Objective:
To demonstrate effective strapping emergency in therapeutic management of threat with open cervix.

Methodology:
We conducted a descriptive cohort study at Yopougon Abidjan (Côte d’Ivoire) University Hospital. Over a period of two years (February 2015 to January 2017), the study concerned 11gestantes who presented a severe threat of late miscarriage with the opened cervix, protrusion and intact membranes in the second trimester of Pregnancy. For all pregnant, a strapping of the cervix has been performed according to Mac Donald’s procedure.

Results:
Mean’s age of patients was 30 years, 27.30% primigravida and 36.40% nulliparous. More than half (55%) had a history of abortion. Symptomatology was dominated by pelvic pain (63.60%). The average gestational age at the time of strapping was 20 weeks. Average duration of the interventions was 12, 27min and hospitalization of pregnant after cerclage was 3 days. Following up was marked by a new hospitalization in 3 patients, because of membrane’s rupture at 31 weeks of pregnancy. Average gestational age for childbirth was 36 weeks, 82% of births by caesarean section. 64% of children were born with a score of APGAR greater than 7 at the first minute. No cases of newborn death have been noted. Average time between strapping and childbirth was 115 days or 15 weeks.

Conclusion:
Emergency cervical strapping is used to prolong the duration of pregnancy and to reduce risk of high prematurity, thereby improving fetus viability and prognosis.

Introduction:
Over the past few decades, the incidence of placenta accreta, increta and percreta have increased due to the increasing cesarean delivery rate. The American College of Obstetricians and Gynecologists estimated that placenta accreta complicates 1 in 2500 deliveries. It is a leading cause of intractable postpartum hemorrhage requiring emergency peripartum hysterectomy and maternal deaths.

Aims and Objectives:
The purpose of this study was to evaluate the demographic profile, high risk factors, fetal and maternal outcome and management options in women presenting with morbidly adherent placenta to our hospital which is a tertiary care referral centre.

Materials and Methods:
This was a retrospective study conducted in the department of Obstetrics and Gynecology, mamata medical college, khammam from January 2005 to December 2014 for a period of ten years. All the pregnant women who were diagnosed with morbidly adherent placenta were included in the study. Patients were identified from the admission and labour room registers.

Results:
Forty women were having Morbidly Adherent Placenta in the study period. 50% placenta accreta, 30% placenta increta and 20% placenta percreta. The mean age was 25.5 ± 3.8 years with 10% >35 years of age. The mean parity was 2.5 ± 0.9. Only 10% of them were booked patients. 70% had previous caesarean section and 5% had prior curettage. Placenta previa was present in 70% women. 10% women had no known risk factors. 80% presented antenatally, 20 % presented postdelivery with retained placenta. 70% presented with antepartum hemorrhage, 10% had asymptomatic placenta previa at term. 5 % presented with shock between 28 and 30 weeks. 85 % underwent hysterectomy. Massive blood loss was present in all the women with a mean blood loss of 2.8l. An average of 8 units of whole blood and six units of fresh frozen plasma were transfused. Bladder was injured during dissection in 15% and partial cystectomy was done in 5% due to bladder involvement by percreta. 60% of the women had to be shifted to ICU. The maternal mortality in our study was 25%. All of them died due to DIC. The average gestational age in our study was 34.2 weeks. 70% of the newborns were preterm with an average birth weight of 2.1 kg. The perinatal mortality was 45%.

Conclusion:
To conclude, incidence of placenta accreta is increasing and previous caesarean section and placenta previa are important risk factors, so there is a need to keep the primary caesarean section rates at a low level. Early preoperative diagnosis in the suspected women is the key to save the women’s life. Adherent placenta should be suspected even in the second trimester in women with known high risk factors who are undergoing MTP or suction evacuation.

Policies and guidelines exist at the local, state, national and international levels for the identification of pregnant women with mental health issues for their care and management needs throughout the perinatal period. It is known that there is an increased rate of adverse birth outcomes in this population and this case series highlights the lack of clarity in these guidelines, particularly regarding which clinicians are required for multidisciplinary team management. This leads to a system design that allows gaps in service provision to occur for some more vulnerable women. Recommendations for future research and clinical approaches are discussed.