RESUMEN
Adherent placenta means a placenta that is not delivered spontaneously or even after manual removal within 30 minutes of baby birth. It is an uncommon and frequently unanticipated event with serious potential health circumstances and it should be managed by the medical team. This case study presents a rare instance of placenta increta in a 25-year-old woman, second gravida, at 36 weeks of gestation, with a history of cesarean section 16 months prior due to chorioamnionitis. The patient presented to the labor room in active labor, and antenatal ultrasound indicated placental implantation on the posterior surface of the upper uterine segment. Given the short inter-delivery interval, an emergency preterm lower segment cesarean section (LSCS) was performed, resulting in the birth of a healthy baby girl weighing 1.8 kg. During surgery, a morbidly adherent placenta was found over the fundus of the uterus. Following consultations with the patient and her relatives, an emergency obstetric total hysterectomy was performed. Intraoperatively, the patient received one unit of packed cell volume (PCV) and, postoperatively, two additional units of PCV and two units of fresh frozen plasma (FFP) were administered. On the third postoperative day, the patient developed right lung consolidation, necessitating a five-day stay in the Obstetric Intensive Care Unit (OBICU). The remaining postoperative period was uneventful, and the patient was discharged on the 10th postoperative day with the healthy infant. Placenta accreta, including its variants increta and percreta, represents abnormal placental implantation into the uterine wall, a condition whose incidence is rising due to increased cesarean sections and improved imaging detection.
RESUMEN
BACKGROUND: Cesarean section is on the rise all over the world; it has become a safe surgery due to better anesthesia, asepsis, blood transfusion and antibiotics. Traditionally, the patients are kept nil orally till they pass flatus. This study was performed to find out acceptance and tolerability of early feeding, its side effects and complications if any. METHODS: This comparative study was conducted in a service hospital. There were two groups of 70 cases each where one was administered early feeding and the second group was put on standard delayed feeding as is traditionally done in most of the hospitals. Gastrointestinal outcomes and other parameters were noted in both the groups and analyzed. RESULTS: During the study period, every alternate willing case without any exclusion criteria was allotted to each group. Early feeding was started 6 h after surgery in the study group, whereas it was withheld till passage of flatus in the control group. Appearance of bowel sounds and passage of flatus were earlier in study group (21.6 and 34.5 h, respectively) as compared with control group (31.7 and 49.2 h, respectively). There were no complications or side effects of early feeding. CONCLUSION: There is no justification to withholding oral feeds as is traditionally done. Early feeding should be initiated without fear of any side effects. Patients have an early postoperative recovery; it is cost-effective and results in higher patient satisfaction.