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TORRENGA BAS, HUIRNE JUDITHA, BOLTE ANTOINETTEC, VAN WAESBERGHE JANHEINTM, DE VRIES JOHANNAI. Postpartum monitoring of retained placenta.Two cases of abnormally adherent placenta. Acta Obstet Gynecol Scand 2012; 92:472-5. [DOI: 10.1111/j.1600-0412.2012.01494.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation. Eur Radiol 2012; 23:262-71. [PMID: 22760345 DOI: 10.1007/s00330-012-2573-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the potential of magnetic resonance (MR) imaging in evaluating placental vascularity and predicting placental resorption delay after conservative management of invasive placenta. METHODS MR examinations of 23 women with conservative management of invasive placenta were reviewed. Twelve women had pelvic embolisation because of postpartum haemorrhage (Group 1) and 11 had no embolisation (Group 2). Comparisons between the two groups were made with respect to the delay for complete placental resorption at follow-up MR imaging and degree of placental vascularity 24 h after delivery on early (30s) and late (180 s) phase of dynamic gadolinium chelate-enhanced MR imaging. RESULTS The median delay for complete placental resorption in the cohort study was 21.1 weeks (range, 1-111 weeks). In Group 1, the median delay for complete placental resorption was shorter than in Group 2 (17 vs 32 weeks) (P = 0.036). Decreased placental vascularity on the early phase was observed in Group 1 by comparison with Group 2 (P = 0.003). Significant correlation was found between the degree of vascularity on early phase of dynamic MR imaging and the delay for complete placental resorption (r = 0.693; P < 0.001). CONCLUSIONS MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.
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Affiliation(s)
- V V Wong
- Department of Obstetrics and Gynaecology, Limerick Regional Maternity Hospitals, Limerick, Republic of Ireland.
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Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int 2012; 2012:873929. [PMID: 22645616 PMCID: PMC3356715 DOI: 10.1155/2012/873929] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/29/2012] [Accepted: 02/19/2012] [Indexed: 11/18/2022] Open
Abstract
Placenta accreta is a severe pregnancy complication and is currently the most common indication for peripartum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Main risk factor for placenta accreta is a previous cesarean delivery particularly when accompanied with a coexisting placenta previa. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Diagnosis can be achieved by ultrasound in the majority of cases. Women with placenta accreta are usually delivered by a cesarean section. In order to avoid an emergency cesarean and to minimize complications of prematurity it is acceptable to schedule cesarean at 34 to 35 weeks. A multidisciplinary team approach and delivery at a center with adequate resources, including those for massive transfusion are both essential to reduce neonatal and maternal morbidity and mortality. The optimal management after delivery of the neonate is vague since randomized controlled trials and large cohort studies are lacking. Cesarean hysterectomy is probably the preferable treatment. In carefully selected cases, when fertility is desired, conservative management may be considered with caution. The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition.
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Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH). Arch Gynecol Obstet 2012; 286:549-61. [DOI: 10.1007/s00404-012-2329-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Amsalem H, Kingdom JCP, Farine D, Allen L, Yinon Y, D'Souza DL, Kachura J, Pantazi S, Windrim R. Planned caesarean hysterectomy versus "conserving" caesarean section in patients with placenta accreta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 33:1005-1010. [PMID: 22014777 DOI: 10.1016/s1701-2163(16)35049-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Invasive placentation (placenta accreta, increta, or percreta) presents significant challenges at Caesarean section. Caesarean hysterectomy in such circumstances may result in massive blood loss despite surgical expertise. We reviewed two divergent surgical approaches: planned Caesarean hysterectomy versus a "conserving surgery" in which the placenta is left in situ after Caesarean section. METHODS We conducted a single-centre retrospective review of all patients who delivered with invasive placentation between 2000 and 2009. We included only patients with antenatally diagnosed invasive placentation and planned mode of delivery. RESULTS Twenty-six patients met the inclusion criteria. Caesarean hysterectomy was planned in 16 patients and conserving surgery in 10. Intraoperative and postoperative complications were comparable in the two groups. Four of 10 patients initially treated by conservative surgery required a subsequent hysterectomy for severe vaginal bleeding, coagulopathy, or sepsis. No pregnancies were subsequently reported in the conserving surgery group. CONCLUSION An initial conserving surgical procedure is an option in patients with extensive invasive placentation, but it requires further monitoring for potential complications and carries a high subsequent hysterectomy rate.
