Management of Placenta Accrete in a Tertiary Care Hospital: Step by Step Approach

The study aimed to evaluate the value of management of placenta accrete using step by step approach using case series clinical study. This study was conducted on 74 pregnant females, who were selected to suffer from placenta accrete either diagnosed antenatal by MRI or Doppler U/S or both. Or diagnosed intraoperative .and the patients were excluded if the patient had previous four or more cesarean scars. Or If the patient is 40 years old or more.

The patients were submitted to steps by step approach for management of placenta accrete from step one to step five in order, but they will not proceed from any step to the next step except if this step fails to control the condition. The data from this approach regarding the duration of the step ,amount of bleeding ,units of blood used intraoperative ,any surgical complication, postpartum sepsis ,need of postpartum ICU were recorded.

This study enrolled 74 patients. six cases were found intraoperative to suffer from placenta percreta ,and 29 cases were found to suffer from placenta increte ,the range of preoperative and postoperative HB in non-complicated cases was 1-2.6gm (mean 1.628) and the range of no of needed units for intraoperative blood transfusion in non-complicated cases was 0-3 units (mean 1.04), the total operative time was range from 18-108 minutes (mean 46.08 minutes), 12 cases (16%) were complicated by bladder injury, 6 cases (8%) were complicated by uterine atony, 21 cases (28%) were complicated by sepsis, 9 cases (12%) needed ICU admission.

So, step by step approach should be used in management of placenta accrete as it has shorter operating time ,less intraoperative blood loss and shorter hospital stay ,it also has less intraoperative and postoperative complications despite being insignificant.

Keywords: Placentas accrete; Hysterectomy; Step by step; Bleeding