Mode of Delivery: An Independent Risk Factor for Adhered Basal Plate Myometrium in Primigravidae

Article Type: Original Article
Authors: Brijesh Thakur, Rajiv Acharya, Shweta Mishra, Sanjay Kaushik, Seema Acharya


Background: Placenta accreta syndrome (PAS) is believed to be due to defects at the placenta-myometrial interface. The paucity of literature on this aspect is remarkable possibly because of the relative infrequency of this condition until now. The present study was designed to assess the representation of BPMYO in placenta of primigravidae delivered vaginally and those delivered by cesarean section.Materials and methods: 100 delivered placenta (50 from vaginal and 50 from cesarean deliveries in primigravidae without any known risk factor) were sent for histopathology for the period of 18 months. Minimum 05 sections were taken from maternal surface containing basal plate. Gross as well as microscopic findings, focality of BPMYO, pathological staging (stage 0–3) and diagnosis were recorded and correlated with smooth muscle actin immunohistochemistry findings.Results: Presence of basal plate myometrial fibers in both groups was not significantly different depending upon maternal age, weight, height, POG or placental disc weight. No statistically significant difference was noted between both groups considering stage 1 vs 2, largest fragment of BPMYO, average number of BPMYO foci, mean total length and percentage of BPMYO, however, significant association of cesarean delivery was observed with multifocal BPMYO.Conclusion: Method of placental separation and mode of delivery was found to have no independent bearing on representation of BPMYO on basal plate, although significant multifocal presence of BPMYO was associated with cesarean sections.

Keywords: Accreta, BPMYO, cesarean, placenta, primigravidae, SMA
Issue Number: Issue - 3   September - December 2022
Pages: 97 - 138
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