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Tan SEG, Jobling TW, Wallace EM, Mcneilage LJ, Manolitsas T, Hodges RJ. Surgical management of placenta accreta: a 10-year experience. Acta Obstet Gynecol Scand 2013; 92:445-50. [DOI: 10.1111/aogs.12075] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/18/2012] [Indexed: 11/24/2022]
Affiliation(s)
- SE Grace Tan
- Maternal Fetal Medicine Unit; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | - Thomas W Jobling
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | | | - L Jane Mcneilage
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | - Thomas Manolitsas
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
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Panici PB, Anceschi M, Borgia ML, Bresadola L, Masselli G, Parasassi T, Perrone G, Brunelli R. Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta. J Matern Fetal Neonatal Med 2012; 25:2512-6. [DOI: 10.3109/14767058.2012.712566] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ballas J, Hull AD, Saenz C, Warshak CR, Roberts AC, Resnik RR, Moore TR, Ramos GA. Preoperative intravascular balloon catheters and surgical outcomes in pregnancies complicated by placenta accreta: a management paradox. Am J Obstet Gynecol 2012; 207:216.e1-5. [PMID: 22831808 DOI: 10.1016/j.ajog.2012.06.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/05/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of the study was to compare outcomes between patients who did and did not receive preoperative uterine artery balloon catheters in the setting placenta accreta. STUDY DESIGN This was a retrospective case-control study of patients with placenta accreta from 1990 to 2011. RESULTS Records from 117 patients with pathology-proven accreta were reviewed. Fifty-nine patients (50.4%) had uterine artery balloons (UABs) placed preoperatively. The mean estimated blood loss (EBL) was lower (2165 mL vs 2837 mL; P = .02) for the group that had UABs compared with the group that did not. There were more cases with an EBL greater than 2500 mL and massive transfusions of packed red blood cells (>6 units) in the group that did not have UABs. Percreta was diagnosed more often on final pathology in the group with UABs. Surgical times did not differ between the 2 groups. Two patients (3.3%) had complications related to the UABs. CONCLUSION Preoperative placement of UABs is relatively safe and is associated with a reduced EBL and fewer massive transfusions compared with a group without UABs.
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Omar HR, Karlnoski R, Mangar D, Patel R, Hoffman M, Camporesi E. Staged Endovascular Balloon Occlusion versus Conventional Approach for Patients with Abnormal Placentation: A Literature Review. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hesham R. Omar
- Department of Internal Medicine, Mercy Hospital and Medical Center, Chicago, Illinois
| | - Rachel Karlnoski
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Devanand Mangar
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Rita Patel
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Mitchel Hoffman
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Enrico Camporesi
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
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CLAUSEN CAROLINE, STENSBALLE JAKOB, ALBRECHTSEN CHARLOTTEK, HANSEN MARCA, LÖNN LARS, LANGHOFF-ROOS JENS. Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta. Acta Obstet Gynecol Scand 2012; 92:386-91. [DOI: 10.1111/j.1600-0412.2012.01451.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dilauro M, Dason S, Athreya S. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis. Clin Radiol 2012; 67:515-20. [DOI: 10.1016/j.crad.2011.10.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 10/14/2022]
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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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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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Abstract
Hemorrhage remains as one of the top 3 obstetrics related causes of maternal mortality, with most deaths occurring within 24-48 hours of delivery. Although hemorrhage related maternal mortality has declined globally, it continues to be a vexing problem. More specifically, the developing world continue to shoulder a disproportionate share of hemorrhage related deaths (99%) compared with industrialized nations (1%). Given the often preventable nature of death from hemorrhage, the cornerstone of effective mortality reduction involves risk factor identification, quick diagnosis, and timely management. In this monograph we will review the epidemiology, etiology, and preventative measures related to maternal mortality from hemorrhage.
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Affiliation(s)
- Sina Haeri
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicineand Texas Children’s Hospital, 1709 Dryden Street, Houston, TX 77030, USA.
