Objective: To evaluate placenta accrete spectrum rate in women having previous cesarean deliveries and placenta previa major/low-lying anterior placentas.
Methodology: All pregnant patients with previous cesarean section diagnosed as placenta previa major operated between Jan 2017 to July 2019 were included in the study. Data were collected from Medix tm, OT register and morbidity register.
Results: A total of 27 cases of previous cesarean section with major degree placenta previa were operated during the study period. Doppler ultrasound was performed in all cases. The diagnosis of placenta accreta spectrum was made in 63% (n=17) of cases. Out of 17 cases diagnosed with Doppler ultrasound, diagnosis was confirmed per operatively in 11(64.7%) cases. Out of 10 cases in which placenta accrete was ruled out by Doppler scan, one case of placenta accreta was found during cesarean section. The sensitivity of Doppler ultrasound was 91.6% while specificity was 56.2%. Significant morbidity was seen in all 12 case of placenta accreta. Cesarean hysterectomy was performed in 11 out of 12 cases (91%), while PPH and blood products transfusion were done in all 12 cases (100%). Bladder injury was seen in one case 11%.
Conclusion: Placenta accrete spectrum is associated with significant morbidity. However, the operative approach needs improvement to reduce the morbidity. As the cesarean section is the major risk factors for this devastating complication, the obstetricians must make every attempt to avoid unnecessary cesarean section.
Key words: Placenta accrete, caesarean section, placenta previa.
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