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CLINICAL STUDY OF PLACENTA ACCRETA SPECTRUM DISORDERS IN TERTIARY CARE HOSPITAL

Aims and objectives
To study the range of Placenta Accreta Spectrum (PAS) disorders, management of PAS, maternal outcome in PAS and post-operative complications in patients managed either by conservative or non-conservative management.
Methodology 
Patient were diagnosed antenatally by 2D grey scale USG (ultrasonography) as PAS 0, 1 ,2 and 3 along with colour doppler studies. The decision of conservative versus non conservative management was taken by MDT (multidisciplinary team) along with the patients and relatives and after written and informed consent and elective surgery was planned between 34-35 weeks of gestation.
Results 
Total number of cases studied over the period of 1 year were 45. On 2D gray scale USG, PAS 0 was seen in 60% followed by PAS 3 in 17.77% and only 6.66% of PAS 2. According to weeks of gestation OH with IIAL (internal iliac ligation) was performed in 42.22 % and OH without IIAL was performed in 37.77% and 20% patients who were managed by conservative method, 6 of them needed peripartum hysterectomy. Massive transfusion protocol was activated in all the cases.
Conclusion 
The highest risk of placenta accreta spectrum disorders are amongst women whose pregnancy is complicated by placenta previa and with a prior scar on the uterus, due to the abnormal placental implantation on the scar site. The management of PAS disorders should be at tertiary care centre along with multidisciplinary care team.