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Interventional radiology in the treatment of morbidly adherent placenta: are we asking the right questions? Int J Obstet Anesth 2011; 20:279-81. [DOI: 10.1016/j.ijoa.2011.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/06/2011] [Indexed: 11/24/2022]
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Sadashivaiah J, Wilson R, Thein A, McLure H, Hammond CJ, Lyons G. Role of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta. Int J Obstet Anesth 2011; 20:282-7. [PMID: 21852107 DOI: 10.1016/j.ijoa.2011.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 06/06/2011] [Accepted: 06/18/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. METHODS We have reviewed our experience with bilateral prophylactic uterine artery balloon occlusion in the management of women with suspected placenta accreta. Thirteen women at high risk of major haemorrhage due to placenta praevia or suspected placenta accreta were retrospectively studied. Uterine artery balloons were placed prophylactically under neuraxial anaesthesia in the angiography suite followed by caesarean delivery in the obstetric operating theatre. RESULTS Intraoperative blood loss and transfusion requirements were low in our case series. There were no hysterectomies or admissions to the intensive care unit. Fetal bradycardia necessitating immediate caesarean delivery occurred in two women (15.4%). CONCLUSION In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.
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Affiliation(s)
- J Sadashivaiah
- Department of Obstetric Anaesthesia, St. James' University Hospital, Leeds, UK.
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Esakoff TF, Handler SJ, Granados JM, Caughey AB. PAMUS: placenta accreta management across the United States. J Matern Fetal Neonatal Med 2011; 25:761-5. [PMID: 21843108 DOI: 10.3109/14767058.2011.598585] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is lack of consensus regarding the optimal strategy for management of abnormal placentation. We set out to determine the actual practices of providers across the United States (U.S.). METHODS This was a cross-sectional survey of maternal-fetal medicine providers in the U.S. registered with the Society for Maternal Fetal Medicine (SMFM). Questions regarding management strategies for placenta accreta were addressed by the survey. Both univariable and multivariable analyses were performed to determine if a relationship between demographic factors and management strategies exists. RESULTS Approximately 64% of responders were male and 62% had been in practice less than or equal to 20 years. The respondents represented all the major regions of the U.S. and the majority had performed one to five cases in the past year. The gestational age at delivery varied by both the number of years in practice and by geographic location. About 35% of providers report the use of ureteral stents and 36% of providers use internal femoral artery balloons though this varied by region. Regional differences and recent experience play a role in whether to attempt placental removal first. Though the majority of providers believe hysterectomy is the only management option for accreta, 32% of providers have attempted conservative management. CONCLUSIONS There is wide variation in the actual practices of physicians in the U.S. with regard to management of placenta accreta.
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Affiliation(s)
- Tania F Esakoff
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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114
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Jolley JA, Nageotte MP, Wing DA, Shrivastava VK. Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners. J Matern Fetal Neonatal Med 2011; 25:756-60. [DOI: 10.3109/14767058.2011.594467] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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115
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Jeffrey A, Clark V. The anaesthetic management of caesarean section in the interventional radiology suite. Curr Opin Anaesthesiol 2011; 24:439-44. [DOI: 10.1097/aco.0b013e32834811d4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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116
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Barth WH, Kwolek CJ, Abrams JL, Ecker JL, Roberts DJ. Case records of the Massachusetts General Hospital. Case 23-2011. A 40-year-old pregnant woman with placenta accreta who declined blood products. N Engl J Med 2011; 365:359-66. [PMID: 21793748 DOI: 10.1056/nejmcpc1103561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- William H Barth
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, and the Harvard Medical School, Boston, USA
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Takeda A, Koyama K, Imoto S, Mori M, Nakano T, Nakamura H. Temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy for cervical myoma. Eur J Obstet Gynecol Reprod Biol 2011; 158:319-24. [PMID: 21658835 DOI: 10.1016/j.ejogrb.2011.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/05/2011] [Accepted: 05/13/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our initial experience with temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy (LAVH) for cervical myoma. STUDY DESIGN Thirteen patients with cervical myoma were treated by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries from September 2008 to October 2010. Preoperative evaluation of cervical myoma was made by ultrasonography, magnetic resonance imaging and three-dimensional computerized tomographic angiography, and curative management was made by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. RESULTS Nine patients with extracervical myoma and 4 patients with intracervical myoma were successfully managed by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. For extracervical myomas, the median extirpated uterine weight was 591 g (range 360-1010 g). Median duration required for placement of balloon occlusion catheter was 60 min (range 47-69 min). Median surgical duration was 98.5 min (range 77-149 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 66 min (range 42-98 min). The median estimated blood loss was 355 mL (range 50-1950 mL). For intracervical myomas, the median extirpated uterine weight was 513 g (range 302-710 g). Median duration required for placement of balloon occlusion catheter was 63 min (range 42-76 min). Median surgical duration was 96.5 min (range 92-100 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 49 min (range 44-60 min). The median estimated blood loss was 210 mL (range 150-650 mL). Transfusion of preoperatively donated autologous blood negated the need for bank blood. There were no major interventional radiological and surgical complications in the present case series. CONCLUSIONS Temporary endovascular balloon occlusion of the bilateral internal iliac arteries is a feasible minimally invasive alternative to control hemorrhage during LAVH for cervical myoma.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, 5-161 Maebata-cho, Tajimi, Gifu 507-8522, Japan.
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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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Ganguli S, Stecker MS, Pyne D, Baum RA, Fan CM. Uterine Artery Embolization in the Treatment of Postpartum Uterine Hemorrhage. J Vasc Interv Radiol 2011; 22:169-76. [DOI: 10.1016/j.jvir.2010.09.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 09/17/2010] [Accepted: 09/20/2010] [Indexed: 11/15/2022] Open
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Shaw P, Duncan A, Vouyouka A, Ozsvath K. Radiation exposure and pregnancy. J Vasc Surg 2011; 53:28S-34S. [DOI: 10.1016/j.jvs.2010.05.140] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 05/24/2010] [Accepted: 05/28/2010] [Indexed: 11/27/2022]
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Firdous Z, Aziz N. Internal IIiac Artery Occlusion Balloon Catheters to Minimize Blood Loss in Adherent Placenta: A Retrospective Cohort Study. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10016-1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Adherent placenta is a rare but life- and fertility-threatening condition, with a rapid increase in incidence in this decade. Cesarean hysterectomy, the traditional management, is associated with very high morbidity due to massive blood loss and adjacent organ damage. The objective was to study the effect of preoperative internal iliac artery balloon catheter placement as a means of reducing morbidity.
Methods
Adherent placenta cases were identified using hospital database over a 9 years period from 2001 to 2009 at Fernandez hospital, a tertiary perinatal center with 5000 deliveries annually. Mothers who had preoperative internal iliac artery balloon placements were compared with those who did not have. Maternal morbidity was assessed in the form of intraoperative blood loss, total units of blood products transfused, mean operative time, length of postoperative hospital stay, use of adjuvant procedures (for control of hemorrhage), adjacent organ damage, cardiac arrest, and maternal mortality.
Results
Forty-one subjects with a diagnosis of adherent placenta were identified out of 32,354 deliveries (incidence of 1:789) and 27 of these had peripartum hysterectomy. Six had preoperative internal iliac artery balloons placement before hysterectomy (study group) and 21 had hysterectomy alone (control group). Significant difference was found in mean amount of blood loss (p = 0.002) and in mean number of blood products given (p = 0.04). No statistically significant difference was found in mean operative time and length of postoperative hospital stay. There were four subjects who had adjacent organ damage, two had cardiac arrest, two required recombinant factor VIIa in the control group when compared with none in the study group.
