201
|
Panigrahi AK, Yeaton-Massey A, Bakhtary S, Andrews J, Lyell DJ, Butwick AJ, Goodnough LT. A Standardized Approach for Transfusion Medicine Support in Patients With Morbidly Adherent Placenta. Anesth Analg 2017. [DOI: 10.1213/ane.0000000000002050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
202
|
Haidar ZA, Papanna R, Sibai BM, Tatevian N, Viteri OA, Vowels PC, Blackwell SC, Moise KJ. Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa? Am J Obstet Gynecol 2017; 217:202.e1-202.e13. [PMID: 28400306 DOI: 10.1016/j.ajog.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. OBJECTIVE The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. STUDY DESIGN A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. RESULTS The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index (14.2 ± 3.8) were higher in morbidly adherent placenta (P < .001); (4) area under the receiver-operating characteristic curve for the vascular and vascular flow indices were 0.99 and 0.97, respectively; (5) the vascular index ≥21 predicted morbidly adherent placenta with a sensitivity and a specificity of 95% (95% confidence interval, 88.2-96.9) and 91%, respectively (95% confidence interval, 87.5-92.4), 92% positive predictive value (95% confidence interval, 85.5-94.3), 90% negative predictive value (95% confidence interval, 79.9-95.3), positive likelihood ratio of 10.55 (95% confidence interval, 7.06-12.75), and negative likelihood ratio of 0.05 (95% confidence interval, 0.03-0.13); and (6) for the severe morbidly adherent placenta, 2-dimensional ultrasound had a sensitivity of 33.3% (95% confidence interval, 11.3-64.6), a specificity of 81.8% (95% confidence interval, 47.8-96.8), a positive predictive value of 66.7% (95% confidence interval, 24.1-94.1), a negative predictive value of 52.9% (95% confidence interval, 28.5-76.1), a positive likelihood ratio of 1.83 (95% confidence interval, 0.41-8.11), and a negative likelihood ratio of 0.81 (95% confidence interval, 0.52-1.26). A vascular index ≥31 predicted the diagnosis of a severe morbidly adherent placenta with a 100% sensitivity (95% confidence interval, 72-100), a 90% specificity (95% confidence interval, 81.7-93.8), an 88% positive predictive value (95% confidence interval, 55.0-91.3), a 100% negative predictive value (95% confidence interval, 90.9-100), a positive likelihood ratio of 10.0 (95% confidence interval, 3.93-16.13), and a negative likelihood ratio of 0 (95% confidence interval, 0-0.34). Intrarater and interrater agreements were 94% (P < .001) and 93% (P < .001), respectively. CONCLUSION The vascular index accurately predicts the morbidly adherent placenta in patients with placenta previa. In addition, 3-dimensional power Doppler vascular and vascular flow indices were more predictive of severe cases of morbidly adherent placenta compared with 2-dimensional ultrasound. This objective technique may limit the variations in diagnosing morbidly adherent placenta because of the subjectivity of 2-dimensional ultrasound interpretations.
Collapse
|
203
|
|
204
|
Pathologically Diagnosed Placenta Accreta and Hemorrhagic Morbidity in a Subsequent Pregnancy. Obstet Gynecol 2017; 129:321-326. [PMID: 28079779 DOI: 10.1097/aog.0000000000001843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify the relationship between pathologically diagnosed placenta accreta and risk of major morbidity in a subsequent pregnancy. METHODS We conducted a retrospective cohort study of patients with pathologically diagnosed placenta accreta in an index pregnancy who returned with a subsequent pregnancy at our academic center from 2007 to 2015. Subsequent delivery outcomes included minor, major, or no morbidity. Minor morbidity included estimated blood loss 500-1,500 cc for vaginal and 1,000-1,500 cc for cesarean delivery, transfusion of one to three units of red cells, and minor surgical procedures. Major morbidity included estimated blood loss greater than 1,500 cc, transfusion of greater than three units of red cells, uterine artery embolization, unplanned laparotomy, or hysterectomy. RESULTS Three hundred thirty-nine patients with pathologically diagnosed accreta did not undergo hysterectomy, and 39 (11.5%) of these returned for subsequent delivery. Of these, 14 (36%) had accretas that had been identified clinically in the index pregnancy. Twenty-one (54%) experienced morbidity in the index pregnancy, 16 of these (76%) minor and five (24%) major. Of patients without morbidity in the first pregnancy, none experienced major morbidity in a subsequent pregnancy, whereas 6 of 21 (29%) with any index morbidity had a subsequent major morbid outcome (P=.02). Of those with a morbid index delivery, 25% had either a clinical or pathologic accreta diagnosis at follow-up compared with none of those who index accreta was nonmorbid (P=.05). CONCLUSION Risk for major hemorrhagic morbidity after a prior pathologically diagnosed accreta depends on the clinical context. Preparation for major blood loss is indicated after any prior pregnancy complicated by hemorrhage or treatment of retained placenta with a pathologic accreta.
Collapse
|
205
|
Singh D, Kaur L. When a cesarean section scar is more than an innocent bystander in a subsequent pregnancy: Ultrasound to the rescue. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:319-327. [PMID: 28440856 DOI: 10.1002/jcu.22485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/17/2017] [Accepted: 03/13/2017] [Indexed: 06/07/2023]
Abstract
Over the years, cesarean section has played a pivotal role in reducing maternal and perinatal morbidity and mortality. With the rising trend of this surgery, a substantial number of pregnant women have a cesarean section scar. The scar can serve as the abode of grave conditions in subsequent pregnancies, namely cesarean scar pregnancy, morbidly adherent placenta, and scar dehiscence. Sonography has emerged as a robust tool for the diagnosis of these potentially life-threatening conditions. This review highlights the key sonographic features of various complications that can occur at the cesarean scar site in subsequent pregnancies. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:319-327, 2017.
Collapse
Affiliation(s)
- Divya Singh
- Prime Imaging and Prenatal Diagnostics, SCO 155, Sector 24 D, Chandigarh, India, 160023
| | - Ladbans Kaur
- Prime Imaging and Prenatal Diagnostics, SCO 155, Sector 24 D, Chandigarh, India, 160023
| |
Collapse
|
206
|
Rac MWF, McIntire DD, Wells CE, Moschos E, Twickler DD. Cervical Length in Patients at Risk for Placenta Accreta. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1431-1436. [PMID: 28339114 DOI: 10.7863/ultra.16.05059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth. METHODS We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used. RESULTS A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n = 43 [34%]) and without (n = 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32- to 34-week ultrasound examinations (mean ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P = .001). However, these findings did not correlate with the degree of invasion (P = .3), or higher rates of vaginal bleeding and preterm labor (P = .19) resulting in preterm birth before 36 weeks (P = .64). CONCLUSIONS Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks.
