Incidence of Placenta Accreta and Association of Booking Status with Maternal Outcomes based on a study in a Tertiary Care Hospital of Rawalpindi
- Umairah yaqub (Assistant professor, Army Medical College Rawalpindi)
- Maria Habib (Postgraduate trainee at KRL hospital, Islamabad)
To determine the incidence of placenta accreta in our institution and to examine the effects of booking status and management of the placenta during the third stage on maternal outcomes.
This descriptive cross sectional study was conducted in a Military hospital, Rawalpindi from March 2016 to Feb 2018. Women having placenta accreta/increta/percreta diagnosed intraoperatively or during histopathological examination of placenta after hysterectomy were served as cases. Once the diagnosis of placenta accreta was made, then further information was recorded in the questionnaire by following that patient till recovery/death.
Descriptive statistics and independent samples t-test were used for analysis.
Out of 11430 deliveries during the study period, 48 women were enrolled with diagnosis of placenta accreta thus making its incidence 41.4/10,000. 14.6% were booked and 85.4% were un-booked. Majority belonged to 35-37 weeks at delivery (68.8%). Increasing number of cesareans sections increased the risk of placenta accreta. Antenatal complications included antepartum hemorrhage (60.4%) and postpartum hemorrhage (22.9%). Majority were transfused with <5 RCC transfusions (60.4%). 95.8% had undergone hysterectomy and in 4.2% uterus were conserved successfully. Injuries to the viscera were found in 66.7% patients and all of them were bladder injuries. Mortality rate was 8.3%. Internal Iliac artery ligation was done in 22.9% and second look laparotomy in 8.3% patients. Sepsis was found in 10.4 % and disseminated intravascular coagulation in 12.5% women. Most of the women had stay of intensive care unit for <3 days. The correlation between visiting history and complications is highly significant i-e correlation value is 0.379 with the significance value of 0.08. It means that as visiting status improved, complication rates also improved.
Our study has highlighted a sharp rise in the incidence of placenta accreta in the recent years because of increasing cesarean section rates. Booking status has significant correlation with the complications encountered by these women.
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