Conservative versus Radical Management of Morbidly Adherent Placenta: An Audit

Background: Maternal and neonatal morbidity and mor-tality are associated with abnormal placentation and obstetric hemorrhage. To reduce morbidity and mortality in morbidly adherent placentas, a high index of suspicion, early antenatal diagnosis, adequate patient counselling, scheduled surgery at a well-equipped institution, and anticipation of high volume blood transfusion are the essential steps. Aim of Study: The aim of this study was to reach the best way of management of abnormal adherent placentathrough evaluation of conservative and radical management of cases ofplacenta accreta over last three years in Mansoura University Hospital. Patients and Methods: A retrospective observational study conducted in Obstetrics and Gynecology Dept. of Mansoura University Hospital. We reviewed the medical records of 250 women who diagnosed as invasive placenta from the beginning of (2017) to the end of (2019). The main aim to reach the best way of management of abnormal adherent placenta through evaluation of conservative and radical management of cases of placenta accreta over last three years in Mansoura University. Results: There was statistically significant higher median volume blood loss, packed RBCs units, fresh frozen plasma and platelet units with radical management than with conserv-ative management. Regarding maternal complications, bladder injury, ureteric injury, major vessel injury, wound infection, coagulopathy, re-admission and ICU admission were higher incidence among cases in radical group than cases with conservative management. Grade 3 was present among cases with radical management only (30.5%) while grade 1 was higher among cases with conservative management 96.9%. Conclusion: According to our study, conservative man-agement in G1 (placenta accreta) is the recommended man-agement option, well-planned cesarean hysterectomy in G3 (placenta percreta) is the only management option. While G2 (placenta increta) can be managed either radically or conserv-atively according to bleeding degree and bleeding control.