Optimising fetomaternal outcome in placenta accreta spectrum in previous c- section delivery - A clinical study with review of current guidelines

Abstract

Introduction: Placenta Accreta Spectrum (PAS) disorders are a major cause of severe maternal morbidity and mortality, particularly in cases with a history of previous caesarean sections. The increasing global incidence of PAS highlights the need for evidence-based strategies to optimize fetomaternal outcome. This study evaluates clinical outcomes in PAS cases managed at our institution while reviewing current guidelines to identify best practices for improving perinatal and maternal care. Materials and Methods: A prospective observational study conducted among 39 pregnant women with previous Caesarean section with placenta previa and PAS, from Sri Siddhartha Medical College and Hospital and district hospital Tumkur from November 2023 to December 2024. Data was collected from the medical departmental records of the obstetric department, of pregnant women with previous cesarean section diagnosed with PAS and treated at our institution. Results: This study included 39 patients. Placenta previa and placenta accreta were noted among 92.3% and 15.4% cases respectively. 23.1% had undergone caesarean hysterectomy with placenta left insitu. Bladder injury and DIC occurred among 7.7% and 38.5% cases respectively. 38.5% cases had prolonged duration of surgery ≥ 2 hours. 92.3% cases had undergone blood transfusion and required ICU admission. Majority had preterm birth with 92.3% cases, 23.1% cases had an Apgar score