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. Swetha

Guide:
Dr.J.Venkateshwar Reddy
Professor & Head,
Department of Obstetrics & Gynaecology
Gandhi Hospital

NEED FOR STUDY

Invasive 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 percreta

AIM

To evaluate the abnormal invasion of placenta into the

myometrium in the pregnant women and to study the
maternal and foetal outcome

OBJECTIVES OF THE STUDY

Prenatal 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

mortality

INTRODUCTION

Normally, 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 form

villi are attached to the myometrium, but donot invade the muscle.

Placenta increta : (18%)

intermediate form

villi partially invade the myometrium

Placenta percreta : (6%)

most severe form

villi penetrate through the entire myometrium or beyond serosa

STUDY DESIGN OF THE TOPIC

Prospective observational study

INCLUSION CRITERIA

Pregnant women with:

Antepartum haemorrhage

Placenta previa

Previous Caesarean section/s

Uterine surgeries like myomectomy

Advanced maternal age

Uterine anomalies

Uterine artery embolization

Endometrial damage like curettage

EXCLUSION CRITERIA

Patients in shock

Women with metallic valves in the heart

Women with prosthetic implants

SAMPLE SIZE

A minimum of 100 cases

DURATION OF THE STUDY

2 Years

MATERIALS AND METHODS

SOURCE 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 Hospital

Informed consent will be obtained from all the

subjects after explaining the nature and purpose
of study

All the patients are subjected to detailed history

and clinical examination using pre-designed
proforma

METHOD:

Complete clinical examination

Blood investigations

Ultrasound

Abnormal colour doppler

MRI

INVESTIGATIONS REQUIRED

Haemoglobin %, RBC count, Total Leucocyte count, Platelet

count, ESR

Renal Function Tests

Complete urine examination

Ultrasonography:

-18-20 weeks

-28-30 weeks

-34-37 weeks

Colour Doppler Study

MRI in selected cases with changes in colour doppler

PROFORMA

Name

Age

IP No.

Booked/ Unbooked

Address

Socioeconomic status

Education

Presenting complaints

Obstetric history- LMP, EDD,S.EDD

Menstrual history

Past history

Family history

Personal history

General examination:

Height, Weight, Built, Nourishment

Temperature,Pulse rate,Blood pressure,Respiratory rate,

Pallor/Icterus/Pedal edema

Thyroid, Breasts, Spine

Obstetric Examination:

Ht of the uterus, presentation, lie,liquor, Previous surgical scars, Scar

tenderness, foetal heart rate

Systemic examination:

CVS,Respiratory system,CNS

Abdominal examination

Diagnosis

Management:

-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 discharge

OUTCOMES MEASURED

MATERNAL :

-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 mortality

RESULTS

INTERPRETATION

REFERENCES

Thank you