Collapse
Affiliation(s)
- Martha W F Rac
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Donald D McIntire
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - C Edward Wells
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Elysia Moschos
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Diane D Twickler
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
207
|
Colmorn LB, Krebs L, Klungsøyr K, Jakobsson M, Tapper AM, Gissler M, Lindqvist PG, Källen K, Gottvall K, Bordahl PE, Bjarnadóttir RI, Langhoff-Roos J. Mode of first delivery and severe maternal complications in the subsequent pregnancy. Acta Obstet Gynecol Scand 2017; 96:1053-1062. [DOI: 10.1111/aogs.13163] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lotte B. Colmorn
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - Lone Krebs
- Department of Obstetrics and Gynecology; Holbaek University Hospital; Holbaek Denmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Medical Birth Register of Norway; Norwegian Institute of Public Health; Bergen Norway
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology; University of Helsinki; Helsinki University Central Hospital; Helsinki Finland
| | - Anna-Maija Tapper
- Department of Gynecology and Pediatrics; University of Helsinki; Helsinki University Central Hospital; Helsinki Finland
- Department of Gynecology and Obstetrics; Hyvinkää Hospital; Helsinki Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare; Helsinki Finland
- Department of Neurobiology, Care Sciences and Society; Division of Family Medicine; Karolinska Institute; Stockholm Sweden
| | - Pelle G. Lindqvist
- Department of Clinical Science Intervention and Technology (CLINTEC); Karolinska Institute and Department of Gynecology and Obstetrics; Karolinska University Hospital; Stockholm Sweden
| | - Karin Källen
- Department of Evaluation and Analysis; Epidemiology and Methodological Support Unit; National Board of Health and Welfare; Stockholm Sweden
- Department of Obstetrics and Gynecology; Institution of Clinical Sciences; University of Lund; Lund Sweden
| | - Karin Gottvall
- Department of Evaluation and Analysis; Epidemiology and Methodological Support Unit; National Board of Health and Welfare; Stockholm Sweden
| | - Per E. Bordahl
- Department of Obstetrics and Gynecology; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science; University of Bergen; Bergen Norway
| | | | - Jens Langhoff-Roos
- Department of Obstetrics; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
208
|
Abstract
PURPOSE To confirm reduced expression of soluble fms-like tyrosine kinase 1 (sFlt-1) in accreta/increta. METHODS Formalin-fixed tissue sections from 11 peripartum hysterectomies with invasive placentation and 5 controls were stained for sFlt-1. Stain intensity was scored in selected 100× microscopic fields. We compared sFlt-1 expression in invasive areas among cases, non-invasive areas among cases and areas from control placentas. RESULTS Chorionic villi displayed significantly decreased sFlt-1 expression in invasive areas of cases compared to control placentas (p = 0.003), as well as in non-invasive areas of cases compared to control placentas (p = 0.01). There was no difference in sFlt-1 expression between invasive and non-invasive areas among cases. CONCLUSIONS Expression of sFlt-1 is diminished in villous trophoblasts from patients with placenta increta or percreta. Local depth of invasion was not associated with sFlt-1 expression, suggesting a more global abnormality across the implantation site rather than localized to areas of histologic invasion.
Collapse
|
209
|
Abstract
OBJECTIVE To characterize where women at risk for and undergoing peripartum hysterectomy delivered in terms of obstetric volume and procedural experience. METHODS We used data from the Perspective database to retrospectively evaluate trends in peripartum hysterectomy and deliveries at high risk of peripartum hysterectomy based on placenta previa and prior cesarean delivery delivered from 2006 through 2014. Hospitals were categorized two separate ways for the analysis: 1) into five roughly equal quintiles based on annualized delivery volume and 2) by the mean number of hysterectomies performed annually over the study period. RESULTS Four thousand eight hundred eleven hysterectomies occurred among 5,388,486 deliveries in 500 hospitals over the study period. The peripartum hysterectomy rate increased from 81.4 per 100,000 deliveries in 2006 to 98.4 in 2014. The prevalence rate of placenta previa in the setting of previous cesarean delivery also increased over the study period. Between 2006-2008 and 2012-2014, peripartum hysterectomy decreased in the lowest delivery volume quintile and increased in the highest delivery volume quintile (-14.9/100,000 deliveries, 95% confidence interval [CI] -25.6 to -4.2 and +35.4/100,000 deliveries, 95% CI 20.3-50.5, respectively). Similarly, hospitals performing high rates of hysterectomies saw the largest increase over the study period. CONCLUSION With peripartum hysterectomy rates increasing in the population, hospitals with high delivery volumes and high rates of hysterectomies saw the largest increases in peripartum hysterectomy rates. These trends support that improved referral practices and uptake of evidence-based recommendations may be occurring.
Collapse
|
210
|
Shamshirsaz AA, Fox KA, Erfani H, Clark SL, Salmanian B, Baker BW, Coburn M, Shamshirsaz AA, Bateni ZH, Espinoza J, Nassr AA, Popek EJ, Hui SK, Teruya J, Tung CS, Jones JA, Rac M, Dildy GA, Belfort MA. Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time. Am J Obstet Gynecol 2017; 216:612.e1-612.e5. [PMID: 28213059 DOI: 10.1016/j.ajog.2017.02.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Morbidly adherent placenta (MAP) is a serious obstetric complication causing mortality and morbidity. OBJECTIVE To evaluate whether outcomes of patients with MAP improve with increasing experience within a well-established multidisciplinary team at a single referral center. STUDY DESIGN All singleton pregnancies with pathology-confirmed MAP (including placenta accreta, increta, or percreta) managed by a multidisciplinary team between January 2011 and August 2016 were included in this retrospective study. Turnover of team members was minimal, and cases were divided into 2 time periods so as to compare 2 similarly sized groups: T1 = January 2011 to April 2014 and T2 = May 2014 to August 2016. Outcome variables were estimated blood loss, units of red blood cell transfused, volume of crystalloid transfused, massive transfusion protocol activation, ureter and bowel injury, and neonatal birth weight. Comparisons and adjustments were made by use of the Student t test, Mann-Whitney U test, χ2 test, analysis of covariance, and multinomial logistic regression. RESULTS A total of 118 singleton pregnancies, 59 in T1 and 59 in T2, were managed during the study period. Baseline patient characteristics were not statistically significant. Forty-eight of 59 (81.4%) patients in T1 and 42 of 59 (71.2%) patients in T2 were diagnosed with placenta increta/percreta. The median [interquartile range] estimated blood loss (T1: 2000 [1475-3000] vs T2: 1500 [1000-2700], P = .04), median red blood cell transfusion units (T1: 2.5 [0-7] vs T2: 1 [0-4], P = .02), and median crystalloid transfusion volume (T1: 4200 [3600-5000] vs T2: 3400 [3000-4000], P < .01) were significantly less in T2. Also, a massive transfusion protocol was instituted more frequently in T1: 15/59 (25.4%) vs 3/59 (5.1%); P < .01. Neonatal outcomes and surgical complications were similar between the 2 groups. CONCLUSION Our study shows that patient outcomes are improved over time with increasing experience within a well-established multidisciplinary team performing 2-3 cases per month. This suggests that small, collective changes in team dynamics lead to continuous improvement of clinical outcomes. These findings support the development of centers of excellence for MAP staffed by stable, core multidisciplinary teams, which should perform a significant number of these procedures on an ongoing basis.
