Role of Timed Hysterectomy in Lowering Morbidity and Mortality of Morbidly Adherent Placenta

OBJECTIVE: To describe the method of reducing morbidity and mortality among women with morbidly adherent placenta who ended up in hysterectomy. METHODOLOGY: This retrospective descriptive case series study included twenty pregnant women with morbidly adherent placenta who needed hysterectomy and managed by team approach at Gynae unit I, Liaquat University of Medical and Health Sciences hospital Hyderabad from January 2019 to February 2020. Data was collected with respect to age, parity, gestational age, booking status, number of previous caesarean section, clinical presentation, time of diagnosis and maternal outcomes. Analysis was through SPSS program version 21. Frequency, percentages, means +/- standard deviation was calculated for various variables. RESULTS: The frequency of morbidly adherent placenta (MAP) was found in 1 in 308 births. The mean age was 29.55 +/- 4.62years. The mean parity and gestational age was 3.1 +/- 1.58 and 33.2 +/- 5.02 weeks respectively. All had one or more than one previous cesarean section with 90% had associated placenta previa. Half of the cases presented with ante partum hemorrhage, and had placenta accrete. Emergency surgery was required in 65% of the cases. Hypovolemic shock (45%), bladder injury (20%) was observed as main complications. Mean blood loss was 1.72 +/- 0.75 liters; mean blood transfusion of 3.6 +/- 1.31 units with mean hospital stay of 7.70 +/- 4.47 days, there was 1mortality (5%) in the study. CONCLUSION: Preoperative confirmed diagnosis, anticipation of high-volume blood transfusion, early recourse to hysterectomy by senior obstetrician, adapting team approach are methods of reducing morbidity and mortality in MAP.