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Do the CEMACH and RCOG green top recommendations influence the outcome of women with morbidly adherent placenta? A review of 16 antenatally diagnosed cases
  1. N Agarwal,
  2. G Badial,
  3. B Khan,
  4. M Thompson,
  5. C Otigbah
  1. Barking, Havering and Redbridge NHS Trust, Romford, UK


Objective to assess the effect of CEMACH and Royal College of Obstetricians and Gynaecologists (RCOG) guidelines in the management of women with morbidly adherent placentae (MAP).

Design A prospective observational study of 16 antenatally diagnosed MAP and their outcome (2004–2009).

Setting Barking, Havering and Redbridge Hospitals NHS Trust, UK.

Methods Over 5 years, women with MAP were identified. Variables assessed were: maternal age, body mass index, parity, ethnicity, accuracy of diagnosis, risk factors for MAP, gestation at diagnosis and delivery, use of cystoscopy and ureteric stenting, use of internal iliac occlusion techniques, complications, estimated blood loss, number of blood units transfused, use of cell salvage, preoperative and postoperative haemoglobin, need for ITU (intensive trauma unit) admission, length of hospital stay and histological confirmation.

Results Early diagnosis facilitates planned multidisciplinary management, improved patient care and opportunities to train junior doctors in an elective setting.

All 16 women identified had elective Caesarean section between 33 and 39 weeks' gestation. 12 women underwent elective Caesarean hysterectomy. 4 were managed conservatively (placenta left in-situ). 2 of these were treated with methotrexate, one of whom required an emergency hysterectomy at a later date, and the other died. The other two women were successfully managed conservatively. Prior to RCOG and CEMACH guidelines, three women with MAP were identified and managed conservatively. The only maternal death in our study came from this group. Subsequent to the compliance to these guidelines, 13 women were identified to have MAP and managed without any mortality.

CEMACH and RCOG guidelines appear to significantly improve the outcome of women with MAP.

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