Collapse
Affiliation(s)
- Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
| | - Karin A Fox
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Hadi Erfani
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Steven L Clark
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Bahram Salmanian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - B Wycke Baker
- Department of Anesthesiology and Obstetric and Gynecologic Anesthesiology, Texas Children's Hospital, Houston, TX
| | - Michael Coburn
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Amir A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Zhoobin H Bateni
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jimmy Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Ahmed A Nassr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut Egypt
| | - Edwina J Popek
- Department of Pathology & Transfusion Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Shiu-Ki Hui
- Department of Pathology & Transfusion Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jun Teruya
- Department of Pathology & Transfusion Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Celestine Shauching Tung
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jeffery A Jones
- Department of Urology, Baylor College of Medicine, Houston, TX
| | - Martha Rac
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Gary A Dildy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Michael A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| |
Collapse
|
211
|
Solórzano Vázquez J, Ruvalcaba Ortiz G, Hernández Higareda S, Morales de Avila C. Pérdida sanguínea y uso de hemoderivados en casos de cesárea e histerectomía por acretismo placentario. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
212
|
Angileri SA, Mailli L, Raspanti C, Ierardi AM, Carrafiello G, Belli AM. Prophylactic occlusion balloon placement in internal iliac arteries for the prevention of postpartum haemorrhage due to morbidly adherent placenta: short term outcomes. Radiol Med 2017; 122:798-806. [PMID: 28551762 DOI: 10.1007/s11547-017-0777-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate outcomes of uterine conserving surgery with occlusion balloon technique. A critical review of the complications was performed. MATERIALS AND METHODS Between 2010 and 2016, pregnant women, with a prenatal diagnosis of morbidly adherent placenta (MAP), were treated with occlusion balloon catheters in both internal iliac arteries. Parameters such as need for hysterectomy, incidence of PPH, grade of MAP, estimated blood loss during delivery (EBL) and transfusion requirements, mean recovery time and duration of the balloon inflation, were collected and reviewed. Complications requiring further management were analysed. RESULTS Thirty-seven women with MAP underwent prophylactic occlusion balloon placement (POBC). Mean recovery was 4.48 days (range 2-10). Catheters were successfully positioned and balloons inflated in obstetric theatre following caesarean delivery in 100% of the cases. The uterus was conserved in every case. The MAP grades were 20 percreta, 3 increta and 14 accreta. The EBL was not statistically different between the different grades of placentation. There was a statistically significant association in the number of patients requiring blood transfusions and the degree of placental invasion (p = 0. 0119). PPH occurred in 5 patients (13.5%) and arterial thrombosis in 4 patients (11%). The EBL during delivery was significantly higher (2811 mL) in patients with complications (p = 0.0102). Furthermore, the group of patients that had complications required statistically significant more blood transfusions compared to those without complications (p = 0.0001). No maternal mortality or foetal morbidity occurred. CONCLUSION The utilisation of Prophylactic occlusion balloon catheters allows uterine conserving surgery to be performed safely with few maternal complications.
Collapse
Affiliation(s)
- Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy
| | - Leto Mailli
- Radiology Department, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | - Claudio Raspanti
- Interventional Radiology Unit, Careggi Academic and Regional Hospital of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Via A. di Rudinì 8, Milan, 20142, Italy.
| | - Anna-Maria Belli
- Radiology Department, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| |
Collapse
|
213
|
Perlman NC, Little SE, Thomas A, Cantonwine DE, Carusi DA. Patient selection for later delivery timing with suspected previa-accreta. Acta Obstet Gynecol Scand 2017; 96:1021-1028. [PMID: 28374887 DOI: 10.1111/aogs.13140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We identified patients with previa and suspected accreta who are at lowest risk of unscheduled delivery or major morbidity with planned delivery beyond 34 weeks' gestation. MATERIAL AND METHODS This was a retrospective cohort study of patients who had reached 34.0 weeks' gestational age with a suspected previa-accreta. We evaluated rates of unscheduled and emergent delivery based on known risk factors for premature birth. In a second analysis, we stratified patients based on level of preoperative morbidity concern and evaluated rates of major transfusion and Intensive Care Unit admission by delivery week (34 weeks, 35 weeks or 36 weeks and beyond). RESULTS Of 84 available patients, we classified 31 patients as low risk for unscheduled delivery and 52 as high risk. The low risk group was scheduled later (36.6 vs. 36.0 weeks; p < 0.01), but demonstrated lower rates of unscheduled delivery prior to 36 weeks (3% vs. 19%, p = 0.05). Of the patients with no prior cesarean section, only one (7%) experienced massive blood loss even though 36% had unscheduled deliveries. We observed no significant increase in major transfusion or massive blood loss with advancing gestational age, likely due to selection of the most concerning patients for early, scheduled delivery. CONCLUSION Patients with suspected previa-accreta and no risk factors for preterm birth are at low risk for an unscheduled delivery prior to 36 weeks. Those with no concern for percreta or increta or no prior cesarean section may also be candidates for later delivery.
Collapse
Affiliation(s)
| | - Sarah E Little
- Harvard Medical School, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ann Thomas
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - David E Cantonwine
- Harvard Medical School, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniela A Carusi
- Harvard Medical School, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
214
|
Abstract
Hysterectomy at the time of an obstetric delivery or postpartum is an uncommon time to perform one of the most common gynecologic procedures. Hysterectomy associated with pregnancy is often unplanned and undesired. Postpartum complications associated with the need for hysterectomy carry significant risks, which pose challenges for mother-infant bonding and can signify an unexpected end to fertility. The most common indication for hysterectomy is postpartum hemorrhage. Postpartum hemorrhage is caused by uterine atony, genital tract laceration, uterine rupture, invasive placentation, infection, or coagulopathy. Multidisciplinary teams improve outcomes and are capable of managing complex medical and surgical complications that occur postpartum.
