Morbidly Adherent Placenta (MAP): Lessons learnt


Context: Once a rare occurrence, MAP is becoming an increasing threat to maternal lives. Aims: To summarize our experience in the management of patients with morbidly adherent placenta. Introduction: MAP is a potentially life threatening hemorrhagic condition responsible for 7% - 10% maternal mortality. Settings and Design: Tertiary care center. Methods and Material: Retrospective study in which data of twelve patients with clinical diagnosis of morbidly adherent placenta was reviewed from Jan 2009 till Sept 2012. Results: The incidence of placenta accreta was found to be increasing every year. Out of twelve cases with clinical diagnosis of MAP, placenta previa was present in 10/12 patients with MAP. All patients had history of previous section. Two patients with preoperative diagnosis of MAP on USG/MRI were found to be normal intra-operative and in one patient focal accreta was diagnosed intraoperatively. Nine patients of MAP underwent caesarean hysterectomy due to excessive bleeding during placental separation and were confirmed histo-pathologically (3 accreta vera, 3 increta and 3 percreta). Internal iliac artery ligation was done in 2 patients. Two patients with placenta percreta had bladder rupture which was repaired and these two patients subsequently expired. Conclusions: The incidence of placenta accreta is increasing due to higher cesarean section (C/S) rate. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary approach.

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Wadhwa, L. , Gupta, S. , Gupta, P. , Satija, B. and Khanna, R. (2013) Morbidly Adherent Placenta (MAP): Lessons learnt. Open Journal of Obstetrics and Gynecology, 3, 217-221. doi: 10.4236/ojog.2013.31A040.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] O’Brien, J.M., Barton, J.R. and Donaldson, E.S. (1996) The management of placenta percreta: Conservative and operative strategies. American Journal of Obstetrics & Gynecology, 175, 1632-1638. doi:10.1016/S0002-9378(96)70117-5
[2] Hung, T.H., Shau, W.Y., Hsieh, C.C., Chiu, T.H., Hsu, J.J. and Hsieh, T.T. (1999) Risk factors for placenta accreta. Obstetrics & Gynecology, 93, 545-550. doi:10.1016/S0029-7844(98)00460-8
[3] Miller, D.A., Chollet, J.A. and Goodwin, T.M. (1997) Clinical risk factors for placenta previa-placenta accreta. American Journal of Obstetrics & Gynecology, 177, 210-214. doi:10.1016/S0002-9378(97)70463-0
[4] Wu, S., Kocherginsky, M. and Hibbard, J.U. (2005) Abnormal placentation: Twenty-year analysis. American Journal of Obstetrics & Gynecology, 192, 1458-1461. doi:10.1016/j.ajog.2004.12.074
[5] Silver, R.M., Landon, M.B., Rouse, D.J., Leveno, K.J., Spong, C.Y., et al. (2006) Maternal morbidity associated with multiple repeat Cesarean deliveries. Obstetrics & Gynecology, 107, 1226-1232. doi:10.1097/01.AOG.0000219750.79480.84
[6] Price, F.V., Resnick, E., Heller, A.K. and Christopherson, A.W. (1991) Placenta previa percreta involving the urinary bladder. A Report of two cases and review of the literature. Obstetrics & Gynecology, 78, 508-511
[7] Washecka, R. and Behling, A. (2002) Urologic complications of placenta percreta invading the urinary bladder: A case report and review of the literature. Hawaii Medicine Journal, 61, 66-69.
[8] Fimberg, H.J. and Williams, J.W. (1992) Placenta accreta: Prospective sonographic diagnosis in patients with placenta previa and prior caesarean section. Journal of Ultrasound in Medicine, 11, 333-343.
[9] RCOG Green-top guidelines No 27, December 2011.
[10] The American College of Obstetricians and Gynecologist, Committee Opinion Number 529, July 2012.
[11] Steins Bisschop, C.N., Schaap, T.P., Vogelvang, T.E. and Scholten, P.C. (2011) Invasive placentation and uterus preserving treatment modalities: A systematic review. Archives of Gynecology and Obstetrics, 284, 491-450. doi:10.1007/s00404-011-1934-6

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