Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Gynecology and Obstetrics

Cesarean section is one of the most commonly performed major abdominal operations in women worldwide and its rate is increasing dramatically (Barber et al., 2011).The national cesarean rate in the United States has increased seven-fold; it peaked in 2009 at 32.9% and had dropped slightly, to 32.2%, in 2014 (Hamilton et al., 2015) Rates of maternal morbidity were higher for cesarean than vaginal deliveries; rates of transfusion and ICU admission were highest for primary cesarean deliveries, while rates of ruptured uterus and unplanned hysterectomy were highest for repeat cesarean deliveries. (Curtin et al., 2013) Silver and coworkersstudied the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries and they found that serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the majority of this risk is attributable to that of placenta accreta and/or the need or cesarean hysterectomy (Stanco et al.; 1993) Placenta previa, placenta accreta, and vasa previa cause significant maternal and perinatal morbidity and mortality. With the increasing incidence of both cesarean delivery and pregnancies using assisted reproductive technology, these 3 conditions are becoming more common (Kuhn et al., 2006 and Rao et al., 2012). The incidence of placenta accreta has increased 13-fold since the early 1900s and directly correlates with the increasing cesarean delivery rate. (Wortman et al., 2013).Placenta accreta occurs in approximately 1:1000 deliveries with a reported range from 0.04% rising up to 0.9 % (Garmi and Salim, 2012)

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