Conclusion
Preoperative placement of internal iliac artery occlusion balloon catheters reduced morbidity by minimizing blood loss and adjacent organ damage.
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Thon S, McLintic A, Wagner Y. Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series. Int J Obstet Anesth 2010; 20:64-70. [PMID: 21112764 DOI: 10.1016/j.ijoa.2010.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/15/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endovascular occlusion balloon catheters can be placed preoperatively in internal iliac vessels of patients perceived to be at risk of major obstetric haemorrhage during caesarean section. Their safety and efficacy remains undefined, and we report our experience of 14 patients over four years. METHODS We undertook a chart review of all patients who had undergone prophylactic internal iliac balloon catheters before caesarean section in our institution. RESULTS Balloon catheters were placed in 14 and inflated in 11 (78.6%) patients. Five of the 14 patients (35.7%) underwent emergency balloon catheter placement before unscheduled caesarean section. Surgeons reported that balloon inflation provided favourable surgical conditions in six of 11 cases (54.5%), no improvement in four and was not required in one due to lack of pathology. Within the balloon-inflated group, nine patients underwent a hysterectomy: two electively, the remaining seven because of perioperative confirmation of placenta accreta or for control of bleeding. One patient suffered massive haemorrhage leading to three perioperative hypovolaemic cardiac arrests. Four patients required intervention to avoid complications related to balloon catheters: three minor and one related to catheter displacement and prolonged resuscitation. CONCLUSION Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management.
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Affiliation(s)
- S Thon
- Department of Anaesthetics, Auckland City Hospital, Auckland, New Zealand
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The role of interventional radiology in obstetric hemorrhage. Cardiovasc Intervent Radiol 2010; 33:887-95. [PMID: 20464555 DOI: 10.1007/s00270-010-9864-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 01/20/2010] [Indexed: 12/12/2022]
Abstract
Obstetric hemorrhage remains a major cause of maternal morbidity and mortality worldwide. Traditionally, in cases of obstetric hemorrhage refractory to conservative treatment, obstetricians have resorted to major surgery with the associated risks of general anesthesia, laparotomy, and, in the case of hysterectomy, loss of fertility. Over the past two decades, the role of pelvic arterial embolization has evolved from a novel treatment option to playing a key role in the management of obstetric hemorrhage. To date, interventional radiology offers a minimally invasive, fertility-preserving alternative to conventional surgical treatment. We review current literature regarding the role of interventional radiology in postpartum hemorrhage, abnormal placentation, abortion, and cervical ectopic pregnancy. We discuss techniques, success rates, and complications.
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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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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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Salazar GM, Petrozza JC, Walker TG. Transcatheter Endovascular Techniques for Management of Obstetrical and Gynecologic Emergencies. Tech Vasc Interv Radiol 2009; 12:139-47. [DOI: 10.1053/j.tvir.2009.08.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Teo T, Law Y, Tay K, Tan B, Cheah F. Use of magnetic resonance imaging in evaluation of placental invasion. Clin Radiol 2009; 64:511-6. [DOI: 10.1016/j.crad.2009.02.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 01/20/2009] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
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Wang LM, Wang PH, Chen CL, Au HK, Yen YK, Liu WM. Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report. J Obstet Gynaecol Res 2009; 35:379-84. [DOI: 10.1111/j.1447-0756.2008.00936.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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130
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Abstract
Obstetric hemorrhage is often a sudden, life-threatening event. Successful management hinges on both preoperative preparation if hemorrhage is anticipated as well as knowledge of interventions. Uterine-sparing techniques, such as aggressive and early use of uterotonics, balloon tamponade, uterine compression sutures, arterial ligation, and selective arterial embolization, may be used to control hemorrhage. If these techniques are not adequate, the decision must be made to proceed with hysterectomy. The type of hysterectomy (subtotal vs. total) must be individualized to each patient. Hemostatic agents may be particularly useful in patients who have excessive blood loss from raw tissue surfaces.
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Affiliation(s)
- Monjri Shah
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA
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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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