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Affiliation(s)
- Hagai Amsalem
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
| | - John C P Kingdom
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
| | - Dan Farine
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
| | - Lisa Allen
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
| | - Yoav Yinon
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
| | - Donna L D'Souza
- Department of Medical Imaging, Mount Sinai Hospital, Toronto ON
| | - John Kachura
- Department of Medical Imaging, Mount Sinai Hospital, Toronto ON
| | - Sophia Pantazi
- Department of Medical Imaging, Mount Sinai Hospital, Toronto ON
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Division of Maternal Fetal Medicine, Mount Sinai Hospital, Toronto ON
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Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M, Dahan H, Mebazaa A, Barranger E, le Dref O. Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol 2011; 80:729-35. [DOI: 10.1016/j.ejrad.2010.07.018] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 11/27/2022]
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McLean LA, Heilbrun ME, Eller AG, Kennedy AM, Woodward PJ. Assessing the role of magnetic resonance imaging in the management of gravid patients at risk for placenta accreta. Acad Radiol 2011; 18:1175-80. [PMID: 21820635 DOI: 10.1016/j.acra.2011.04.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 04/07/2011] [Accepted: 04/18/2011] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES The role of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta remains uncertain. The purpose of this study was to evaluate the incremental benefit of MRI after ultrasound (US) for a large cohort of gravid patients at risk for a placenta accreta. MATERIALS AND METHODS A retrospective review of outcomes in women with risk factors for a placenta accreta between November 1995 and February 2008 was performed. Inclusion criteria were high-risk women with abnormal placenta implantation on US or operative diagnosis of placenta accreta, with or without a prenatal MRI. Delivery mode, diagnosis, and transfusion requirements were compared. RESULTS Ranging in age from 19 to 43 years, with zero to five prior cesarean sections, 139 women met inclusion criteria. The MRI was performed in 28.7% (40/139). US, MRI, and operative diagnoses were highly correlated (P < .001). Women who underwent both US and MRI were more likely to deliver by cesarean hysterectomy (P < .001). When the cohort is stratified by outcome diagnosis (normal, previa, accreta), no difference in delivery mode is found; regardless of whether subjects were imaged by US alone or US and MRI. Transfusion requirements were highest in the US and MRI group (mean of 3.9 units vs. 0.9 units in the US only group, P < .001). CONCLUSION This study fails to demonstrate that the incremental use of MRI for placenta accreta changes delivery mode in stratified analysis. Patients who underwent both US and MRI were most likely to have a cesarean hysterectomy delivery, and required more blood products, suggesting that undergoing tests may be indicative of an abnormal and at risk patient population.
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Affiliation(s)
- Logan A McLean
- Department of Radiology, University of Utah School of Medicine, Salt Lake City, 8413-2140, USA
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Cho FN, Liu CB, Li JY, Chen SN. Complete resolution of diffuse placenta increta in a primigravida with twin pregnancy: sonographic monitoring. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:363-366. [PMID: 21557250 DOI: 10.1002/jcu.20768] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 09/23/2010] [Indexed: 05/30/2023]
Abstract
We report a case of timely diagnosis of placenta increta by sonography during the third stage of labor, which avoided any attempt at manual removal of a retained placenta and thus prevented additional postpartum bleeding. The use of intra-cervical injection of vasopressin and methotrexate and application of transcatheter arterial embolization of bilateral uterine arteries and right internal iliac arteries resulted in a good outcome.
