A Clinical Profile of Placenta Accreta Spectrum Disorders in a Tertiary Care Centre

Abstract

Introduction: Placenta accreta spectrum (PAS) refers to abnormal placental
implantation. In placenta accreta, villi attach to the myometrium due to
the lack of decidua. Placenta increta involves villi invading uterine
muscles and blood vessels, while placenta percreta extends beyond the
uterus, affecting structures like the bladder. Risk factors include placenta
previa, prior uterine surgery, manual placental removal, uterine
anomalies, and multiple pregnancies. Complications can range from
severe hemorrhage and sepsis to hysterectomy or even death if untreated.
Magnetic resonance imaging is the most reliable diagnostic tool. RCOG
guidelines recommend delivery between 34 and 36 weeks for confirmed
cases. Treatment depends on severity and reproductive goals, with
hysterectomy often being the preferred option after resuscitation and
blood transfusion.
Methods: After receiving approval from the institutional ethics committee,
patient records with placenta accreta syndrome were reviewed and
analyzed. The study evaluates the type of adherent placenta, associated
socio- clinical factors, relevant medical history, diagnostic methods, and
management approaches used during delivery. Additionally, maternal and
fetal outcomes were assessed.
Results: A total of 30 patients with placenta accreta spectrum were
included in the study. The increased incidence was seen with increasing
age. Most of them had history of lower segment cesarean section out of
which few underwent cesarean hysterectomy. There was association of
pelvic inflammatory disease , artificial reproductive techniques , dilatation
and curettage . Blood transfusion was needed in most cases and most
babies had neonatal intensive care unit admission due to preterm delivery.
Conclusion: Placenta previa is the most critical risk factor for pathological
placentation, with a prior cesarean section being the next most significant.
Prenatal diagnosis through ultrasonography and magnetic resonance
imaging is essential for improving clinical outcomes. A multidisciplinary
approach in managing pregnant women with placenta accreta spectrum
disorders has been shown to effectively reduce blood loss, the need for
hysterectomy, hospital stay duration, and intensive care unit admissions.
Categories: Obstetrics/Gynecology