Saturday, February 9, 2013

One of the reason to avoid unindicated Caesarean section - Placenta Accreta

Caesarean is a beautiful surgery and has saved many a maternal as well as foetal lives since the time of probably Julius Caesar.

But like any other operative procedure it has it's downsides as well.Repeated caesarean section has been associated with increased chances of Placenta Praevia (placenta attached in lower segment of the uterus) and Placenta accreta, increta and percreta ( Where placenta encroaches and grows very deep inside the muscle and at times out of the muscle) of the uterus.Both of them are dangerous and potentially life threatening condition.

While placenta praevia can lead to painless bleeding which can need early caesarean to deliver a preterm baby,blood transfusions and if not properly managed conditions like DIC etc.
Placenta Accreta doesn't lead to bleeding usually as the placenta is embed ed deep in the uterus but the problem is when the lady is delivered the placenta won't get separated from the uterus.An attempt to take it out in pieces can lead to a disaster with unimaginable bleeding.The options for treatment are:
If the family is complete - caesareran Hysterectomy
If Family is incomplete -Leave a part of placenta inside,use methotrexate injections.It can lead to vaginal discharge ,infection and quite a mess.In fact it is not a very satisfactory method of treatment but might be option for a lady who hasn't completed her family.

Last month I operated on a Lady in whom the able radiologist Dr Girish Pandit has suspected a placenta accreta quite early in the pregnancy.Her MRI at Max Gurgaon confirmed it.As in her case as her pregnancy was planned decision making was much easy.So immediately after delivering the baby I went ahead for a quick removal of uterus.The whole process was very smooth and the lady recovered as quickly as after a normal caesarean and didn't need a blood transfusion either.Histopathological examination confirmed it to be a percreta.Interestingly this lady had two uterus and two cervix.

.But the condition can be quite uncontollable incase of an undiagnosed Placenta accreta.When I was a registrar in Indraprastha Apollo Hospital,One of the soc lites and wife of a politician got admitted for Caesarean section.Her Ultrasound suggested Placenta praevia but there was no mention of placenta accreta.Two stalwarts of Indian OBGY operated on her.Dr Soonawala flew from Mumbai to operate on her and the primary consultant was very senior Dr Urmil Sharma.On table it was diagnosed as having the condition.A trial was made to take the placenta piecemeal and then there was torrential bleed.The whole OT floor got flooded.It was credit to Dr Makru the Blood bank head who insured a constant supply of blood and blood product.May be more than 90 units of blood/blood product was consumed.Ultimately Vascular surgeon Dr S K Chaku was called for help.With a joint effort of such a experienced team that Lady survived.She was in the ICU for many days.Today when I see her pictures in any page 3 event it makes me feel really thankful to the GOD.

Thus ,not a bad idea to restrict the caesareans to only indicated reasons..........

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