O. Okendrajit Singh1 , Gayatri Devi Pukhrambam2 , Aheibam Bidya Devi3 , M. Arun Singh
BACKGROUND Caesarean section delivery, in spite of its popularity has its short- and long-term complications like infections, haemorrhage, adhesions, abnormal placentation, uterine rupture and hysterectomy. Many studies have shown an increasing incidence of abnormal placentation which includes placenta previa, placenta accreta, placenta increta and placenta percreta to be related with the rising trend of caesarean section delivery. Again, abnormal placentation is a life-threatening condition often associated with massive postpartum haemorrhage and in recent studies it is the most common indication for peripartum hysterectomy. Deliveries by caesarean section are also increasing in our institute. METHODS In this hospital based cross-sectional study, 91 peripartum hysterectomy cases received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, during a ten-year study period (January, 2009 to December, 2018) were included in the study. The gross and microscopic histopathological findings were statistically analysed in relation to age, parity, number of previous caesarean sections using SPSS software. Significance of the risk of abnormal placentation between cases of previous caesarean section and vaginal deliveries was evaluated by chi-square test (p-value of ≤ 0.05) and odds ratio (OR). RESULTS During the ten years study period, 91 peripartum hysterectomy cases were selected and studied. The overall rate of peripartum hysterectomy was 1.27 per 1000 births. The age of the cases ranged from 20 to 45 years and 81.3 % were multiparous (parity two and above). The main pathological lesions were abnormal placentation- 41 (45.05%), ruptured uterus- 16 (17.58%), uterine atony- 21 (23.07%) and retained product of conception- 13 (14.28%). In 32 (35.16%) cases, there was history of previous caesarean section once in 14 and twice in 18, of which 23 (71.88%) cases had abnormal placentation pathology comprising of placental praevia 12 (37.50%), placental accreta 4 (12.5%), placental increta 5 (15.62%) and 2 (6.25%) placental percreta. CONCLUSIONS Abnormal placentation which includes placenta praevia, placenta accreta, placenta increta and placenta accreta is one of the most important causes of intractable postpartum haemorrhage necessitating a peripartum hysterectomy. Previous caesarean delivery has a 5.82 times higher risk of developing placentation abnormalities in subsequent pregnancies than previous vaginal delivery.