Collapse
Affiliation(s)
- Christopher Kevin Huls
- Department of Obstetrics and Gynecology, Banner University Medical Center, 1111 E McDowell, Phoenix, AZ, USA; Department of Obstetrics and Gynecology, University of Arizona, Phoenix, AZ, USA; Phoenix Perinatal Associates of Mednax, Inc., 1840 South Stapley Drive, Suite 131, Mesa, AZ 85204, USA.
| |
Collapse
|
215
|
Development of a scoring system to predict massive postpartum transfusion in placenta previa totalis. J Anesth 2017; 31:593-600. [DOI: 10.1007/s00540-017-2365-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
|
216
|
Histopathology of Placenta Creta: Chorionic Villi Intrusion into Myometrial Vascular Spaces and Extravillous Trophoblast Proliferation are Frequent and Specific Findings With Implications for Diagnosis and Pathogenesis. Int J Gynecol Pathol 2017; 35:497-508. [PMID: 26630223 DOI: 10.1097/pgp.0000000000000250] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Placenta creta is characterized by invasion of placental villi into the myometrium in the setting of a dysfunctional or absent decidua. Histopathologic diagnosis of placenta creta is important, particularly in cases of hysterectomy because of unanticipated intractable postpartum hemorrhage. Previous studies have documented a higher amount and depth of myometrial infiltration by the implantation site intermediate trophoblast compared with controls. In addition, we have anecdotally observed chorionic villi in myometrial vascular spaces in specimens with placenta creta. The aim of this study was to explore the prevalence and specificity of these features. Sixty-one postpartum hysterectomies, 44 with placenta creta and 17 without were reviewed. Villous intrusion into vascular spaces was recorded. Using immunohistochemistry for GATA3, the amount of intermediate trophoblast (number of positive cells in five 40× fields) and depth of trophoblast myometrial infiltration were assessed. Mean gestational ages of the creta group (34.4 yr; range, 20-43 yr) and control group (35 yr; range, 25-51 yr) were comparable. Presence of chorionic villi in myometrial vascular spaces was frequent in placenta creta: 31/44 versus 1/17 controls (70.4% vs. 5.8%, P<0.0001). This finding was more common in the percreta (87.5%) and increta (84%) than in the accreta (27.2%, P=0.0008). Mean depth of trophoblast myometrial invasion was greater in cretas (47.9%) than in controls (14.5%, P=0.004). Likewise, mean distance of deepest trophoblast to serosa was shorter in the cretas (7.3 mm) than in controls (23.8 mm, P<0.0001). These differences were, however, attributable to placentas increta and percreta. When only accretas and controls were compared, the myometrial depth of trophoblast was similar. The mean intermediate trophoblast cell count in the placental bed was greater in cretas (664) than in controls (288, P<0.0001). Such difference was seen in all creta cases despite the type (accreta 639, increta 676, percreta 661). A trophoblast count of ≥100 cells/high-power field was seen in 75.8% of cretas and 11.1% of controls (P=0.0009). For the first time, we document the finding of chorionic villi intrusion into myometrial vascular spaces, which is highly specific of placenta creta. In addition, assessment of the amount of intermediate trophoblast using GATA3 immunohistochemistry can assist in the diagnosis. We hypothesize that placental invasion in placenta creta is due, at least partially, to transformation of low-resistance myometrial vessels leading to subsequent protrusion of villi into their lumens, in the context of absent decidua.
Collapse
|
217
|
Fan D, Li S, Wu S, Wang W, Ye S, Xia Q, Liu L, Feng J, Wu S, Guo X, Liu Z. Prevalence of abnormally invasive placenta among deliveries in mainland China: A PRISMA-compliant Systematic Review and Meta-analysis. Medicine (Baltimore) 2017; 96:e6636. [PMID: 28422862 PMCID: PMC5406078 DOI: 10.1097/md.0000000000006636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Abnormally invasive placenta (AIP) or placenta accreta (PA) is considered numerous adverse maternal and fetal-neonatal complications. There has been no detailed study to characterize the prevalence of AIP among deliveries in mainland China. OBJECTIVES We aimed to fill this gap and obtained overall and regional estimates of AIP prevalence via a systematic review and meta-analysis. METHODS This systematic review and meta-analysis was totally performed following the Meta-analysis of Observational Studies in Epidemiology guidelines for systematic reviews of observational studies, and the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement for reporting systematic reviews and meta-analysis. RESULTS A total of 23 articles (including 350,939) were included. Most studies (22) focused on the placenta increta (PI), only 2 articles in PA, and none in placenta percreta (PP). In this meta-analysis, the overall prevalence of AIP was 0.22% (95% confidence interval 0.18%-0.27%) in a heterogeneous set of studies (I = 93.5%). In a subgroup, the prevalence of PA and PI was 0.48% and 0.23%, respectively. Stratified analyses of PI found that the prevalence was similar in North (0.23% [0.14%-0.32%]) and South (0.23% [0.15%-0.32%]), and lower in Central (0.20% [0.09-0.31%]); the inlanders (0.17% (0.12%-0.23%]) had a lower prevalence of PI than those living in coastal areas (0.24% [0.35%-0.63%]). As time goes on, the prevalence, from 0.03% (0.02%-0.04%) in 1970 to 1979 to 0.48% (0.30%-0.66%) in 2010 to present, was higher and higher. The different prevalence was also found in different in maternal age groups. CONCLUSIONS This first systematic review and meta-analysis found that the prevalence differed among different geographic areas and maternal age groups. The results would be useful for the design of abnormally invasive placenta planning and implementation adequate health care systems and treatment programs in mainland China.
Collapse
Affiliation(s)
- Dazhi Fan
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei
| | - Song Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei
- Chaohu Hospital Affiliated Anhui Medical University, Chaohu, Anhui
| | - Shuzhen Wu
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| | - Wen Wang
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| | - Shaoxin Ye
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| | - Qing Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei
- Department of Library, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Jinping Feng
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| | - Song Wu
- School of Integrated Traditional and Western Medicine, Anhui University of Chinese Medicine, Hefei, Anhui, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong
| |
Collapse
|
218
|
Response to the comments of Dr Shigeki Matsubara. Taiwan J Obstet Gynecol 2017; 56:271. [DOI: 10.1016/j.tjog.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/18/2022] Open
|
219
|
Wang Z, Li X, Pan J, Zhang X, Shi H, Yang N, Jin Z. Uterine Artery Embolization for Management of Primary Postpartum Hemorrhage Associated with Placenta Accreta. ACTA ACUST UNITED AC 2017; 31:228-232. [PMID: 28065219 DOI: 10.1016/s1001-9294(17)30005-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the efficacy and safety of uterine artery embolization (UAE) in the management of primary postpartum hemorrhage associated with placenta accreta. Methods We retrospectively reviewed the medical records of patients with placenta accreta between January 2010 and August 2014. Totally 18 women (mean age 30.8±4.2 years) of primary massive postpartum hemorrhage with diagnosis of placenta accrete received treatment of UAE after delivery. Images of DSA and medical records were reviewed. Technical success was defined as control of bleeding after embolization. The complications, control of hemorrhage and recurrent bleeding of the placenta left inside the uterus were retrospectively collected for assessment. Results All patients underwent transcatheter embolization of bilateral uterine arteries. The technical success rate of embolization was 100%. Bleeding was controlled in 17 of 18 patients (94%) during follow-up period (median 18 months, 3-31months) without further bleeding recurred. One patient with placenta percreta undertook an emergent hysterectomy along with surgical bladder repair after UAE because of persistent uterine bleeding. Eight patients had postembolization syndrome and no other complications occurred. Conclusion Uterine artery embolization is an effective and safe treatment for the management of primary postpartum massive hemorrhage associated with placenta accreta.
