CORRELATIVE EVALUATION OF THE ABNORMAL INVASION OF PLACENTA INTO THE MYOMETRIUM USING ULTRASONOGRAPHY, COLOUR DOPPLER AND MRI AND MATERNAL AND FETAL OUTCOME AT A TERTIARY CARE CENTER-Dr. S. SwethaGuide:Dr.J.Venkateshwar ReddyProfessor & Head,Department of Obstetrics & GynaecologyGandhi HospitalNEED FOR STUDYInvasive placenta is a life threatening condition characterized by an abnormal invasion of the placenta into the maternal uterus , posing serious risks for the mother and the baby

Despite antenatal work up, diagnosis is made late at the time of delivery when there is haemorrhage

Recent advances could allow a prenatal screening of placenta accreta, increta and percretaAIMTo evaluate the abnormal invasion of placenta into the myometrium in the pregnant women and to study the maternal and foetal outcomeOBJECTIVES OF THE STUDYPrenatal detection of the abnormal invasion of the placenta in the pregnant women

To reduce the complications associated with invasive placenta

To decrease the associated maternal and foetal morbidity and mortalityINTRODUCTIONNormally, the placenta attaches to the superficial layer of the uterine cavity (decidua). The placenta must be strong enough to anchor to this layer until the end of pregnancy, but must detach immediately after delivery.

The decidua is very important in achieving this balance because it controls the depth of invasion of the placenta and orchestrates the ability of the placenta to release when the baby is delivered. Therefore, if the decidua is damaged or abnormal, an invasive placenta may develop. This is most commonly seen in the area of a scar on the uterine wall from a previous Caesarean section or other uterine surgery.Placental villous adherence is classified on the basis of depth of myomertial invasion into:

Placenta accreta vera : (76%)mildest formvilli are attached to the myometrium, but donot invade the muscle.

Placenta increta : (18%)intermediate formvilli partially invade the myometrium

Placenta percreta : (6%)most severe formvilli penetrate through the entire myometrium or beyond serosaSTUDY DESIGN OF THE TOPICProspective observational studyINCLUSION CRITERIAPregnant women with:Antepartum haemorrhagePlacenta previaPrevious Caesarean section/sUterine surgeries like myomectomyAdvanced maternal ageUterine anomaliesUterine artery embolizationEndometrial damage like curettageEXCLUSION CRITERIAPatients in shockWomen with metallic valves in the heartWomen with prosthetic implantsSAMPLE SIZEA minimum of 100 casesDURATION OF THE STUDY2 YearsMATERIALS AND METHODSSOURCE OF THE DATA:This study includes a minimum of 100 pregnant women possessing the risk factors for invasive placenta presenting to the Department of Obstetrics and Gynaecology at Gandhi HospitalInformed consent will be obtained from all the subjects after explaining the nature and purpose of studyAll the patients are subjected to detailed history and clinical examination using pre-designed proformaMETHOD:Complete clinical examinationBlood investigationsUltrasoundAbnormal colour dopplerMRIINVESTIGATIONS REQUIREDHaemoglobin %, RBC count, Total Leucocyte count, Platelet count, ESRRenal Function TestsComplete urine examinationUltrasonography:-18-20 weeks-28-30 weeks-34-37 weeksColour Doppler StudyMRI in selected cases with changes in colour dopplerPROFORMANameAgeIP No.Booked/ UnbookedAddressSocioeconomic statusEducationPresenting complaints Obstetric history- LMP, EDD,S.EDDMenstrual historyPast historyFamily historyPersonal historyGeneral examination: Height, Weight, Built, NourishmentTemperature,Pulse rate,Blood pressure,Respiratory rate, Pallor/Icterus/Pedal edemaThyroid, Breasts, SpineObstetric Examination:Ht of the uterus, presentation, lie,liquor, Previous surgical scars, Scar tenderness, foetal heart rateSystemic examination:CVS,Respiratory system,CNSAbdominal examinationDiagnosisManagement:-Transfusion of blood/ blood products-Gestational age at delivery-Mode of delivery- Emergency/Elective LSCS-Post partum period-Condition at discharge/ Deaths

Baby details:-Term/Preterm-Weight-APGAR - at 1min & 5min-Resuscitation -NICU admission-Deaths/ condition at dischargeOUTCOMES MEASUREDMATERNAL :-No.of cases detected in the antenatal period-No.of cases detected in the intrapartum period-No.of maternal deaths

FOETAL:-Viability of the foetus-No.of preterm deliveries-No.of NICU admissions-Congenital malformations -Perinatal morbidity and mortalityRESULTS

INTERPRETATION

REFERENCESThank you