Association of Placenta Acreta Septrum with previous C-section and its feto-maternal outcome
Objective: To evaluate the Association of Placenta Acreta Septrum with previous C-section and its feto-maternal outcome.
Methodology: This Retrospective Cohort study was conducted in the department of Obstetrics and Gynecology, Sheikh Zayed women CMC Hospital Larkana from January 2017 to December 2021. The patients were clinically diagnosed as having Placenta Acreta Septrum and were confirmed from ultrasound findings. The PAS patients were managed by following usual standard protocols. Information related to patients demographics, maternal history of obstetrics and gynaecology, comorbidities and prenatal findings, time of diagnosis, indication and time of delivery, plan of management and surgical procedures performed were all extracted from the patients' medical records. Neonatal outcomes were also documented, including birth weight, APGAR score, admission to critical care, and length of hospital stay.
Results: The mean age was observed 29.36 ± 4.6 years, median gravidity of 3 and median parity of the patients was 2. The history of previous C-section was positive in 27 (45.76%) patients with majority 16 (27.12%) having one caesarian section, followed by 7 (11.86%) women having two previous C-sections. Placenta previa was noted in 21 (35.59%) patients and history of curettage was noted in 34 (57.63%) patients. Anemia was observed in 93.22% women having PAS. A large bulk 44.07% of women had to undergo hysterectomy. Some 18.64% women required admission to ICU. The mean birth weight was noted to be 2.8±0.40 kg, mean APGAR score at one minute 7.3±1.6 and 5 minutes was noted to be 8.6±1.1. A large bulk 45.76% of the newborns required admission to the NICU with median length of stay of 7 days.
Conclusions: The main risk factors for PAS were identified as higher age (>32 years) of mother, previous history of caesarian sections and this risk increases with increasing number of C-sections, multiparity and history of placenta previa and curettage.
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