Placenta Accreta spectrum (pas) disorders: A 10-year study at tertiary care center, Ahmedabad, western India

Abstract

Background: The last 30 years have witnessed the dramatic increase in the incidence of placenta accreta spectrum (PAS) disorders from 0.12% to 0.31%. The spectrum of abnormal placental invasion ranges from the subclinical findings of adherent placental basal plate with the myometrial fibres to the substantial presentation of placenta percreta.Methods: In this retrospective study of 10 years, there were 81,650 deliveries at our tertiary care center and 28 patients were diagnosed with PAS disorders. The placental localization and diagnosis of placental spectrum disorders were confirmed with ultrasound and color doppler. Results: Total deliveries during the 10 years study were 81,650, out of which 27 cases met the diagnostic criteria of PAS with ultrasound and 1 case diagnosed intraoperatively resulting incidence of PAS to 0.035%. There is increase in incidence of PAS from 0.0125% in 2010 to 0.1% in 2019. All these patients were planned for elective cesarean section at 35 weeks gestation, but 2 of them presented in emergency with bouts of bleeding and required immediate intervention. Massive hemorrhage was reported in 12 (42.8%) cases and 26 (92.9%) cases required blood transfusion. Bladder injury was reported in 6 (21.4%) case. Maternal mortality has been noted in 1(3.5%) case which was complicated with disseminated intravascular coagulation and acute renal failure. Conclusions: Favorable outcome in PAS disorders can only be achieved with preoperative multidisciplinary input and perioperative measures require adequate time in order to be instituted.