Frequency of Placenta Previa – Placenta Accreta in Patients with Previous Cesarean Section

Objective: To study the frequency of placenta previa/ accreta in patients with previous cesarean section. Study Design: Prospective hospital based study. Place and Duration of Study: Gyne unit 2 Nishtar Hospital Multan from November 2010 to September 2011. Patients and Methods: The study included patients admitted with the suspicion of placenta previa through the out patient department in the ward and in the labor room as emergency cases with antepartum hemorrhage. Diagnosis was confirmed by transabdominal ultrasound and in patients with anterior placenta previa and previous cesarean section, doppler ultrasound was requested to diagnose placenta accreta. Detailed history, clinical examination and baseline investigation was done in all patients. Results: During the study period 38 cases of major degree placenta previa were managed. 22 (57.89%) were emergency admissions and 16 (42.10%) were admitted throughout patient department. 29 (76.39%) patients had previous cesarean section and 9 (23.68% patients had all previous vaginal deliveries. 8 (27.58%) patients had previous one cesarean section and 21 (72.41%) had 2 or more cesarean sections, 4 (10.52%) patients had placenta accreta and out of these 3 patients were diagnosed antenatally by doppler ultrasound and one patient was diagnosed at emergency cesarean section. Conclusion: The major risk factor for the placenta previa is uterine scaring and therefore the incidence is increasing with increasing cesarean section rate. Placenta accreta is one of the most serious complications of placenta previa. It is suggested that in patients with anterior major degree placenta previa and previous cesarean section, antenatal diagnosis of placenta accreta should be made by doppler ultrasound so that appropriate management plan can be made.