FREQUENCY OF PLACENTA ACCRETA SPECTRUM DISORDERS IN NINEVAH PROVINCE HOSPITALS: A HISTOLOGIC STUDY.

Objectives - to provide a view on the frequency, and the risk factors of placenta accreta spectrum disorders (PAS) in Nineveh Province, and to assess the morphological alterations associated with these disorders. A prospective and retrospective cross-sectional study was carried out on paraffinized blocks of 19 females, with gestational age ≥32 weeks, presented with peripartum haemorrhage and subjected to emergency hysterectomy at Maternity Teaching Hospitals, Nineveh Province, North of Iraq. Clinical data, including the mother's age and obstetrics history, were recorded when available. All cases were examined for the presence or absence of histological invasion of placentas supported by immunohistochemistry. The mean age of cases was 34.4±1.6 years by the dominance of the fourth decade. The mean gestational age at the time of diagnosis was 35.6±0.8 weeks. The PAS frequency was increasing and reaching up to 1.18 per 1000 live birth. About 60% of the cases gave a history of previous Cesarean section with or without a concomitant placenta previa. According to light microscopic examination, placenta accreta spectrum disorders were identified in 12(63.1%) cases. The immune expression of cytokeratin was significantly correlated with placental invasion, (p=0.001). The present study reveals an increase in the frequency of abnormal placentation in Nineveh Province. These disorders have well-known predisposing factors. The histo-pathological findings, other than interface decidual loss, may explain the abnormality in placental tissue implantation.