• Haifa'a Alchalabi, Isam Lataifeh, Basil Obeidat, Faheem Zayed, Yousef S Khader, and Nail Obeidat.
• Department of Obstetrics and Gynaecology and.
• J. Matern. Fetal. Neonatal. Med. 2014 Nov 1; 27 (17): 1734-7.

ObjectiveTo assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used.Materials And MethodsThis is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search.ResultsA total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group.ConclusionMAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

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