Collapse
Affiliation(s)
- Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaoguang Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Pan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiaobo Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Haifeng Shi
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ning Yang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
220
|
Toledano RD, Leffert LR. Anesthetic and Obstetric Management of Placenta Accreta: Clinical Experience and Available Evidence. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0200-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
221
|
Wang YL, Su FM, Zhang HY, Wang F, Zhe RL, Shen XY. Aortic balloon occlusion for controlling intraoperative hemorrhage in patients with placenta previa increta/percreta. J Matern Fetal Neonatal Med 2017; 30:2564-2568. [PMID: 28264601 DOI: 10.1080/14767058.2016.1256990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/AIMS To investigate whether abdominal aortic balloon occlusion (ABO) effectively reduces intraoperative hemorrhage in patents with placenta previa increta/increta. METHODS Forty-three women were diagnosed as placenta previa increta/percreta by ultrasound and MRI. These patients' assessments were taken by their chief physician, and they were under necessity of previous cesarean section as confirmed by the committee of experts during consultation. There was no significant difference in disease risk rating between them in whole process. Although our department provided a more appropriate method, 10 of 43 patients chose intraoperative aortic balloon occlusion (IABO). Other 33 patients who refused that suggestion were considered as control group. Fully informed consents were obtained from all patients in this study group. The intraoperative blood loss, blood transfusion, rate of hysterectomy and complications of mothers and fetus of IABO group and control group were analyzed. RESULTS The median intraoperative blood loss was 1000 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). The median volume of transfused red blood cells was 1100 ml in the IABO group compared with 2000 ml in the control group (p < 0.05). 33.3% (11/33) patients in the control group had hemorrhagic shock, and one of them suffered from cardiac arrest intraoperatively because of severe bleeding. However, none of these serious events occurred in the IABO group (p < 0.05). The hysterectomy rate was 70% (7/10) in the IABO group and 63.3% (21/33) in the control group (p > 0.05). No IABO-related complications were observed in the mother and fetus. CONCLUSION IABO is an effective and safe method to control intraoperative blood loss and blood transfusion in patients with placenta previa increta/percreta.
Collapse
Affiliation(s)
- Ying-Lan Wang
- a Department of Obstetrics and Gynecology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| | - Fang-Ming Su
- a Department of Obstetrics and Gynecology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| | - Hai-Ying Zhang
- a Department of Obstetrics and Gynecology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| | - Fang Wang
- a Department of Obstetrics and Gynecology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| | - Rui-Lian Zhe
- a Department of Obstetrics and Gynecology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| | - Xin-Ying Shen
- b Department of Radiology, The Second Hospital of Jinan University, People's Hospital of Shenzhen , Shenzhen , China
| |
Collapse
|
222
|
Büke B, Akkaya H, Demir S, Sağol S, Şimşek D, Başol G, Barutçuoğlu B. Relationship between first trimester aneuploidy screening test serum analytes and placenta accreta. J Matern Fetal Neonatal Med 2017; 31:59-62. [PMID: 28027672 DOI: 10.1080/14767058.2016.1275546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study is to determine whether there is a relationship between first trimester serum pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (fβhCG) MoM values and placenta accreta in women who had placenta previa. STUDY DESIGN A total of 88 patients with placenta previa who had first trimester aneuploidy screening test results were enrolled in the study. Nineteen of these patients were also diagnosed with placenta accreta. As probable markers of excessive placental invasion, serum PAPP-A and fβhCG MoM values were compared in two groups with and without placenta accreta. RESULTS Patients with placenta accreta had higher statistically significant serum PAPP-A (1.20 versus 0.865, respectively, p = 0.045) and fβhCG MoM (1.42 versus 0.93, respectively, p = 0.042) values than patients without accreta. CONCLUSIONS Higher first trimester serum PAPP-A and fβhCG MoM values seem to be associated with placenta accreta in women with placenta previa. Further studies are needed to use these promising additional tools for early detection of placenta accreta.
Collapse
Affiliation(s)
- Barış Büke
- a Department of Gynecology and Obstetrics, Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Hatice Akkaya
- a Department of Gynecology and Obstetrics, Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Sibel Demir
- b Department of Gynecology and Obstetrics , Aksaray Ortaköy State Hospital , Aksaray , Turkey
| | - Sermet Sağol
- c Obstetrics and Gynecology Clinic , Ege University Faculty of Medicine , İzmir , Turkey
| | - Deniz Şimşek
- c Obstetrics and Gynecology Clinic , Ege University Faculty of Medicine , İzmir , Turkey
| | - Güneş Başol
- d Department of Biochemistry , Ege University Faculty of Medicine , İzmir , Turkey
| | - Burcu Barutçuoğlu
- d Department of Biochemistry , Ege University Faculty of Medicine , İzmir , Turkey
| |
Collapse
|
223
|
ÖZTAŞ E, ÖZLER S, ERGİN M, EREL Ö, GÜMÜŞ GÜLER B, ÇAĞLAR AT, YÜCEL A, UYGUR D, DANIŞMAN N. Decreased oxidative stress may contribute to the disease process in placenta accreta. Turk J Med Sci 2017; 47:1180-1184. [DOI: 10.3906/sag-1605-141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
224
|
Belfort MA, Shamshiraz AA, Fox K. Minimizing blood loss at cesarean-hysterectomy for placenta previa percreta. Am J Obstet Gynecol 2017; 216:78.e1-78.e2. [PMID: 27984036 DOI: 10.1016/j.ajog.2016.10.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 11/13/2022]
Abstract
Preventing blood loss at the time of a cesarean delivery during a scheduled, nonemergent cesarean hysterectomy for placenta percreta may reduce the need for crystalloid and blood product transfusion. Commonly a classical hysterotomy is created and this can result in as much as a 500-800 mL blood loss before the hysterotomy is closed. Our technique involves placement of 4 full-thickness interrupted sutures in a box pattern to create an unperfused area of upper uterine segment. Diathermy is used to open the uterus to the membranes in the center of the "box" without blood loss. A finger is then inserted between the membranes and uterus to create a space into which 1 side of an 80-mm linear cutting stapler is introduced. The other side of the stapler is then attached and clamped closed, and the stapler is activated. Forward motion of the lever lays down 2 rows of staples, and backward movement of the lever divides the uterine muscle between the 2 staple lines. The stapler is removed and reloaded and reintroduced 1 or 2 times as needed to create an avascular hysterotomy large enough to atraumatically deliver the baby. The membranes are then opened and the baby is delivered. Following this the umbilical cord is clamped and cut without any attempt to remove the placenta, replaced in the uterine cavity, and the hysterotomy is closed with a running locked suture that incorporates the membrane edges. The hysterectomy then proceeds. In most cases there is minimal blood loss (usually <20 mL) from the cesarean delivery.
