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Background: Many maternal and fetal complications were
reported during delivery for patients diagnosed to have placenta accrete spectrum (PAS). Cesarean delivery (CD) is
considered to be the most common risk factor for developing PAS disorders during pregnancy specially with increasing rate of CD in developing countries.
Methods: A cross- sectional study over 12 months in a tertiary care obstetric unit between January 2020 and January
2021.
Results: 47 pregnant females having history of previous
one CD were divided into 2 groups after ultrasonic and intraoperative evaluation of placenta site and invasion to the
uterine wall.14 cases were in the low risk group ad 33 cases
were in the high-risk group. The mean ages of patients were
(27.6 ± 4.6 & 27.6 ± 4.6, p value =0.961) respectively. The
median gravidity was (3 & 2) in both groups. We found that
36.4 % of case in the high-risk group had unreliable indications of the primary CD. Emergency caesarean deliveries
were done in about 18 % of cases in the high-risk group < br />either due to failure to progress in labour or foetal distress.
We reported successful conservative management in both
groups using either cervico-isthmic compression suture
or step wise approach. There was statistically significant
in the mean amount of intraoperative blood loss (1000 ml
(850-1200) &1600 ml (850-2500), p < 0.001) in the low and
high-risk groups respectively. We reported 3 cases of intraoperative pulmonary embolism, urinary bladder injury and HELLP (hemolysis, elevated liver enzymes
and low platelet count) syndrome among patients in the high-risk group. There was statistically significant longer hospital stay duration
among patients in the high-risk group ranging
from 2 days up to 21 days. On the other hand,
there were no serious complications reported
in the low risk group.
Conclusion: Decreasing rate of primary CD
and optimizing obstetric care are mandatory
to prevent maternal of fetal complication that
could happen due to having future PAS. Fertility sparing surgery is feasible during surgical management of PAS disorders.
DOI
10.21608/egyfs.2021.195171
Keywords
Key words: Placenta accrete spectrum, Caesarean delivery, primary, fertility sparing, planned surgical management, maternal. neonatal complications
Authors
Affiliation
Department of Obstetrics
and Gynaecology, Mansoura
University Hospital, Mansoura
Faculty of Medicine, Mansoura,
Egypt.
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https://egyfs.journals.ekb.eg/article_195171.html
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https://egyfs.journals.ekb.eg/service?article_code=195171
Publication Title
The Egyptian Journal of Fertility of Sterility
Publication Link
https://egyfs.journals.ekb.eg/
MainTitle
Risk factors for occurrence of placenta accrete spectrum following primary cesarean delivery