MATERNAL OUTCOMES OF MORBIDLY ADHERENT PLACENTA, A STUDY AT PEMH RAWALPINDI

Abstract

Objectives: To assess the maternal outcomes associated with morbidly adherent placenta (MAP), including hemorrhagic complications, transfusion requirements, surgical complications, intensive care unit (ICU) admission, duration of hospital stay, and maternal mortality, and to evaluate the role of previous caesarean section, previous uterine surgery, and placenta previa as important associated risk factors.

Methodology: A hospital-based observational study was conducted in the Department of Obstetrics and Gynecology, Pakistan Emirates Military Hospital (PEMH), Rawalpindi. A total of 100 pregnant women with suspected or confirmed MAP were enrolled through consecutive sampling. Demographic characteristics, obstetric history, antenatal diagnosis, type of placental invasion, mode of presentation, operative management, estimated blood loss, transfusion requirements, surgical and postoperative complications, ICU admission, hospital stay, and maternal mortality were assessed.

Results: The mean maternal age was 31.2 ± 4.8 years, and 94% of women were multiparous. Previous caesarean section was reported in 92% of patients, while 71% had undergone at least two previous caesarean deliveries. Previous uterine surgery was present in 87%, and placenta previa in 72%. Placenta accreta, increta, and percreta accounted for 43%, 34%, and 23%, respectively. Antenatal diagnosis was achieved in 78% of cases. Caesarean hysterectomy was performed in 86%. Mean estimated blood loss was 2,150 ± 1,120 mL. Postpartum hemorrhage occurred in 68%, blood transfusion was required in 82%, and massive transfusion in 38%. Bladder injury occurred in 19%, ICU admission in 24%, and maternal mortality was 2%.

Conclusion: MAP was associated with substantial maternal morbidity and hemorrhagic complications. Previous caesarean section, uterine surgery, and placenta previa were common risk factors. Early antenatal diagnosis, planned delivery, multidisciplinary management, and adequate blood-product preparation are essential to improve maternal outcomes.