Association of previous caesarean scar and the development of placenta praevia and placenta accreta

This is a descriptive prospective study conducted in the four major hospitals in Khartoum States during the period from November 2002 to June 2003. The aim of the study was to determine the relationship between the increasing number of previous C/S scars and the subsequent development of placenta praevia (P.P) and placenta praevia accreta (P.P.A) and to assess the outcome of management. Fifty cases were included in the study and the following results were obtained: the highest occurrence of P.P was among those between 30-39 years as they represented 64.00% of the cases studied. The greatest number of cases was among those with parity of 5 and more. They represented 28% of the cases. In the study 34.00% had 2 previous C/S, while only 4.00% had 5 previous scars and more. In this study, 11.00% of the cases were diagnosed clinically, while 16.00% of the cases were diagnosed by abdominal U/S and 52.00% of the cases were suspected clinically to have PP and the diagnosis was confirmed by abdominal U/S. Regarding the previous gynaecological history, 38.00% of the group studied had previous abortion, while 4.00% had previous myomectomy. In 80.00% of cases the operations were done under GA, while spinal anaesthesia was used in 20.00% of cases. In the group studied, 40.00% of them had developed PPH, while 20.00% of the cases were found to have P.P.A Abdominal hysterectomy was done in 12.00% of the cases and 4.00% of patients had bladder injuries. Significant association was found between increasing number of previous C/S and the subsequent development of PPA. In the study the association between P.P.A and C/S hysterectomy was confirmed to be highly significant