Collapse
Affiliation(s)
- Michael A Belfort
- Texas Children's Percreta Center and Baylor College of Medicine, Section of Maternal Fetal Surgery, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Houston, TX.
| | - Alireza A Shamshiraz
- Texas Children's Percreta Center and Baylor College of Medicine, Section of Maternal Fetal Surgery, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Houston, TX
| | - Karin Fox
- Texas Children's Percreta Center and Baylor College of Medicine, Section of Maternal Fetal Surgery, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Houston, TX
| |
Collapse
|
225
|
Budorick NE, Figueroa R, Vizcarra M, Shin J. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. J Matern Fetal Neonatal Med 2016; 30:2422-2427. [DOI: 10.1080/14767058.2016.1252744] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nancy E. Budorick
- Department of Radiology, Loyola University Medical Center, Maywood, IL, USA,
| | - Reinaldo Figueroa
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Quinnipiac University, Hartford, CT, USA,
| | - Michael Vizcarra
- Department of Obstetrics and Gynecology, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA, USA, and
| | - James Shin
- Department of Radiology, Stony Brook University Health Sciences Center School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
226
|
Abide Yayla C, Ozkaya E, Tayyar A, Senol T, Senturk MB, Karateke A. Predictive value of complete blood count parameters for placental invasion anomalies. J Matern Fetal Neonatal Med 2016; 30:2324-2328. [DOI: 10.1080/14767058.2016.1247266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Cigdem Abide Yayla
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Enis Ozkaya
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Ahter Tayyar
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Taylan Senol
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - M. Baki Senturk
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Ates Karateke
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
227
|
Oztas E, Ozler S, Caglar AT, Yucel A. Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy. Kaohsiung J Med Sci 2016; 32:579-585. [DOI: 10.1016/j.kjms.2016.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/26/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022] Open
|
228
|
Wang YL, Duan XH, Han XW, Zhao XL, Chen ZM, Chu QJ. Abnormal placentation: the role of MRI in diagnosis and therapeutic planning. Clin Radiol 2016; 72:176.e9-176.e14. [PMID: 27776737 DOI: 10.1016/j.crad.2016.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/30/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the role of magnetic resonance imaging (MRI) for diagnosis and therapeutic planning in patients with abnormal placentation (AP). MATERIALS AND METHODS Overall, 168 consecutive patients with suspected placenta previa and AP were referred for MRI before caesarean section (CS). The ability of MRI to properly detect and assess abnormal placentation was correlated with findings at CS, which were considered the reference standard diagnostic tool. For each patient, MRI was used to determine whether the AP was suitable for complete/incomplete delivery, hysterectomy, or conservative treatment. Treatment planning with MRI was prospectively compared with the actual treatment that had been carried out in each patient decided at CS. RESULTS Placenta previa was detected at MRI in 63 patients and AP in 105 patients; 16 patients had false-positive MRI findings, and three had false-negative findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI compared to findings at CS were 88.9% (149 of 168), 96.7% (89 of 92), 78.9% (60 of 76), 84.8% (89 of 105), and 95.2% (60 of 63), respectively. Treatment planning could be correctly made on the basis of MRI with accuracy, sensitivity, specificity, PPV, and NPV of 97%, 100%, 92.6%, 95.2%, and 100%, respectively. CONCLUSIONS MRI offers high diagnostic accuracy in the detection of AP, and it may be helpful in the detailed planning of treatment.
Collapse
Affiliation(s)
- Y-L Wang
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China.
| | - X-H Duan
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - X-W Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - X-L Zhao
- Department of Obstetrics, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Z-M Chen
- Department of Obstetrics, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Q-J Chu
- Department of Anesthesiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| |
Collapse
|
229
|
Measuring circulating placental RNAs to non-invasively assess the placental transcriptome and to predict pregnancy complications. Prenat Diagn 2016; 36:997-1008. [DOI: 10.1002/pd.4934] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/08/2016] [Accepted: 09/30/2016] [Indexed: 11/07/2022]
|
230
|
Pinto PV, Machado AP, Montenegro N. Risk of hemorrhage in abnormally invasive placenta according to its management. J Matern Fetal Neonatal Med 2016; 30:2139-2145. [DOI: 10.1080/14767058.2016.1240163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Pedro Viana Pinto
- Serviço de Ginecologia e Obstetrícia, Alameda do Professor Hernâni Monteiro, Centro Hospitalar São João, Porto, Portugal and
| | - Ana Paula Machado
- Serviço de Ginecologia e Obstetrícia, Alameda do Professor Hernâni Monteiro, Centro Hospitalar São João, Porto, Portugal and
| | - Nuno Montenegro
- Serviço de Ginecologia e Obstetrícia, Alameda do Professor Hernâni Monteiro, Centro Hospitalar São João, Porto, Portugal and
- Serviço de Ginecologia e Obstetrícia, Faculdade de Medicina da Universidade do Porto, Alameda do Professor Hernâni Monteiro, Centro Hospitalar São João, Porto, Portugal
| |
Collapse
|
231
|
Daney de Marcillac F, Lecointre L, Guillaume A, Sananes N, Fritz G, Viville B, Boudier E, Nisand I, Gaudineau A, Langer B, Akladios C. Morbimortalité maternelle associée au traitement conservateur d’un placenta anormalement adhérent (accreta) diagnostiqué en anténatal. À propos d’une série continue de 15 cas. ACTA ACUST UNITED AC 2016; 45:849-858. [DOI: 10.1016/j.jgyn.2016.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
|
232
|
Kohn JR, Popek E, Diaz-Arrastia CR, Guan X, Shamshirsaz AA, Belfort MA, Fox KA. Placenta Percreta and Incomplete Uterine Rupture after Endometrial Ablation and Tubal Occlusion. AJP Rep 2016; 6:e445-e450. [PMID: 28050333 PMCID: PMC5201430 DOI: 10.1055/s-0036-1597892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Endometrial ablation offers symptomatic relief for menorrhagia. Pregnancy after ablation is rare but is often complicated due to pregnancy loss, growth restriction, preterm premature rupture of membranes, preterm delivery, and morbidly adherent placentation, a dangerous complication that can result in hemorrhage, intensive care unit admission, and cesarean hysterectomy. We report a case of pregnancy conceived contemporaneously with endometrial ablation and tubal occlusion. Diagnosis of pregnancy was delayed due to low suspicion. Complications included cervical implantation and placenta percreta, necessitating hysterectomy with the fetus in situ. Intraoperatively, incomplete uterine rupture was noted. Abnormal neovascularization, fibrous adhesions, and anatomical distortion necessitated a complex surgical approach. Women undergoing endometrial ablation must be thoroughly counseled about the serious risks of postablation pregnancy, the need for contraception, and the risk of sterilization failure. Pregnancy should remain in the differential diagnosis for women of reproductive age, regardless of tubal occlusion. Cases of placenta percreta should be referred early to centers of excellence with multidisciplinary teams.
