cesarean scar diagnosed with morbidly adherent placenta. Ethical approval and informed consent were obtained, and all participants underwent thorough clinical evaluation, ultrasound assessment, and laboratory testing to confirm diagnosis and assess maternal condition. Ultrasound using gray-scale and color Doppler was performed to identify features suggestive of placenta accreta spectrum, such as loss of the retroplacental clear zone and abnormal vascular patterns. All women were delivered by cesarean section under preparedness for major hemorrhage, with intraoperative findings and histopathology confirming the diagnosis and classifying the type of placental adherence. Detailed intraoperative and postoperative outcomes, including complications, transfusions, and surgical management approaches, were carefully recorded to evaluate the clinical course and maternal outcomes.
Results: Out of 262 patients studied, 24 (9.2%) were diagnosed with morbidly adherent placenta (MAP), while 238 (90.8%) did not have it. Most MAP cases occurred in women aged 30–35 years (66.7%), showing a significant link between age and MAP (p = 0.025), while higher parity (3–4) was also significantly associated (58.3%, p = 0.042). Among MAP types, placenta accreta was most common (54.2%), followed by increta (20.8%) and percreta (25.0%). Major complications included massive blood transfusion in 54.2% of cases and bladder injury in 45.8%, indicating that MAP was linked with serious maternal morbidity.

Conclusion: This study showed that morbidly adherent placenta can occur even after one previous cesarean section, with significant risks of bleeding and surgical complications. Early diagnosis, careful monitoring, and delivery in a well-equipped tertiary care center are essential to reduce maternal morbidity and improve outcomes.