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Affiliation(s)
- Fu-Nan Cho
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan.
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113
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Jung HN, Shin SW, Choi SJ, Cho SK, Park KB, Park HS, Kang M, Choo SW, Do YS, Choo IW. Uterine artery embolization for emergent management of postpartum hemorrhage associated with placenta accreta. Acta Radiol 2011; 52:638-42. [PMID: 21498276 DOI: 10.1258/ar.2011.100514] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although uterine artery embolization (UAE) is a well-recognized alternative treatment for postpartum hemorrhage (PPH) with a high clinical efficacy, the reported success rate of UAE for PPH associated with placenta accreta (PA) is lower. Recently, with advances in techniques and expertise, a few studies have reported favorable results of UAE in controlling PPH in the setting of PA. PURPOSE To evaluate the efficacy of UAE in the emergent management of intractable PPH associated with PA. MATERIAL AND METHODS Seventeen consecutive patients who underwent emergent UAE for the management of PPH associated with PA were included in this retrospective study. Medical records were reviewed regarding the delivery and UAE procedure. Follow-up gynecologic outcomes after UAE were obtained by telephone interview. RESULTS UAE successfully controlled PPH in 14 patients (82.4%). Three patients underwent hysterectomy after UAE failed to stop the bleeding. All hysterectomy cases were accompanied by uterine atony or total placenta previa. Relevant gynecologic findings were obtained from 10 patients; three patients were breastfeeding and seven patients resumed normal menstruation, including one pregnancy. CONCLUSION UAE appears to be a safe and effective means by which to control PPH associated with PA. PA complicated by uterine atony or placenta previa may be at increased risk of UAE failure.
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Affiliation(s)
- Hye Na Jung
- Department of Radiology and Center for Imaging Science
| | | | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science
| | - Hong Suk Park
- Department of Radiology and Center for Imaging Science
| | - Minho Kang
- Department of Radiology and Center for Imaging Science
| | | | - Young Soo Do
- Department of Radiology and Center for Imaging Science
| | - In-wook Choo
- Department of Radiology and Center for Imaging Science
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Steins Bisschop CN, Schaap TP, Vogelvang TE, Scholten PC. Invasive placentation and uterus preserving treatment modalities: a systematic review. Arch Gynecol Obstet 2011; 284:491-502. [PMID: 21638046 PMCID: PMC3133648 DOI: 10.1007/s00404-011-1934-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/05/2011] [Indexed: 01/01/2023]
Abstract
Purpose We present a systematic review to evaluate failure rates (secondary hysterectomy or maternal mortality) and success rates (subsequent menstruation or pregnancy) after different uterus preserving treatment modalities in women with invasive placentation. Methods A review of English, German or Dutch language-published research, using Medline and Embase databases, was performed. Studies of any design were included. Results Ten cohort studies and 50 case series or case reports were included. Expectant management reported a secondary hysterectomy in 55/287 (19%), maternal mortality in 1/295 (0.3%), a subsequent menstruation in 44/49 (90%) and a subsequent pregnancy in 24/36 (67%). Embolization of the uterine arteries described a secondary hysterectomy in 8/45 (18%), a subsequent menstruation in 8/13 (62%) and a subsequent pregnancy in 5/33 (15%). Methotrexate therapy presented a secondary hysterectomy in 1/16 (6%), a subsequent menstruation in 4/5 (80%) and a subsequent pregnancy in 1/2 (50%). Uterus preserving surgery showed a secondary hysterectomy in 24/77 (31%), maternal mortality in 2/55 (4%), a subsequent menstruation in 28/34 (82%) and a subsequent pregnancy in 19/26 (73%). Conclusions This review indicates that different uterus preserving treatment modalities may be effective in managing invasive placentation. Despite the extensive review of the literature, no conclusions about the superiority of any modality can be drawn.
