MANAGEMENT STRATEGIES FOR PLACENTA AC C RETA SPECTRUM A RETROSPECTIVE STUDY

Dr. Fasiha Tasneem* and Dr. Kajol Mantri

ABSTRACT

Introduction:
Placenta accreta spectrum is a life threatening condition caused due to abnormal placentation and
decidualisation. The absence of nitabuch layer leads to abnormal trophoblastic invasion and thus forming a
morbidly adherent placenta. This may result into life threatening antepartum and post partum haemorrhage and
thus causing severe maternal morbid ity and mortality. The incidence of placenta accreta spectrum has increased
over the last decade, causes being increased rate of caesarean section, other uterine procedures like myomectomy,
dilatation and curettage, manual removal of placenta, isthmocele, etc. There is not enough research and data
regarding its management in a low resource set up like our institute. This study aims at solving these doubts and
acknowledging multiple surgical methods and complications during management of PAS at a tertiary ca re centre in
a low resource set up. Materials And Methods: A retrospective cross sectional study was performed from the year
2022 to 2024. 32 cases were found to have PAS and were managed in our institute using various surgical methods
which involved caesa rean hysterectomy, leaving placenta in situ, myometrial segmental resection, complete
removal of placenta. These methods were combined with bilateral internal iliac artery ligation in few cases. It also
includes management of some rare cases of PAS which u nderwent obstetric hysterectomy with foetus in situ and
management of placenta percreta in caesarean scar pregnancy with scar rupture. Observations and Results: It was
observed that uterine conservative surgery was successful in 59.36 % and 40.62% patients underwent caesarean
hysterectomy. All cases had history of uterine procedure in previous pregnancies. Foetal outcomes were good in
78.11 % cases. The overall incidence of PPH (primary and secondary) in entire study was 50 %. There was 1
maternal mortality (3.12%) due to PAS. Other maternal morbidities observed were prolonged hospitalisation due to
intraoperative complications of bladder and ureter injury followed by repair and/ or DJ stenting in 21.87 % cases,
post operative ICU admission in 25 % cases, po st operative ventilatory support in 18.75 cases, intra and /or post
operative inotropic support in 18.75% cases, surgical site infection in 9.39 % cases. Conclusion: In a case of PAS,
planned delivery at 35+0 to 36+6 weeks of gestation is recommended. Ove rall, all surgical methods in this study
have good maternal outcomes but the choice of surgical method depends entirely on clinical judgement, surgical
expertise, type of institution, availability of multidisciplinary team, pre operative ultrasound finding s, availability
of resources to manage complications (i.e. blood and blood products, broad interventions and post operative care in
ICU).

Keywords: PAS (Placenta accreta spectrum), Antepartum and Post partum haemorrhage.