AMEI's Current Trends in Diagnosis & Treatment

Register      Login

VOLUME 3 , ISSUE 1 ( January-June, 2019 ) > List of Articles


Outcome of Abnormal Placental Attachments in Pregnancies with a Review of Literature

Reena Sood, Parvinder Arora, Harleen K Cheema, Madhu Nagpal

Keywords : Antepartum hemorrhage, Placenta accreta, Placenta previa

Citation Information : Sood R, Arora P, Cheema HK, Nagpal M. Outcome of Abnormal Placental Attachments in Pregnancies with a Review of Literature. Curr Trends Diagn Treat 2019; 3 (1):1-7.

DOI: 10.5005/jp-journals-10055-0057

License: CC BY-NC 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Objective: The study evaluated the clinical course of a low-lying placenta, the outcome of a placenta previa with or without morbidly adherent placenta, and the association with previously reported risk factors. Materials and methods: A prospective descriptive study was conducted from December 2016 to May 2018 at a tertiary care hospital and medical institute on 66 cases of a sonographically diagnosed abnormal placental attachment at 20 or more than 20 weeks of gestation. We analyzed the potential risk factors and the respective outcomes of pregnancies with an abnormal placental attachment. Results: Of the 66 patients in the study, most of the patients (60.6%) were above the age of 30 years; the mean maternal age in the present study was 29.03 years. In this study, the rate of placental migration was 85% in patients without any history of a prior uterine surgery compared to 19.6% in patients with a history of a prior uterine surgery. The major outcome in our study was operative delivery (in 45 patients). A live birth was observed in 64 cases and 2 cases presented with an Intrauterine fetal demise. Of the 64 live born babies in the study, 14 (21.2%) were small for the gestational age and 50 (75.8%) were appropriate for the gestational age. Conclusion: Our study concluded that the most consistent risk factor of an abnormal placental attachment in pregnancy is scarred uterus. Abnormal placental attachment was associated with a higher operative delivery, hysterectomy, and blood transfusions.

