A PROSPECTIVE OBSERVATIONAL STUDY ON PROPORTION, RISK FACTORS AND FETO-MATERNAL OUTCOME OF PLACENTA ACCRETA SPECTRUM IN A TERTIARY TEACHING INSTITUTE OF WEST BENGAL.

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Background:- In modern obstetrics, Placenta Accreta Spectrum (PAS) is a leading cause of severe maternal complications, and a signicantly elevated risk of life-threatening morbidity and mortality. The mortality rate associated with PAS is alarmingly high in underdeveloped countries. The primary drivers of maternal morbidity and mortality in PAS cases are severe bleeding during or after delivery, and the resulting complications, which can have devastating outcomes for the affected mother and fetus. Aim and Objectives : Aim of this study was to evaluate the incidence, risk factors and feto-maternal outcome of placenta accreta spectrum (PAS) in a tertiary teaching institute of West Bengal. This was a prospective observational study conducted in Materials and Methods :- the department of obstetrics and gynaecology of a tertiary teaching institute in Paschim Medinipur, West Bengal for a duration of 12 months (From 1st May 2023 to 30th April 2024). A total 41 pregnant women were diagnosed as PAS during this study period. All these 41 diagnosed cases of PAS, fullling eligibility criterias, were included in this study. A comprehensive data collection tool was employed to gather diverse information for this study. The data was analyzed using descriptive statistics and organized into a structured format. The parameters for each case of placenta accreta spectrum (PAS) were assessed by evaluating risk factors, diagnostic methods, management strategies, and associated morbidity and mortality. Results:- Total 41 cases were diagnosed as placenta accreta spectrum (PAS) during this study period (12 months) against 14500 deliveries , giving an proportion rate of 0.28%. Most patients were between 25-35 years old (65.85%) and multigravida (92.68%). More than half of the patients (53.66%) belong to middle socioeconomic status. 60.98% cases were booked cases. Previous cesarean section (85.37%) and concurrent placenta previa (58.54%) were common risk factors. Other risk factors were h/o endometrial curettage (17.07%), h/o myomectomy (9.76%), h/o manual removal of placenta (7.32%), h/o hysterotomy (2.44%), In-vitro fertilization (4.88%) and Twin pregnancy (2.44%). Ultrasound and MRI were used for diagnosis, with 39.02% cases diagnosed during intra-operative period. 48.78% cases of PAS were delivered between 34-36+6 weeks . 65.85% cases underwent Elective CS and 34.15% cases underwent Emergency CS. Classical CS was done in 46.34% cases and LSCS done in 53.66% cases. After CS, 43.90% cases underwent obstetric hysterectomy and 51.22% cases underwent conservative management and 4.88% cases underwent expectant management. Signicant blood loss and transfusions were common, with 100% cases requiring blood transfusion. ICU admission, mechanical ventilation, and inotrope support were needed in many cases. Post-operative complications included fever, bladder/bowel injury, AKI, and maternal death (2.44%). Eighteen patients (43.90%) stayed in the hospital for 7 days, while 23 patients (56.10%) had hospital stays of more than 7 days. 90.24% of fetal births (37/41) were live births, while 9.76% (4/41) resulted in stillbirth or intrauterine death. By birth weight, 75.61% of newborns weighed over 2.5 kg, 14.63% weighed between 1.5-2.5 kg, and 9.76% weighed under 1.5 kg. Additionally, 70.27% of live births had a healthy APGAR score above 7, while 29.73% scored below 7. Furthermore, 24.32% of live births required NICU admission. The increasing caesarean section rate has led to a rise in placenta Conclusion:- accreta spectrum (PAS) cases, posing severe risks to maternal and fetal health. To address this, restricting caesarean sections to absolute indications, antepartum diagnosis, and multidisciplinary team management can help in prevention of complications and ensure better outcomes of mother and fetus.

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