الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Placenta accreta occurs when the chorionic villi invade the myometrium abnormally. It divided in to three grades based on histopathology: accreta, increta and percreta. The incidence of placenta accreta has been steadily increasing attributed to the increasing prevalence of cesarean delivery in recent years.
The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. Other predisposing factors have been identified including: multiparity, previous uterine surgery, advanced maternal age and previous uterine curettage.
The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage that occurs at the time of attempted manual placental separation. Poorly controlled hemorrhage related to placenta accreta, increta and percreta is the indication for one to two thirds of peripartum hysterectomies, disseminated intravascular coagulopathy, adult respiratory distress syndrome, renal failure, unplanned surgery, and death.
Prenatal diagnosis of placenta accreta is critical to obstetric outcome, by enabling early arrangements for elective caesarean section and possible hysterectomy, and decreases placenta accreta associated complications such as the need for the transfusion of blood products. Diagnosis is usually made by means of ultrasonography or MRI in women presenting the risk factors.
The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because removal of the placenta is associated with significant hemorrhagic morbidity. However, surgical management of placenta accreta may be individualized.
The aim of this study was to determine the incidence, risk factors and outcome of mangement of patients with placenta accreta at Menoufia university hospital during the past 4 years. In this study, there were 70 patients diagnosed as having placenta accreta during the past 4 years.
The results showed the following:
• The incidence of placenta accreta were 0.85 of total deliveries 1.67% of caesarean deliveries.
• Risk factor of placenta accreta were:
1. Placenta previa with prior cesarean section. All cases had placenta previa and 69 cases had at least one previous CS.
2. Increased maternal age (the mean age of included women was 31years)
3. Multiparity {the median parity was 2.5 (range :0-4}
4. Prior uterine curettage.15 of the 70 patients (21.4%) had a history of previous uterine curettage.
• The ultrasonography was suggestive of morbid adherent in 58 cases.
• The intraoperative data were:
Summary
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- Bladder injury occurred in 13 cases and performed bladder repair.
- All cases received PRBCs and FFP, Platelet transfusion was in only one woman.
- Uterine preserving procedures included in 26 cases (37.1%),15 cases by bilateral uterine artery ligation and resection of lower uterine segment and 11 cases by compression sutures with bilateral uterine artery ligation.
- Cesarean hysterectomy performed in 44 cases (62.9%), two cases after trial of conservative management while 42 cases had primary CS hysterectomy.
- The post-operative data were:
• ICU admission occurred in 8 cases (11.4%).
• Two patients had wound infection.
• One case needed reoperation.
• Postpartum pyrexia occurred in 1 case (1.4%).
• Median duration of hospital stay was 5 days (range :3-35)
- Neonatal outcome:
• The mean gestational age at delivery was 36.87 weeks (range:32-38 weeks)
• 11 infants were admitted to neonatal intensive care unit (NICU)