Thus conservative management of morbidly adherent placenta
has a role where fer tility is to be preserved and there is no uncontrollable haemorrhaging.
Conclusion: Previous caesarean section and placenta previa are major risk factors for morbidly adherent placenta
. Patient education, antenatal diagnosis with well planned surgical intervention and anticipation of blood loss are keys to successful management.
A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta
. J Ultrasound Med.
Since conservatively managed cases are also a part of the morbidly adherent placenta
continuum, the exclusion of these cases was questioned for potentially affecting the study result.
An abnormal placentation into the uterine wall could present a risk of maternal and fetal morbidity (morbidly adherent placenta
, MAP) and mortality, so it should be identified and defined early on (1, 2).
The most common indication for obstetric hysterectomy in our study was ruptured uterus due to obstructed labor (30.3%) and morbid adherent placenta
These patients included postpartum hemorrhage due to atonic uterus, ruptured uterus, genital tract tears and morbidly adherent placenta
. These were managed at hospital and after concerning with hospital to be referred were transferred in ambulance along with nursing staff.
The folding sutures following tourniquet binding is a conservative surgical approach for placenta previa combined with the morbidly adherent placenta
. The approach includes three steps: (1) Perioperative placenta localization and delivery of the fetus; (2) tourniquet binding and placenta removal; and (3) folding sutures.
History of prior caesarean section was associated with atony in 41.6% of cases, with morbidly adherent placenta
in 81% of cases, and with uterine rupture in 56% of cases.
* If morbidly adherent placenta
- as previous, consider use of Baum's curette.
Pathologically adherent placenta
previously thought to be rare, is now on the rise due to rise in caesarean section rates.