Identify of Preoperative and Postoperative Complication of Planned Management and Emergency Management of Patients with PAS Disorder

Background: Placenta accreta spectrum (PAS) often results in significant blood loss and peripartum hysterectomy; the mother may not survive. In many cases, timely prenatal diagnosis allows for careful birth planning in a specialized facility with a highly qualified multidisciplinary team. This has been shown to reduce maternal morbidity. Scheduled deliveries are associated with lower rates of bleeding and emergency procedures when compared to emergency deliveries. Objective: The aim of this study is to identify the preoperative and postoperative complication of planned management and emergency management of patients with PAS disorder. Methods: The cross-sectional comparative study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka from 18th January 2020 to 17th July 2020. A total of 84 patients diagnosed as a case of PAS disorder (antenatally and peroperative diagnosed) and scheduled for planned management or emergency management of PAS were included according to inclusion and exclusion criteria. 42 planned management of PAS disorder patients as Group A and 42 emergency management of PAS disorder patients as Group B. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, mean ± SD of age was calculated 26.3 ± 4.3 years for Group – A and 28.1 ± 3.2 years for Group – B. Urban population were predominant in group-A. About 30 (70.0%)) patients in group-A and 10 (23.8%) patients in group-B came from urban. Large number of respondents 22 (52.4%) and 10 (50.0%) were housewife in both groups. Among the patients, the lower class 18 (42.9%) and 23 (54.8%) comprised the major percentage of the patients in both groups. More participants in Group-A 29 (69.00%) received ANC regularly than Group B 10 (23.80%), the difference was statistically significant (p<0.05). In group-A maximum patients presented with only USG findings of PAS disorders and with APH or without APH 26 (61.8%). In group-B, PPH and internal haemorrhage 10 (23.8) was noted predominantly. The mild anemia was more in 23 (54.8%) patients in group A and 16 (38.1%) patients in group B which was statistically significant (p < 0.001). More participants in Group-B 26 (61.9%) required early termination, whereas majority of group A 35 (83.3%) was terminated at 35-36 weeks. There was a statistically significant difference between groups. Maximum patients were managed by peripartum hysterectomy 35 (82.0%) and 31 (73.8%) in group A & B respectively. Presence of multidisciplinary team was arranged in 38 (90.4%) in group A and 18 (42.9%) in group B. General anesthesia and CV line was given in 36 (85.7%) patients in group-A and 27 (64.3%) patients in group-B. Massive blood transfusion was needed in 23 (54.8%) patients in Group B & only 3 (7.1%) patients in Group A. Placenta acreta was present 11 (26.2%) patients in group A and 7 (16.7%) patients in group B. Placenta percreta with bladder invasion and peroperative bladder injury was higher in group-B patients. More than 3 L blood was transfused 3 (7.1%) patients in group A and 23 (54.8%) patients in group B. PPH, Sepsis, Re-exploration, DIC and ICU admission were the significant complication in Group-B patients, reported 41 (95.0), 4 (9.5%), 8 (19.0%), 9 (21.4%) and 21 (50.0%) of women and in less complication in Group A 13 (31.0), 0%, 0%, 1 (2.3) and 4 (9.5). In this study mortality rate was 2 (4.8%) in group-B (due to irreversible shock &DIC). Poor outcomes were significantly higher in group-B. NICU admission for prematurity was required in 9 (21.4%) of the babies in group-A and 23 (54.8%) babies of group-B. Birth asphyxia was observed in 4 (9.5%) of the babies in group-A and 13 (31.0%) in Group-B. Conclusion: Prenatal diagnosis and placenta preservation may be linked to lower rates of morbidity in mothers. For morbidly adherent placenta linked with placenta previa, we advise hysterectomy as the preferred course of therapy following extremely thorough prenatal counseling. Maternal problems and fetal outcomes may be improved by early risk factor identification and proactive management.