Hysterectomy as a management option for morbidly adherent placenta.
OBJECTIVE
To determine the outcome of interval (delayed) hysterectomy as compared to cesarean (immediate) hysterectomy in cases of placental invasion in previous cesarean sections.


METHODS
Comparative study.


METHODS
Department of Obstetrics and Gynecology, Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January 2008 to June 2011.


METHODS
The study subjects included 28 women with history of previous cesarean section who had low lying as well as morbidly adherent placenta (MAP) of variable degree. Patients were classified into two groups (group A and B) according to whether cesarean or interval hysterectomy was needed at time of delivery. Demographic data, obstetrical risk factors such as parity and number of previous cesarean sections were compared as well as radiological and histopathological findings, and details of the management. Chi-square, Fisher's exact and t-tests were used to compare proportions and mean values.


RESULTS
The frequency of MAP in previous cesarean sections turned out to be 1.83/1000 (28/15,340) deliveries. Mean maternal age (26.54 vs. 29.13 years, p=0.05), mean gestational age (33.8 vs. 36 weeks, p=0.05), estimated blood loss (2615.38 vs. 1506.6 mL, p=0.001), volume of blood transfused (9.76 vs. 2.9 pints, p=0.001) and the duration of hospital stay (10.69 vs. 32.86 days, p=0.001) differed significantly between group A and group B. One maternal death occurred in each group. Eight patients had other complications in group A compared to 3 patients in group B. Three neonatal deaths occurred in group A compared to nil in group B.


CONCLUSIONS
The frequency of morbidly adherent placenta was 1.83/1000 deliveries. The management and outcome differed markedly according to emergency and scheduled antenatal diagnosis. Counselling and antenatal radiological screening can reduce the high morbidity and mortality associated with it.
Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
Afia
A
Ansar
Department of Surgery, Jinnah Postgraduate Medical Centre, Karachi.
Tooba
T
Malik
Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
Samia
S
Shuja
Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi.
Saba
S
Khan
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008423:Maternal Age; D009017:Morbidity; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery*; D010154:Pakistan / Q000453:epidemiology; D010921:Placenta Accreta / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult