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Placental adhesive spectrum disorders (PASD) are on the increase. Histologically, the placenta may be adherent to the myometrium without intervening decidua (acreta), invade the myometrium (increta) and/or extend beyond the myometrium and seen via the serosa of the uterus or invade into adjacent tissues like the bladder or parametrium (percreta). Since there are difficulties in defining each entity by ultrasound or by histology and also due to the possibility of histology showing different degrees of invasion in the same case, PASD is the term now commonly used and the previous terminology of morbidly adherent placenta is no longer used. The main contributor towards PSAD is previous caesarean section (CS). With the global increase in CS, the incidence of PASD and related morbidity and mortality is on the increase.
Caesarean section rates are on the rise and this may be partly due to lack of appropriate training and experience in instrumental deliveries as well as medico-legal issues. Since caesarean section performed in the second stage of labour is associated with increased maternal morbidity, an appropriately performed instrumental vaginal delivery may help avoid the unnecessary risks.
Instrumental vaginal deliveries can be hazardous in inexperienced hands and should be undertaken with due care and supervision. Various intrapartum measures may help reduce the need for assisted vaginal delivery such as use of partogram, upright or lateral maternal position, one-to-one support to the woman in labour, delayed pushing in women having epidural anaesthesia or judicious use of oxytocin in the second stage of labour, especially in women with epidural anaesthesia.
Global and national confidential inquiry reports show that 60 to 80% of maternal and neonatal morbidity and mortality are due to avoidable errors. This comprehensive and illustrated second edition offers a practical guide to the management of obstetric, medical, surgical, anaesthetic and newborn emergencies in addition to organisational and training issues. The book is divided conveniently into nine sections and updated throughout in line with modern research and practice. Several new chapters cover setting up skills and drills training in maternity services to reduce avoidable harm, managing obstetric emergencies during 'home births' and in low-risk midwifery units, and minimizing maternal and fetal morbidity in failed operative vaginal delivery. Each chapter includes a practical algorithm for quick reference, the scientific basis for proposed actions, a case-based practical exercise and useful learning tools such as 'Key Pearls' and 'Key Pitfalls'. An invaluable resource for obstetricians, neonatologists, midwives, medical students, anesthesiologists and the wider perinatal team.