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Affiliation(s)
- Charlotte N Steins Bisschop
- Department of Obstetrics and Gynecology, Diakonessenhuis Utrecht, Bosboomstraat 1, 80250, 3508 TG Utrecht, The Netherlands.
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Hull AD, Moore TR. Multiple repeat cesareans and the threat of placenta accreta: incidence, diagnosis, management. Clin Perinatol 2011; 38:285-96. [PMID: 21645796 DOI: 10.1016/j.clp.2011.03.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Placenta accreta is a significant source of obstetric morbidity and mortality. Its incidence is increasing as a direct consequence of the increasing cesarean section rate, which reflects increased rates of maternal obesity, increased numbers of multiple gestations secondary to assisted reproductive technology, physician concern about litigation for adverse obstetric outcome, and a decline in the use of operative vaginal delivery for both cephalic and breech presentations. Optimum management for most cases requires elective cesarean hysterectomy, ideally performed at about 34 weeks' gestation. A multidisciplinary approach produces the best outcomes.
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Affiliation(s)
- Andrew D Hull
- Division of Perinatal Medicine, Department of Reproductive Medicine, University of California San Diego, San Diego, CA 92103-8433, USA
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Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90:1140-6. [PMID: 21488840 DOI: 10.1111/j.1600-0412.2011.01147.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Minna Tikkanen
- Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.
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Esakoff TF, Sparks TN, Kaimal AJ, Kim LH, Feldstein VA, Goldstein RB, Cheng YW, Caughey AB. Diagnosis and morbidity of placenta accreta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:324-327. [PMID: 20812377 DOI: 10.1002/uog.8827] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the diagnostic precision of ultrasound examination for placenta accreta in women with placenta previa and to compare the morbidity associated with accreta to that of previa alone. METHODS This was a retrospective cohort study of all women with previa with/without accreta examined at the University of California, San Francisco (UCSF) between 2002 and 2008. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of ultrasound examination for the diagnosis of accreta were calculated and compared with results from similar studies in the literature. Univariable analysis was used to compare clinical outcomes. RESULTS The PPV of an ultrasound diagnosis of accreta was 68% and NPV was 98%. Ultrasound had a sensitivity of 89.5%. Compared with previa alone, accreta had an odds ratio (OR) of 89.6 (95% CI, 19.44-412.95) for estimated blood loss > 2 L, an OR of 29.6 (95% CI, 8.20-107.00) for transfusion and an OR of 8.52 (95% CI, 2.58-28.11) for length of hospital stay > 4 days. CONCLUSION Placenta accreta is associated with greater morbidity than is placenta previa alone. Ultrasound examination is a good diagnostic test for accreta in women with placenta previa. This is consistent with most other studies in the literature.
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Affiliation(s)
- T F Esakoff
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Unterscheider J, Kamal Y, Breathnach F, Geary MP. Morbidly adherent placentation: conservative management is an acceptable option in selected cases. J OBSTET GYNAECOL 2011; 31:181-3. [PMID: 21281040 DOI: 10.3109/01443615.2010.539721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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119
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Awan N, Bennett MJ, Walters WAW. Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for Women, Sydney. Aust N Z J Obstet Gynaecol 2011; 51:210-5. [PMID: 21631438 DOI: 10.1111/j.1479-828x.2010.01278.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There appears to be a rise in the rate of emergency peripartum hysterectomy (EPH) in the developed world. AIMS To determine the incidence, indications, risk factors, complications and management of EPH in our tertiary level teaching hospital, the Royal Hospital for Women (RHW) in Sydney, over the last decade. METHODS A retrospective analysis was conducted of all cases of EPH performed at the RHW between the years 1999-2008 inclusive. EPH was defined as one performed after 20 weeks gestation for uncontrollable uterine bleeding not responsive to conservative measures occurring at any time after delivery but within the first 6 weeks post-partum. Cases were ascertained via our hospital obstetric database. RESULTS There were 33 EPH among 38,998 births, a rate of 0.85 per 1000 births. Indications for EPH were morbid adherence of the placenta (54.8%), placenta praevia (19.4%), uterine atony (12.9%) and uterine rupture or cervical laceration (9.7%). A significant association between previous caesarean section (CS) and abnormal placentation was confirmed (P=0.011), especially for morbid adherence of the placenta (P=0.004). There was one maternal death. Maternal morbidity was significant, with disseminated intravascular coagulation and urinary tract injury among the most common complications. All women required blood transfusions, and over a quarter were admitted to the intensive care unit. CONCLUSIONS In our series, abnormal placentation causing severe haemorrhage was the commonest indication for EPH. Previous CS is a risk factor for abnormal placentation and particularly for morbid adherence of the placenta. The morbidity associated with EPH is considerable.
