Risk factors for occurrence of placenta accrete spectrum following primary cesarean delivery | ||||
| The Egyptian Journal of Fertility of Sterility | ||||
| Article 3, Volume 25, Issue 3, September 2021, Page 20-30 PDF (2.63 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2021.195171 | ||||
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| Author | ||||
| Mohamed Taman, Mohamed Emam, Hamed Youssef | ||||
| Department of Obstetrics and Gynaecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt. | ||||
| Abstract | ||||
| 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. | ||||
| Keywords | ||||
| Key words: Placenta accrete spectrum; caesarean delivery; primary; fertility sparing; planned surgical management; maternal. neonatal complications | ||||
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