Collapse
Affiliation(s)
| | - Edwina Popek
- Department of Pathology, Baylor College of Medicine, Houston, Texas
| | - Concepcion R Diaz-Arrastia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, Houston, Texas
| | - Xiaoming Guan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Michael A Belfort
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
233
|
Smulian JC, Pascual AL, Hesham H, Qureshey E, Bijoy Thomas M, Depuy AM, Flicker AB, Scorza WE. Invasive placental disease: the impact of a multi-disciplinary team approach to management. J Matern Fetal Neonatal Med 2016; 30:1423-1427. [DOI: 10.1080/14767058.2016.1216099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
234
|
O'Brien KL, Uhl L. How do we manage blood product support in the massively hemorrhaging obstetric patient? Transfusion 2016; 56:2165-71. [DOI: 10.1111/trf.13753] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Kerry L. O'Brien
- Beth Israel Deaconess Medical Center and Harvard Medical SchoolBoston Massachusetts
| | - Lynne Uhl
- Beth Israel Deaconess Medical Center and Harvard Medical SchoolBoston Massachusetts
| |
Collapse
|
235
|
Karaman E, Kolusarı A, Çetin O, Çim N, Alkış İ, Yıldızhan R, Şahin HG, Gül A. Local resection may be a strong alternative to cesarean hysterectomy in conservative surgical management of placenta percreta: experiences from a tertiary hospital. J Matern Fetal Neonatal Med 2016; 30:947-952. [DOI: 10.1080/14767058.2016.1192119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
236
|
Ahmadzia HK, Thomas SM, Murtha AP, Heine RP, Brancazio LR. Obstetric hemorrhage survey: Attitudes and practices of maternal-fetal medicine fellows. J Neonatal Perinatal Med 2016; 9:133-137. [PMID: 27197937 DOI: 10.3233/npm-16915119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate experiences related to obstetric hemorrhage and suspected abnormal placentation among first year maternal-fetal medicine fellows. STUDY DESIGN A cross-sectional anonymous survey was administered at the Society for Maternal-Fetal Medicine fellow retreat in March 2013. Fellows were asked about management strategies that reflected both their individual and institutional practices. RESULTS There was a 56% response rate (55/98). In cases of postpartum hemorrhage due to uterine atony, there was variable use of the uterine tamponade device. The median incremental time for balloon deflation was every 5 hours (IQR = 2-12). Compared to the east coast, fellows from the west coast performed more hysterectomies (mean±SD; 2.9±2.4 vs. 1.2±1.2, p = 0.004). During a peripartum hysterectomy, 29% of fellows used a handheld cautery device such as Ligasure® or Gyrus®. Fifty-six percent responded that their institution never recommend planned delayed hysterectomies for abnormal placental implantation. CONCLUSION There is wide variation in practice among first year maternal-fetal medicine fellows in management of peripartum hysterectomy and postpartum hemorrhage.
Collapse
Affiliation(s)
- H K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - S M Thomas
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - A P Murtha
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - R P Heine
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| | - L R Brancazio
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
237
|
Tanaka M, Matsuzaki S, Matsuzaki S, Kakigano A, Kumasawa K, Ueda Y, Endo M, Kimura T. Placenta accreta following hysteroscopic myomectomy. Clin Case Rep 2016; 4:541-4. [PMID: 27398192 PMCID: PMC4891474 DOI: 10.1002/ccr3.562] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 02/08/2016] [Accepted: 03/28/2016] [Indexed: 12/17/2022] Open
Abstract
Hardly any report exists on the influence of hysteroscopic myomectomy on subsequent pregnancy. Placenta accreta is most often associated with placenta previa in women with multiple prior cesarean sections. We report the first case of placenta accreta without placenta previa during the first pregnancy subsequent to hysteroscopic myomectomy.
Collapse
Affiliation(s)
- Mie Tanaka
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Satoko Matsuzaki
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology Osaka University Graduate School of Medicine Osaka Japan
| |
Collapse
|
238
|
Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand 2016; 60:457-64. [PMID: 26597396 DOI: 10.1111/aas.12656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/12/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair). Each director surveyed provided information about the anesthetic and transfusion management in their labor and delivery units for three types of abnormal placentation based on antenatal placental imaging: PP, low suspicion for PA, and high suspicion for PA. The primary outcome was use of neuraxial or general anesthesia for PP and PA Cesarean delivery. Univariate statistics were used for survey responses using counts and percentages. RESULTS The response rate was 100%. Spinal anesthesia is the preferred anesthetic mode for PP cases, used in 17/26 (65.4%) of labor and delivery units. By comparison, most representatives reported that they perform general anesthesia for patients with PA: 18/26 (69.2%) for all low suspicion cases of PA and 25/26 (96.2%) for all high suspicion cases of PA. Although a massive transfusion protocol was available in the majority of hospitals (84.6%), the availability of thromboelastography and cell salvage was much lower (53.8% and 19.2% hospitals respectively). CONCLUSIONS In our survey, representatives of anesthesia labor and delivery services in Israel are almost exclusively using general anesthesia for women with high suspicion for PA; however, almost two-thirds use spinal anesthesia for PP without suspicion of PA. Among representatives, we found wide variations in anesthesia practice patterns with regard to anesthesia mode, multidisciplinary management, and hemorrhage anticipation strategies.
Collapse
Affiliation(s)
- A. Ioscovich
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - D. Shatalin
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - A. J. Butwick
- Department of Anesthesia; Stanford University School of Medicine; Stanford California USA
| | - Y. Ginosar
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
| | - S. Orbach-Zinger
- Department of Anesthesia; Rabin Medical Center (Beilinson Campus); Petah Tikvah; Tel Aviv University; Tel Aviv Israel
| | - C. F. Weiniger
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
| |
Collapse
|
239
|
Abstract
Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.