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Affiliation(s)
- Nida Awan
- The School of Women's and Children's Health, University of New South Wales Royal Hospital for Women, Sydney, New South Wales, Australia
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Conservative management of placenta accreta in a multiparous woman. J Pregnancy 2010; 2010:329618. [PMID: 21490740 PMCID: PMC3065870 DOI: 10.1155/2010/329618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 08/27/2010] [Indexed: 11/18/2022] Open
Abstract
Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.
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El-Messidi A, Morissette C, Faught W, Oppenheimer L. Application of 3-D Angiography in the Management of Placenta Percreta Treated with Repeat Uterine Artery Embolization. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:775-9. [DOI: 10.1016/s1701-2163(16)34620-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Soliman N, Babar SA. Spontaneous rupture of the uterus secondary to placenta percreta with conservation of the uterus. J OBSTET GYNAECOL 2010; 30:517-8. [DOI: 10.3109/01443615.2010.487575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Placenta accreta is the abnormal adherence of the placenta to the uterine wall. Where placenta accreta is present, the failure of the placenta to separate normally from the uterus after delivery is accompanied by severe postpartum hemorrhage. The best outcomes in placenta accreta are in prenatally diagnosed electively delivered cases. Management should take place in centers with special expertise. All obstetric units should have an obstetric hemorrhage protocol in place.
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Patsouras K, Panagopoulos P, Sioulas V, Salamalekis G, Kassanos D. Uterine rupture at 17 weeks of a twin pregnancy complicated with placenta percreta. J OBSTET GYNAECOL 2010; 30:60-1. [DOI: 10.3109/01443610903315660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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125
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Challenges of major obstetric haemorrhage. Best Pract Res Clin Obstet Gynaecol 2010; 24:353-65. [PMID: 20110196 DOI: 10.1016/j.bpobgyn.2009.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 11/27/2009] [Indexed: 11/15/2022]
Abstract
Every minute of every day, a woman dies in pregnancy or childbirth. The biggest killer is obstetric haemorrhage, the successful treatment of which is a challenge for both the developed and developing worlds. The presence of an attendant at every birth and access to emergency obstetric care are key to reducing maternal morbidity and mortality in the developing world while resource-rich countries have a rising caesarean section rate with its consequential effect on the incidence of abnormal placentation and its link with peripartum hysterectomy. Management of obstetric haemorrhage involves early recognition, assessment and resuscitation. Various methods are available to try to stop the bleeding - from pharmacological methods to aid uterine contraction (e.g., oxytocinon, ergometrine and prostaglandins) to surgical methods to stem the bleeding (e.g., balloon tamponade, compression sutures or arterial ligation). Interventional radiology can be used if placenta accreta is suspected. Cell salvage has been introduced into obstetrics relatively recently in an attempt to reduce allogeneic transfusion.
