Summary:
Morbid adherent placenta collectively includes placenta
accrete, increta, and percreta, according to the depth of
invasion through the decidua-myometrial junction.
Incidence is increasing due to increase in the incidence of
scarred uterus. Scarred either due to caesarean section,
myomectomy or repeated D&C. These conditions are
responsible for massive obstetrics haemorrhage, associated
complications like consumption coagulopathy, multisystem
organ failure & death. Also there is a risk for peripartum
surgical complication, such as injury to the bladder, ureter
& bowel. There is also the need for relaparotomy,
complication of blood transfusion, admission in intensive
care unit. Indicated or emergency preterm delivery needs
admission of the newborn to neonatal intensive care unit.
Outcome can be improved by multi disciplinary expertise
and experienced approach for delivery, including the
conservative management to avoid peripartum
hysterectomy. Such team approach by maternal-fetal
medicine, gynaecological surgeon, vascular, trauma,
urology surgeon, transfusion medicine, intensivist,
neonatologist, intervention radiologist, anaesthesiologist,
specialized nursing staff and ancillary personnel.
Key words: morbid adherent placenta, conservative
management, obstetric haemorrhage