Placenta Accreta __ Still a Dilemma

Objectives: To determine the etiological risk factors and outcomes of placenta accreta. Study Design: Descriptive study. Setting: Gynae Unit III Jinnah Hospital, Lahore. Duration of Study: Two years from 1st Sept 2009 to 31st Aug 2011. Materials and Methods: All the patients who presented with suspected placenta previa, previous cesarean section or myomectomy scar and previous D C in OPD and emergency department were included in the study. Trans-abdominal ultrasound was carried out in all the patients when diagnosed or had suspicion of placenta accrete it was confirmed by color Doppler. MRI was carried out in those patients who had anterior placenta previa along with placenta accreta. Data regarding age, parity, booking status and previous obstetric history were recorded and analyzed. Results: During the study period there were 9046 deliveries and 13 patients presented with placenta accreta giving the incidence of 1 in 695 deliveries. Majority of all patients (84.61%) with placenta accreta were between 31 – 35 years of age. Seventy seven percent were multi gravidae and 23% were grand multi gravidae. More than 2/3rd of the patients were booked. Forty six percent of the patients had previous 2 C/S, 38.5% had previous 3 C/S and 15.5% had H/O D C. In 77% placenta previa was present along with placenta accreta. All the patients with placenta accreta were operated under General anaesthesia and had hysterectomy. There was no maternal deaths. Conclusion: Placenta accreta is an obstetric catastrophe associated with high maternal and perinatal morbidity and mortality in developing countries. Antenatal care should be improved and all patients with previous C/S should have USG to diagnose placenta previa and accreta. This study showed a strong association of placenta accrete with previous C/S, placenta previa and previous D C.