Placenta Accreta Spectrum Disorders, a Formidable Challenge of Contemporary Obstetrics: A Case Series and Brief Review QR01-QR06
Dr. Tajinder Kaur,
MMIMSR, MMU, Mullana, Ambala-133203 Haryana, India.
The prevalence of Placenta Accretea Spectrum disorders (PAS) is rising as a result of increasing caesarean section rates. PAS is considered high risk because of severe maternal morbidity and mortality associated with it. A peripartum hysterectomy is required leading to loss of future fertility. The knowledge and awareness of clinical risk factors, associated with possibility of PAS, is essential for antenatal diagnosis and optimum planning to reduce maternal morbidity. The purpose of present case series was to evaluate the risk factors, the circumstances and modality of diagnosis, clinical course, mode of management, and clinical outcome in six cases of PAS identified at our tertiary care centre, over a period of 18 months from February 2019 to August 2020. All the patients had histological confirmation of PAS. The most common risk factors observed were previous caesarean in five (83.33%) cases, concomitant placenta previa in five (83.33%), multiparity in five (83.33%), and increased maternal age in four (66.66.%) cases. Ultrasound imaging was the imaging modality of choice, but missed diagnosis in two cases. Obstetric haemorrhage was the most common complication observed in five (83.33%) of cases. The primary mode of management was Caesarean delivery followed by hysterectomy. The initiatives such as, Trial Of Labour After Caesarean (TOLAC) and External Cephalic Version (ECV) in Primi breech can help reduce caesarean rates, and thus incidence of PAS. A knowledge of high risk factors and antenatal imaging expertise can help in timely diagnosis of PAS. A good outcome is dependent on early antenatal diagnosis, preparation for delivery and postpartum care. The management should involve a multidisciplinary team.