Morbidly Adherent Placenta Treatments and Outcomes

Citation

Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Leveno, Kenneth J.; Iams, Jay D.; Tita, Alan T. N.; & Saade, George R., et al. (2015). Morbidly Adherent Placenta Treatments and Outcomes. Obstetrics & Gynecology, 125(3), 683-689. PMCID: PMC4347990

Abstract

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.

URL

http://dx.doi.org/10.1097/aog.0000000000000680

Reference Type

Journal Article

Year Published

2015

Journal Title

Obstetrics & Gynecology

Author(s)

Bailit, Jennifer L.
Grobman, William A.
Rice, Madeline Murguia
Reddy, Uma M.
Wapner, Ronald J.
Varner, Michael W.
Leveno, Kenneth J.
Iams, Jay D.
Tita, Alan T. N.
Saade, George R.
Rouse, Dwight J.
Blackwell, Sean C., for the
Eunice Kennedy Shriver
National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network [
John M. Thorp, Jr., Member
]

PMCID

PMC4347990