Title: Pregnancy outcome in Placenta Accrete Spectrum Analysis: a Low resource setting analysis

Objective : To evaluate the risk factors ,maternal and perinatal outcome in pregnant women with Placenta Accrete Spectrum in a low resource setting

Methods: It was a retrospective evaluation of clinically suspected and /or histologically confirmed cases over four year period in the department of Obstetrics and Gynecology ,KGMU,Lucknow.It is one of the largest referral centres in North India.the study was approved by the Institutional Ethics Committee.three categories of adherent placenta were defined based on the degree of myometrial invasion as placenta accreta,increta and percreta.Data like age ,parity,gestational age ,number of antenatal visits ,surgical details,placental location ,blood products,need for critical care support and maternal outcome were recorded. Perinatal outcomes were taken as birth weight,admission to neonatal unit/intensive  care unit and perinatal deaths. SPSS was used for statistical analysis.

Results: The total number of deliveries during the period were 39,154. Placenta accrete spectrum (PAS) was confirmed in 119 women. the incidence of PAS was one per 329 deliveries. the mean maternal age was 29.3 years. the mean parity was 2.1. of women with PAS,52.9%,21% & 26.1% had accreta,increta and percreta respectively. previous lower segment cesarean section with placenta previa was the commonest  risk factor. Placenta previa alone contributed to 23.8% cases while 19% women had history of LSCS alone.Of all,68% had no antenatal care ,89% underwent cesarean hysterectomy ,57.9% needed critical care. There were 15 (12.6%) maternal deaths.Of neonates,70 neonates had a mean Apgar of 8 at 5  minutes of birth,24 were stillbirths and 25 needed care in Neonatal Intensive care unit.

Conclusion: The incidence of placenta accrete spectrum is increasing.Placenta creta/adheranta was the commonest type.Previous LSCS with placenta previa is the commonest risk factor.Antenatal diagnosis ,preoperative counseling ,planning and multidisciplinary approach at the time of delivery is necessary to reduce the maternal and perinatal morbidity and mortality.The condition is extremely challenging in a low resource setting where universal antenatal coverage is still far from reality and majority of these women come to hospital at the time of delivery.