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Abstract
OBJECTIVE To estimate the effects of prenatal diagnosis and delivery planning on outcomes in patients with placenta accreta. METHODS A review was performed of all patients with pathologically confirmed placenta accreta at the University of California, San Diego Medical Center from January 1990 to April 2008. Cases were divided into those with and without predelivery diagnosis of placenta accreta. Patients with prenatal diagnosis of placenta accreta were scheduled for planned en bloc hysterectomy without removal of the placenta at 34-35 weeks of gestation after betamethasone administration. Maternal and neonatal outcomes were assessed. RESULTS Ninety-nine women with placenta accreta were identified, of whom 62 were diagnosed before delivery and 37 were diagnosed intrapartum. Comparing women with predelivery diagnosis with those diagnosed at the time of delivery, there were fewer units of packed red blood cells transfused (4.7+/-2.2 compared with 6.9+/-1.8 units, P=.02) and a lower estimated blood loss (2,344+/-1.7 compared with 2,951+/-1.8 mL, P=.053), although this trend did not reach statistical significance. Comparison of neonatal outcomes demonstrated a higher rate of steroid administration (65% compared with 16%, P<or=.001), neonatal admission to the neonatal intensive care unit (NICU) (86% compared with 60%, P=.005), and longer neonatal hospital stays (10.7+/-1.9 compared with 6.9+/-2.1 days, P=.006). Length of NICU stay, rates of respiratory distress syndrome, and surfactant administration did not differ between the groups. CONCLUSION Predelivery diagnosis of placenta accreta is associated with decreased maternal hemorrhagic morbidity. Planned delivery at 34-35 weeks of gestation in this cohort did not significantly increase neonatal morbidity. LEVEL OF EVIDENCE II.
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Moores KL, Keriakos RH, Anumba DO, Connor ME, Lashen H. Management challenges of a live 12-week sub-hepatic intra-abdominal pregnancy. BJOG 2009; 117:365-8. [PMID: 20015307 DOI: 10.1111/j.1471-0528.2009.02450.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K L Moores
- ST5 in Obstetrics and Gynaecology, Doncaster Women's Hospital, Doncaster, UK.
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Opinion: Integration of diagnostic and management perspectives for placenta accreta. Aust N Z J Obstet Gynaecol 2009; 49:578-87. [DOI: 10.1111/j.1479-828x.2009.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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BENNETT MJ, TOWNSEND L. Conservative management of clinically diagnosed placenta accreta following vaginal delivery. Aust N Z J Obstet Gynaecol 2009; 49:647-9. [DOI: 10.1111/j.1479-828x.2009.01090.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng MK, Jack GS, Bolton DM, Lawrentschuk N. Placenta Percreta With Urinary Tract Involvement: The Case for a Multidisciplinary Approach. Urology 2009; 74:778-82. [DOI: 10.1016/j.urology.2009.01.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 11/16/2022]
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Gudmundsson S, Dubiel M, Sladkevicius P. Placental morphologic and functional imaging in high-risk pregnancies. Semin Perinatol 2009; 33:270-80. [PMID: 19631087 DOI: 10.1053/j.semperi.2009.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The placenta is vital for fetal growth and development. Improvement in ultrasound and magnetic resonance imaging have improved our understanding of placental morphology that can be important as in the case of placental accrete/percreta. Functional imaging is presently mainly performed by the use of Doppler ultrasound and can give information on placental perfusion, which can be vital for clinical diagnosis. This review summarizes the present knowledge on placental imaging and it's clinical value in high-risk pregnancies.
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Abstract
Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta. The diagnosis is typically made by gray-scale ultrasound and confirmed with magnetic resonance imaging, which may better delineate the extent of placental invasion. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta. Aggressive management of hemorrhage through the use of uterotonics, fluid resuscitation, blood products, planned hysterectomy, and surgical hemostatic agents can be life-saving for these patients. Conservative management, including the use of uterine and placental preservation and subsequent methotrexate therapy or pelvic artery embolization, may be considered when a focal accreta is suspected; however, surgical management remains the current standard of care.
