Rising cesarean rates and placenta accreta spectrum: Fetomaternal outcomes from a tertiary care study

The human placenta is a discoid organ that is hemochorially connected to the mother, playing crucial roles in gestation such as foetal nourishment, protection, gas exchange, and hormone production. Abnormal placental development can lead to complications such as placenta previa, placenta accreta, vasa previa, and velamentous cord insertion. The placenta accreta spectrum (PAS), formerly known as morbidly adherent placenta, involves abnormal implantation and invasion, including placenta increta and percreta.Materials and Methods: This was a prospective observational study carried out in department of Obstetrics and Gynaecology, SKIMS, Soura for a period of two years from June 2022 to June 2024. Pregnant women having features of Placenta accreta spectrum were included in the study. Pregnant women having upper segment placenta and placenta previa without accrete were excluded from the study.Results and Observations: Most of the patients (38.1%) were aged between 30-34 years with majority being multigravidas (96.8%). Most of the patients were booked with only 11 (17.5%) unbooked with most 61.9% being from rural areas. The most common risk factor was placenta previa accounting for 79.4% and among previous surgeries LSCS accounting for 96.8% of cases. Majority of patients had an antenatal diagnosis with Ultrasound in 82.5%, MRI in 9.5% of patients. In around 8% of patients it was an incidental finding. The most common finding on USG was multiple placental lacunae in 90.5% followed by thinning of retroplacental myometrium in 79.4%. Other findings like bulging of placenta and bladder interruption were observed in 55.6% and 34% patients respectively. Most of the patients 54% (34) had undergone two LSCS previously and 31.7% (20) has undergone only one LSCS. Around 20 (31.7%) patients presented with antenatal haemorrhage. Around 60% patients delivered between 34-37 weeks, 30.2% patient delivered between 31-34 weeks. Most patients 77.8% had an elective LSCS.Conclusion: To reduce the preventable maternal and perinatal morbidity and mortality associated with PAS, it is important to bring down the cesarean section rates. It is crucial to focus on early antenatal registration, primary diagnosis through transabdominal sonography, colour Doppler and MRI. These patients should only be dealt in centres with expertise and resources available to deal such patients in order to improve patient outcome.