Case Load of Placenta Previa and Accreta at Assuit Women's Health Hospital: Maternal and Neonatal Outcomes

Abstract
Background: Placenta previa and accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage, so it has become one of the most important leading cause of emergency hysterectomy which represents 40-60% of cases. Maternal morbidity had been reported to occur in up to 60% and mortality in up to 7% of women with placenta accreta. Also the additional potential intra operative and post-operative morbidity were associated with massive blood transfusion, hypovolymea, surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome, need for blood transfusion, electrolyte imbalance, renal failure and infection.
Aim of Study: The aim of the current study was to define the prevalence of placenta previa and accreta in the period from January 2016 to December 2016 and to evaluate the maternal and neonatal outcomes.
Patients and Methods: The study design was a retrospec-tive descriptive study from recorded data in the period from January 2016 to December 2016 on all patients delivered at Women's Health Hospital, Assuit University including all cases of placenta previa with or without placenta accretta, maternal and neonatal data was evaluated. Finally, the obtained data was analyzed by means of SPSS software (Version 16.0) and pResults: Total number of deliveries 13486 cases the incidence of placenta previa was 267 cases (1.98%), also the incidence of placenta accreta was 55 cases (0.4%), uterine artery ligation in 166 cases (62.1%), placenta left in situ in one case (0.37%), intra uterine balloon insertion in 6 cases (2.25%), transverse B Lynch in 10 cases (3.75%), internal iliac artery ligation in 4 cases (1.5%), cesarean hysterectomy was performed in 37 cases (13.8%), bladder injury occurred in 33 cases (12.4%), ureteric injury in 3 cases (1.1%), colon injury in one case (0.37%), vascular injury occurred in one case (0.37%), post partum internal hemorrhage occurred in 3 cases (1.1%), post partum pelvic hematoma occurred in one case (0.37%), ICU admission was needed in 20 cases (7.5%), post-operative blood transfusion was needed in 62 cases (23.2%), re intervention needed in 8 cases (2.9%), maternal mortality was 4 cases (1.5%), the mean gestational age was 34.73±2.8 weeks. Also there were 66 neonatal cases (22.1%) needed assisted ventilation in the form of ambu bag or en-dotrachial intubation gestation. NICU admission needed in 41 neonatal cases (15.4%), and neonatal mortality reported in 7 neonatal cases (2.6%). Congenital anomalies were reported in 2 neonatal cases (0.7%).
Conclusion: The incidences of placenta previa and placenta accreta were higher than which reported internationally due to increase CS rate. Also there is no definite planned manage-ment method widely accepted except for hysterectomy.