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Morbidly adherent placenta treatments and outcomes
Jennifer L Bailit1, William A Grobman, Madeline Murguia Rice
1Departments of Obstetrics and Gynecology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio; Prentice Women's Hospital, Northwestern University, Chicago, Illinois; Columbia University, New York, New York; the University of Utah Health Sciences Center, Salt Lake City, Utah; the University of Texas Southwestern Medical Center, Dallas, the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas; The Ohio State University, Columbus, Ohio; the University of Alabama at Birmingham, Birmingham, Alabama; Brown University, Providence, Rhode Island; The George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
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.
