Early diagnosis of placenta accreta in case of mid trimester postabortal haemorrhage with previous 3 cesarean sections

Abstract

: To know the risk and management of postabortal haemorrhage in patients with previous caesarean delivery to prevent maternal mortality. : Placenta accreta is an emergency life threatening obstetric situation may also complicate first trimester and midtrimester abortion and encountered as profuse vaginal bleeding and difficulty in placenta removal at delivery. The incidence of placenta accreta increased from 1 in 30,000 pregnancies in 1960 to 1 in 533 pregnancies in 2000. Placenta accreta developed in 55 of 590 women with placenta previa and 7 of 156080 without placenta previa. Increased incidence of caesarean increases the incidence of placenta accreta. Multiple caesarean deliveries are largest risk factor for placenta accreta. On the basis of a high risk factor, suspected case of placenta accreta spectrum, must be diagnose and be in charge of a multidisciplinary team with better maternal and fetal outcome. A 36 years old patient, P3L3A1 had prior 3 LSCS with retained placenta with profuse bleeding per vaginum with history of expulsion of fetus (18 week) on the way to hospital, presented to labor room. Patient was unbooked and uninvestigated. Initial resuscitation done along with oxytocic given but no sign of placental separation was there and bleeding was continued. On the basis of torrential bleeding and history of previous three caesarean deliveries, patient is immediately shifted to the operation theatre for exploratory laparotomy in view or provisional diagnosis of a morbidly adherent placenta with torrential haemorrhage. On laparotomy, the anterior surface of lower uterine segment of uterus accompanied by numbers of engorged blood vessels. Bladder was spared. Decision of exploratory laparotomy taken into consideration of morbidly adherent placenta, and procedure was ended with Subtotal hysterectomy, haemostasis achieved. 2 units PCV transfused intraoperatively and patient was shifted to intensive care unit for observation postoperatively. Her postoperative duration was uneventful; she got discharged on postoperative day6 under satisfactory condition. The specimen was sent for histopathological examination. Vigilant monitoring and timely intervention in obstetric emergencies can avoid maternal mortality. We wish to highlight the vigilant monitoring and timely decision, active collaboration by multidisciplinary team improve outcomes in patient of postabortal haemorrhage in midtrimester with previous caesarean delivery with placenta accreta spectrum.