Publication:

Comparative study of abnormal placentation in patients with previous two caesarean section over two time periods

Background The CS epidemic is a reason for immediate concern and there is increase in repeat CS as well these days. The secondary increase in repeat CS delivery has been associated with increase in CS complications particularly increase in complications associated with abnormal placentation. We aim to compare the change in rate of abnormal placentation i.e. placenta previa, placenta percreta and accreta and maternal and fetal outcomes associated with two or more caesarean sections.

Methods Women with previous two LSCS were studied from May 2003-May 2004 and again from May 2013- May 2014. It is a comparative analysis of two prospective observational studies where the rate of abnormal placentation and maternal and fetal outcomes were compared after a period of ten years in the same tertiary care institute.

Results 104 women (0.99% of total confinements) had previous two or more LSCS from May 2003-04 (Group 1), whereas 60 such women (0.75% of total confinements) were there from May 2013-14 (Group 2). There was 2.88% incidence of abnormal placentation in Group 1 as compared to 18.33% in Group 2. The modality of management in Group 1 for adherent placenta was obstetric hysterectomy whereas conservative approach was increasingly used in Group 2. There were no maternal or neonatal deaths.

Conclusions Morbidly adherent placenta although on the increase can be increasingly tackled by conservative means. A multi-disciplinary approach is imperative to reduce maternal morbidity and mortality.