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2015 ; 125
(3
): 683-689
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Morbidly adherent placenta treatments and outcomes
#MMPMID25730233
Bailit JL
; Grobman WA
; Rice MM
; Reddy UM
; Wapner RJ
; Varner MW
; Leveno KJ
; Iams JD
; Tita ATN
; Saade G
; Rouse DJ
; Blackwell SC
Obstet Gynecol
2015[Mar]; 125
(3
): 683-689
PMID25730233
show ga
OBJECTIVE: To describe recent maternal and neonatal delivery outcomes among women
with a morbidly adherent placenta in major centers across the United States.
METHODS: This study reviewed a cohort of 115,502 women and their neonates born in
25 hospitals in the United States between March 2008 and February 2011 from the
Assessment of Perinatal EXcellence data set. All cases of morbidly adherent
placenta were identified. Maternal demographics, procedures undertaken, and
maternal and neonatal outcomes were analyzed. RESULTS: There were 158 women with
a morbidly adherent placenta (1/731 births, 95% confidence interval 1/632-866).
Eighteen percent of women with a morbidly adherent placenta were nulliparous and
37% had no prior cesarean delivery. Only 53% (84/158) were suspected to have a
morbidly adherent placenta before delivery. Women with a prenatally suspected
morbidly adherent placenta experienced large blood loss (33%), hysterectomy
(92%), and intensive care unit admission (39%) compared with 19%, 45%, and 22%,
respectively, in those not suspected prenatally to have a morbidly adherent
placenta (P<.05 for all). CONCLUSION: Eighteen percent of women with a morbidly
adherent placenta were nulliparous. Half of the morbidly adherent placenta cases
were suspected before delivery and outcomes were poorer in this group, probably
because the more clinically significant morbidly adherent placentas are more
likely to be suspected before delivery. LEVEL OF EVIDENCE: : II.