Placenta Accreta Spectrum Disorders, a Formidable Challenge of Contemporary Obstetrics: A Case Series and Brief Review
Correspondence Address :
Dr. Tajinder Kaur,
MMIMSR, MMU, Mullana, Ambala-133203, Haryana, India.
E-mail: teji1305@gmail.com
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 a 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 5 (83.33%) cases, concomitant placenta previa in 5 (83.33%), multiparity in 5 (83.33%), and increased maternal age in 4 (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 5 (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.
Caesarean delivery, Caesarean hysterectomy, Postpartum haemorrhage
10.7860/JCDR/2021/49546.15603
Date of Submission: Mar 31, 2021
Date of Peer Review: May 13, 2021
Date of Acceptance: Aug 24, 2021
Date of Publishing: Nov 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 02, 2021
• Manual Googling: Aug 23, 2021
• iThenticate Software: Sep 15, 2021 (10%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com