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Affiliation(s)
- Samuel T Bauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Human placental lactogen and color Doppler in predicting expulsion of retained adherent placenta: a new clinical observation. Arch Gynecol Obstet 2009; 280:1041-4. [PMID: 19333613 DOI: 10.1007/s00404-009-1045-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/09/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE To present a new clinical observation made in three cases of retained adherent placenta, a rare obstetrical complication, associated with potentially life-threatening hemorrhage. METHODS Three consecutive cases of retained adherent placenta are presented. RESULTS Diagnosis of placenta increta in two and placenta percreta in one case was established with ultrasound and MRI. Methotrexate 50 mg i.v. (300 mg total dose) and follinic acid 0.1 mg/kg were administered on alternating days, over 12 days. On follow-up, placental perfusion on color Doppler was present up to the point when circulating hPL levels were no longer detectable; this was followed in all cases by spontaneous placental expulsion within 10 days. CONCLUSIONS The observation that both color Doppler and human placental lactogen can be used to monitor response to therapy and predict placental expulsion should be evaluated in future cases of retained adherent placenta.
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Henrich W, Surbek D, Kainer F, Grottke O, Hopp H, Kiesewetter H, Koscielny J, Maul H, Schlembach D, von Tempelhoff GF, Rath W. Diagnosis and treatment of peripartum bleeding. J Perinat Med 2009; 36:467-78. [PMID: 18783309 DOI: 10.1515/jpm.2008.093] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Severe peripartum hemorrhage (PPH) contributes to maternal morbidity and mortality and is one of the most frequent emergencies in obstetrics, occurring at a prevalence of 0.5-5.0%. Detection of antepartum risk factors is essential in order to implement preventive measures. Proper training of obstetric staff and publication of recommendations and guidelines can effectively reduce the frequency of PPH and its resulting morbidity and mortality. Therefore, an interdisciplinary expert committee was formed, with members from Germany, Austria, and Switzerland, to summarize recent scientific findings. An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.
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Affiliation(s)
- Wolfgang Henrich
- Department of Obstetrics, Charité-University Medicine Berlin, 13353 Berlin, Germany.
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Wong HS, Zuccollo J, Tait J, Pringle KC. Placenta accreta in the first trimester of pregnancy: sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:100-103. [PMID: 18454480 DOI: 10.1002/jcu.20487] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In a case of histologically confirmed placenta increta, decidual protrusion into the myometrium was observed sonographically at 6 weeks' gestation, corresponding to placental protrusion from a disrupted placental-uterine wall interface seen in the later part of the first and second trimester. It is hypothesized that the histologic finding of decidual scarcity in placenta accreta is not a cause but rather an end result of the recruitment of trophoblasts across the decidual-placental interface in a maternal attempt at healing and/or repair in the presence of uterine injury, disease, or malformation that accounts for the associated factors and course of the condition.
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Affiliation(s)
- Hong Soo Wong
- Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Otago, Wellington South, New Zealand
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Al-Serehi A, Mhoyan A, Brown M, Benirschke K, Hull A, Pretorius DH. Placenta accreta: an association with fibroids and Asherman syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1623-1628. [PMID: 18946102 DOI: 10.7863/jum.2008.27.11.1623] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Placenta accreta is a life-threatening problem that is rising in incidence in the developed world. The increased risk of placenta accreta in women with placenta previa and 1 or more prior cesarean deliveries is well established and prompts careful sonographic evaluation. Our objective was to emphasize that accreta is also identified at sites other than cesarean scars. METHODS Two cases of placenta accreta without placenta previa seen in association with uterine scarring from myomectomy and uterine fibroids are described. RESULTS The sonographic and magnetic resonance imaging findings of accreta are reviewed in the classic setting of prior cesarean deliveries as well as myomectomy and uterine fibroids. CONCLUSIONS We suggest that when the placenta overlies any uterine abnormality, a careful search for invasive placentation is warranted.
