Suman Poddar1, Shilpi Sharma2
BACKGROUND
Placenta accreta spectrum (PAS) disorders have become an emerging obstetric
issue associated with risk of massive obstetric haemorrhage on placental
separation following delivery. Antenatal diagnosis is of utmost importance but
miserably limited due to lack of imaging expertise in this issue. We wanted to
evaluate antenatal diagnosis of PAS disorders and analyse the outcome of
definitive surgical approach.
METHODS
This is a prospective case series analysis done in the Department of Obstetrics and
Gynaecology, RG Kar Medical College & Hospital, Kolkata. In a series, we have
discussed 10 cases dealt well in our institution in the last one year (pre-Covid-era).
Main outcome measures were operative blood loss, bladder injury, high
dependency unit (HDU) admission, component transfusion, and neonatal
morbidity.
RESULTS
Imaging expertise for prenatal diagnosis of PAS disorders was found miserably
limited where 7 out of 10 cases were diagnosed intra-operatively. During
Caesarean section (CS), longitudinal fundal incision was given to take out the baby
with blood loss even less than usual CS. Bladder injury was diagnosed in one
occasion intra-operatively. Peripartum total hysterectomy without touching
placental bed was done in all cases, where uneventful bladder dissection and
bilateral internal iliac artery ligation minimised component transfusion (8 out of
10) and HDU support (5 out of 10). Neonatal outcome was good in cases of
planned CS at 36 weeks (6 out of 10).
CONCLUSIONS
Clinical suspicion plays an important role in our scenario due to lack of imaging
experience & expertise to diagnose PAS disorders. Planned Caesarean delivery at
late preterm period in equipped centre in expert hands improves outcome of such
cases. Peripartum total hysterectomy without touching placental bed is the most
definitive (surgical) approach with sound post-operative recovery.
