الفهرس 
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Abstract
massive obstetric hemorrhage is defined as: blood loss more than 1500 ml, a decrease in hemoglobin more than 4 g/dl; acute transfusion of more than 4 units; or patient receiving treatment for coagulopathy44.
obstetric hemorrhage is the single most significant cause of maternal mortality worldwide accounting for 25–30% of all maternal deaths38.
serious morbidity resulting from hemorrhage includes hypovolumic shock, renal failure, liver failure, adult respiratory distress syndrome, coagulopathy, loss of fertility and pituitary necrosis42.
60–90% of deaths from pph are potentially preventable with better medical care43.
placenta praevia, defined as placental implantation within the lower uterine segment1, represents a true obstetric emergency that is still significantly associated with increased perinatal and maternal morbidity and mortality in developing countries5. morbidities associated with placenta praevia include antepartum hemorrhage, intrapartum hemorrhage, postpartum hemorrhage, morbid adherence of the placenta, need for hysterectomy57.
adherent placenta, including placenta accreta and its variants placenta increta and percreta are complications of placenta praevia57.
in the presence of a placenta praevia, the risk of having placenta accreta increased from 24% in women with one prior cesarean delivery to 67% in women with 3 or more prior cesareans58.
although statistically a rare complication, adherent placenta is now become a major cause of obstetric hemorrhage and thus an important etiology of maternal morbidity and mortality110.
owing to the increasing rate of cesarean delivery, there has been a 10-fold rise in the incidence of placenta accreta since the 1970s62. in a recent survey, placenta accreta was even found to have become the leading cause of emergency peripartum hysterectomy leading to serious comorbidites such as cystostomy; ureteral injury, pulmonary embolism and admission to intensive care unit64.