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Affiliation(s)
- Amal Al-Serehi
- Department of Maternal-Fetal Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada
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Kainer F, Hasbargen U. Emergencies associated with pregnancy and delivery: peripartum hemorrhage. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:629-38. [PMID: 19471625 DOI: 10.3238/arztebl.2008.0629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 07/14/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Peripartum hemorrhage is one of the leading causes of maternal death worldwide (25%). METHODS Selective literature review, including international guidelines, for assessment of the causes and optimal management of this condition. RESULTS The major causes of hemorrhage are uterine atony, placenta previa, and abruptio placentae. The diagnosis of hemorrhage is suspected from its clinical manifestations and confirmed by ultrasonography. In placenta previa, the placenta is implanted in the lower uterine segment and may cover the internal cervical os. Placenta previa is more common in older and multiparous mothers, as well as in mothers who have previously undergone a cesarean section. Placental abruption is defined as separation of the placenta from the uterine wall before delivery of the infant. The risk factors for this condition include preeclampsia, advanced maternal age, and trauma. When it presents with manifestations of acute blood loss, premature abruption placentae must be diagnosed rapidly and treated without delay to save the life of the mother and child. A rare, but highly lethal, cause of bleeding is amniotic fluid embolism, which manifests itself with sudden and unexplained peripartum respiratory distress and cardiovascular collapse. Amniotic fluid embolism is associated with high fetal and maternal mortality (20% and 60% to 80%, respectively) even when it is optimally treated. DISCUSSION Peripartum hemorrhage is an important source of maternal and fetal morbidity and mortality. The prognosis for both mother and child can be markedly improved if the risk factors for hemorrhage are recognized and the problem is treated rapidly and appropriately when it arises.
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Abstract
PURPOSE OF REVIEW Haemorrhage remains a cause of significant maternal morbidity and mortality. This review summarizes the prevention, management and treatment of obstetric haemorrhage and highlights recent advances and developments. RECENT FINDINGS Postpartum haemorrhage is the most common cause of major obstetric haemorrhage and is usually due to uterine atony. Pharmacological treatment has not altered much in recent years with oxytocin and ergometrine remaining first-line options. Although controversy surrounds its advantages over other uterotonics, the use of misoprostol has been increasing, especially in resource-poor countries. Placenta accreta is becoming more common, a sequelae to the rising caesarean section rate. Interventional radiology may reduce blood loss in these cases. Uterine compression sutures, intrauterine tamponade balloons and cell salvage have all made their debut in the last decade. SUMMARY Accurate diagnosis and appropriate management of obstetric haemorrhage can reduce maternal morbidity and mortality. This review outlines the current evidence.
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Judlin P, Thiebaugeorges O. The ligation of hypogastric arteries is a safe alternative to balloon occlusion to treat abnormal placentation. Am J Obstet Gynecol 2008; 199:e11; author reply e12-3. [PMID: 18456224 DOI: 10.1016/j.ajog.2008.03.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
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Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol 2008; 35:519-29, x. [PMID: 18952019 DOI: 10.1016/j.clp.2008.07.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An unintended consequence of the rising cesarean section rate is abnormal placentation in subsequent pregnancies, leading to the clinical complications of placenta accreta and cesarean scar pregnancies. Both of these clinical entities are associated with high rates of maternal morbidity and mortality. This article reviews the potential mechanisms by which uterine scarring may lead to abnormal trophoblast invasion, the association of cesarean section with placenta accreta and scar pregnancies, current management, and suggestions for future research to reduce the incidence of these potentially devastating complications of pregnancy.
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Affiliation(s)
- Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 622 West 168th Street, PH 16-66, Columbia University, New York, NY 10032, USA.
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Antenatally Ultrasound-impressed Placenta Percreta Complicated with Massive Hemorrhage Despite a Combinational Arterial Embolization and Two-stage Surgery. J Med Ultrasound 2008. [DOI: 10.1016/s0929-6441(09)60008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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