Review of the peripartum hysterectomy for placenta previa totalis case maternal morbidity and complications

Aim: To review the risk factors, diagnostic modalities and management options of patients with placenta previa and morbidly adherent placenta. Methods: Three hundred and twenty patients who were diagnosed with placenta previa at the department of obstetrics and gynecology at Ege University School of Medicine between 1.12.2009 and 1.12.2015 were included in the study. Results: Out of 320 patients with placenta previa, 93 (29%) of them underwent cesarean hysterectomy. The review of the pathology results of the specimens showed 'no invasion' in 24 patients, 'placenta accreta' in 11 patients, 'placenta increta' in 21 patients, and 'placenta percreta' in 37 patients. In patients with morbidly adherent placenta, mean gestational age at delivery was 36 weeks and 1 day. In terms of diagnostic imaging, the sensitivity, specificity, positive predictive value, negative predictive value of ultrasound were found to be 84%, 75%, 90% and 62%, respectively. Magnetic resonance imaging showed similar results with a sensitivity of 87%, specificity of 76%, positive predictive value of 92% and negative predictive value of 65%. Internal iliac artery ligation was performed in 35 (37%) cases. The number of packed red blood cell transfusion was higher in patients who did not undergo artery ligation when compared to cases who underwent the procedure. There were 19 bladder injuries in total, out of which, one of them was in 'no invasion' group, 1 patient was in 'accreta' group, 7 patients were in 'increta' group, and 10 patients were in 'percreta' group. The mean amount of packed red blood cell transfusion in patients with no invasion was 4.8 units, while it was 6.15 units in morbidly adherent placenta group. Conclusion: The optimal management of placenta previa and morbidly adherent placenta depends on determination of risk factors and timely diagnosis. Ultrasound has a high accuracy for diagnosis and should be chosen as the first line imaging modality. Delivery should be performed electively before spontaneous onset of labor at 36 weeks by cesarean section unless indicated sooner. Multidisciplinary approach in tertiary care centers will improve maternal and neonatal outcomes.