title: Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy.
abstract: OBJECTIVE
  To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used.
  
  
  METHODS
  This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search.
  
  
  RESULTS
  A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group.
  
  
  CONCLUSIONS
  MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.
authors.affiliation: Department of Obstetrics and Gynaecology and.
authors.forename: Haifa'a
authors.initials: H
authors.lastname: Alchalabi
authors.forename: Isam
authors.initials: I
authors.lastname: Lataifeh
authors.forename: Basil
authors.initials: B
authors.lastname: Obeidat
authors.forename: Faheem
authors.initials: F
authors.lastname: Zayed
authors.forename: Yousef S
authors.initials: YS
authors.lastname: Khader
authors.forename: Nail
authors.initials: N
authors.lastname: Obeidat
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D009017:Morbidity; D010921:Placenta Accreta / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D010923:Placenta Previa / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018457:Placenta, Retained / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011364:Professional Practice; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Hysterectomy; maternal morbidity; morbidly adherent placenta previa; placenta previa; ultrasound diagnosis