  1. World Health Organization. The World Health Report 2005: Make Every Mother and Child Count. Geneva, Switzerland: WHO Press; 2005. p. 62.
  2. Neilson EC, Varner MW, et al. The outcome of pregnancies complicated by bleeding in the second trimester. Surg Gynecol Obstet 1991;173:371–374.
  3. Cresswell JA, Ronsmans C, et al. Prevalence of placenta praevia by world region: a systematic review and meta-analysis. Trop Med Int Health 2013;18:712–724. DOI: 10.1111/tmi.12100.
  4. Chassar Moir J, Myersough PR. Munro Kerr's operative obstetrics, 8th ed., London: Balliere, Tindall & Cassell; 1971. pp. 771–804.
  5. Reddy UM, Abuhamad AZ, et al. Fetal Imaging Workshop Invited P. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med 2014;33(5):745–757. DOI: 10.7863/ultra.33.5.745.
  6. Sunna E, Ziadeh S. Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia. J Obstet Gynaecol 1999;19(2):152. DOI: 10.1080/01443619965471.
  7. Sherman SJ, Carlson DE, et al. Transvaginal ultrasound: does it help in the diagnosis of placenta previa? Ultrasound Obstet Gynecol 1992;2(4):256. DOI: 10.1046/j.1469-0705.1992.02040256.x.
  8. Ananth CV, Smulian JC, et al. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997;177:1071–1078. DOI: 10.1016/S0002-9378(97) 70017-6.
  9. Ananth CV, Wilcox AJ, et al. Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Am J Obstet Gynecol 1996;88:511–516. DOI: 10.1016/0029-7844(96)00236-0.
  10. Ananth CV, Demissie K, et al. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 2003;188:275–281. DOI: 10.1067/mob.2003.10.
  11. Macones GA, Sehdev HM, et al. The association between maternal cocaine use and placenta previa. Am J Obstet Gynecol 1997;177: 1097–1100. DOI: 10.1016/S0002-9378(97)70022-X.
  12. Khadra M, Obhrai M, et al. Placenta percreta revisited. J Obstet Gynaecol 2002;22:689. DOI: 10.1080/014436102762062385.
  13. Faranesh R, Romano S, et al. Suggested approach for management of placenta percreta invading the urinary bladder. Obstet Gynecol 2007;110(2 Pt 2):512–515. DOI: 10.1097/01.AOG.0000267135.31817.d6.
  14. Daskalakis G, Anastasakis E, et al. Emergency obstetric hysterectomy. Acta Obstet Gynecol Scand 2007;86(2):223–227. DOI: 10.1080/00016340601088448.
  15. Taipale P, Hiilesmaa V, et al. Transvaginal ultrasonography at 18-23 weeks in predicting placenta previa at delivery. Ultrasound Obstet Gynecol 1998;12:422–425. DOI: 10.1046/j.1469-0705.1998.12060422.x.
  16. Rajeshwari RR, Rubini M. Maternal and perinatal outcome in placenta previa-one year study in tertiary care center in Tamil Nadu, India. Int J Reprod Contracept Obstet Gynecol 2016;5(8):2819–2822.
  17. Tuzović L, Djelmis J, et al. Obstetric risk factors associated with placenta previa development: case-control study. Croat Med J 2003 Dec;44(6):728–733.
  18. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003;13:175–190. DOI: 10.1080/jmf.
  19. Clark SL, Koonings PP, et al. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985;66:89–92.
  20. Chama CM, Wanonyi IK, et al. From low-lying implantation to placenta praevia: a longitudinal ultrasonic assessment. J Obstet Gynaecol 2004 Aug;24(5):516–518. DOI: 10.1080/01443610410001722545.
  21. Shravage J, Dhumale H, et al. Assessment of placental migration in mid trimester low lying placenta. J Obstet Gynaecol India 2009 Jul/Aug;59(4):317–319.
  22. Banerjee S, Seth S, et al. A Study Of Migration Of Low Lying Placenta In A Tertiary Indian Hospital. JEMDS 2013;2(13):2159–2164. DOI: 10.14260/jemds/511.
  23. Ghourab S, Al-Jabari A. Placental migration and mode of delivery in placenta previa: transvaginal sonographic assessment during the third trimester. Ann Saudi Med 2000;20(5–6):382–385. DOI: 10.5144/0256-4947.2000.382.
  24. Cho JY, Lee YH, et al. Difference in migration of placenta according to the location and type of placenta previa. J Clin Ultrasound 2008;36(2):79–84. DOI: 10.1002/jcu.20427.
  25. Silver RM, Landon MB, et al. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006 Jun;107(6):1226–1232. DOI: 10.1097/01.AOG.0000219750.79480.84.
  26. Miller DA, Choller JA, et al. Clinical risk factors for placenta previa accrete. AJOG 1997;177:210–214. DOI: 10.1016/S0002-9378(97) 70463-0.
  27. Esakoff TF, Handler SJ, et al. PAMUS: placenta accreta management across the United States. J Matern Fetal Neonatal Med 2012;25(6): 761–765. DOI: 10.3109/14767058.2011.598585.
  28. Rosenberg T, Pariente G, et al. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011;284(1):47–51. DOI: 10.1007/s00404-010-1598-7.
  29. Khirasaria DM, Nayak TC. A study of complications in cases of placenta previa. Int J Reprod Contracept Obstet Gynecol 2017;6(12):5503–5507. DOI: 10.18203/2320-1770.ijrcog20175269.
  30. Sheiner E, Shoham-Vardi I, et al. Placenta previa: obstetric risk factors and pregnancy outcome. J Matern Fetal Med 2001;10(6):414–419. DOI: 10.1080/jmf.10.6.414.419.
  31. Koifman A, Levy A, et al. The clinical significance of bleeding during the second trimester of pregnancy. Arch Gynecol Obstet 2008;278(1):47–51. DOI: 10.1007/s00404-007-0530-2.
  32. Kollmann M, Gaulhofer J, et al. Placenta praevia: incidence, risk factors and outcome. J Matern Fetal Neonatal Med 2016;29(9):1395–1398. DOI: 10.3109/14767058.2015.1049152.
  33. Demissie K, Breckenridge MB, et al. Placenta previa: preponderence of male sex at birth. Am J Epidemiol 1999;149:824–830. DOI: 10.1093/oxfordjournals.aje.a009898.
  34. Ojha N. Obstetric factors and pregnancy outcome in placenta previa. J Inst Med 2012;34(2):38–41.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.