Collapse
Affiliation(s)
- Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health Sciences Center, 30 North 1900 East 2B200 SOM, Salt Lake City, UT 84132, USA
| | - Kelli D Barbour
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of Utah Health Sciences Center, 30 North 1900 East 2B200 SOM, Salt Lake City, UT 84132, USA.
| |
Collapse
|
240
|
Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta. Placenta 2016; 39:1-6. [DOI: 10.1016/j.placenta.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/10/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
|
241
|
Collins SL, Ashcroft A, Braun T, Calda P, Langhoff-Roos J, Morel O, Stefanovic V, Tutschek B, Chantraine F. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:271-275. [PMID: 26205041 DOI: 10.1002/uog.14952] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/30/2015] [Accepted: 07/12/2015] [Indexed: 05/26/2023]
Affiliation(s)
- S L Collins
- The Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - A Ashcroft
- The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - T Braun
- Department of Obstetrics and Division of Experimental Obstetrics, Study Group Perinatal Programming, Charité Campus Virchow, Berlin, Germany
| | - P Calda
- Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - J Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - O Morel
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - V Stefanovic
- Fetomaternal Medical Center, Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - F Chantraine
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- University of Liège, CHR de la Citadelle, Liège, Belgium
| |
Collapse
|
242
|
Weiniger CF, Kabiri D, Ginosar Y, Ezra Y, Shachar B, Lyell DJ. Suspected placenta accreta and cesarean hysterectomy: observational cohort utilizing an intraoperative decision strategy. Eur J Obstet Gynecol Reprod Biol 2016; 198:56-61. [DOI: 10.1016/j.ejogrb.2015.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 12/13/2022]
|
243
|
|
244
|
Pan XY, Wang YP, Zheng Z, Tian Y, Hu YY, Han SH. A Marked Increase in Obstetric Hysterectomy for Placenta Accreta. Chin Med J (Engl) 2016; 128:2189-93. [PMID: 26265612 PMCID: PMC4717972 DOI: 10.4103/0366-6999.162508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Obstetric hysterectomy (OH) as a lifesaving measure to manage uncontrolled uterine hemorrhage appears to be increasing recently. The objective of this study was to determine the etiology and changing trends of OH and to identify those at particular risk of OH to enhance the early involvement of multidisciplinary intensive care. Methods: A retrospective study was carried out in patients who had OH in China-Japan Friendship Hospital from 2004 to 2014. Maternal characteristics, preoperative evaluation, operative reports, and prenatal outcomes were studied in detail. Results: There were 19 cases of OH among a total of 18,838 deliveries. Comparing the study periods between 2004–2010 and 2011–2014, OH increased from 0.8/1000 (10/12,890) to 1.5/1000 (9/5948). Indications for OH have changed significantly during this study period with uterine atony decreasing from 50.0% (5/10) to 11.1% (1/9) (P < 0.05), and placenta accreta as the indication for OH has increased significantly from 20.0% (2/10) to 77.8% (7/9) (P < 0.05). Ultrasonography and magnetic resonance imaging (MRI) have been used to make an exact antepartum diagnosis of placenta accreta. A multidisciplinary management led to improved outcomes for patients with placenta accreta. Conclusion: As the multiple cesarean delivery rates have risen, there has been a dramatic increase in OH for placenta accreta. An advance antenatal diagnosis of ultrasonography, and MRI, and a multidisciplinary teamwork can maximize patients’ safety and outcome.
Collapse
Affiliation(s)
| | | | | | | | | | - Su-Hui Han
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
245
|
Camuzcuoglu A, Vural M, Hilali NG, Incebiyik A, Yuce HH, Kucuk A, Camuzcuoglu H. Surgical management of 58 patients with placenta praevia percreta. Wien Klin Wochenschr 2016; 128:360-6. [PMID: 26913862 DOI: 10.1007/s00508-016-0962-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to present our experience with surgical management of placenta praevia percreta. METHODS This study was conducted from January 2009 through March 2014 at Harran University Hospital and was a chart review of all patients who underwent caesarean hysterectomy with the placenta left in situ for placenta praevia percreta. RESULTS The study group comprised 58 patients. All of the patients underwent ultrasound mapping of the placental area before surgery. Emergent caesarean hysterectomy was only performed in 9 patients; 49 patients underwent planned caesarean hysterectomy. Bilateral internal iliac artery ligation was performed in all cases. Four patients (6.9 %) had bladder damage, one patient (1.7 %) required cystotomy, and one patient (1.7 %) required re-operation because of postoperative hemorrhage. The mean operative time was 141.6 (range: 95-355) minutes. Only 17 (29.3 %) patients were administered more than four units of red blood cells. There was no ureteral damage or maternal death. Furthermore, there were no complications in 42 (72.4 %) patients. CONCLUSIONS Caesarean hysterectomy for placenta praevia percreta is associated with increased maternal morbidity. However, preoperative diagnosis of placenta praevia percreta, ultrasound mapping of the placenta, and the presence of a multidisciplinary experienced team may decrease maternal morbidity and mortality. Moreover, the urinary system may be protected in the patients with placenta praevia percreta without serious morbidity.
Collapse
Affiliation(s)
- Aysun Camuzcuoglu
- Department of Obstetrics & Gynaecology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey.
| | - Mehmet Vural
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nese Gul Hilali
- Department of Obstetrics & Gynaecology, Harran University, Sanliurfa, Turkey
| | - Adnan Incebiyik
- Department of Obstetrics & Gynaecology, Harran University, Sanliurfa, Turkey
| | - Hasan Husnu Yuce
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Ahmet Kucuk
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Hakan Camuzcuoglu
- Department of Obstetrics & Gynaecology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey
| |
Collapse
|
246
|
Biberoglu E, Kirbas A, Daglar K, Biberoglu K, Timur H, Demirtas C, Karabulut E, Danisman N. Serum angiogenic profile in abnormal placentation. J Matern Fetal Neonatal Med 2016; 29:3193-7. [DOI: 10.3109/14767058.2015.1118044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ebru Biberoglu
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey,
| | - Ayse Kirbas
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey,
| | - Korkut Daglar
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey,
| | - Kutay Biberoglu
- Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara, Turkey,
| | - Hakan Timur
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey,
| | - Canan Demirtas
- Department of Biochemistry, Gazi University Medical School, Ankara, Turkey, and
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey
| | - Nuri Danisman
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey,
| |
Collapse
|
247
|
Dannheim K, Shainker SA, Hecht JL. Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination. Arch Gynecol Obstet 2016; 293:951-8. [DOI: 10.1007/s00404-015-4006-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
|
248
|
Temizkan O, Angın D, Karakuş R, Şanverdi İ, Polat M, Karateke A. Changing trends in emergency peripartum hysterectomy in a tertiary obstetric center in Turkey during 2000-2013. J Turk Ger Gynecol Assoc 2016; 17:26-34. [PMID: 27026776 PMCID: PMC4794289 DOI: 10.5152/jtgga.2015.16239] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/18/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate emergency peripartum hysterectomy (EPH) cases over a 14-year period in a tertiary center in İstanbul, Turkey. MATERIAL AND METHODS In this retrospective descriptive study, the records of all cases of EPH performed at the Zeynep Kamil Women and Children's Training and Research Hospital between January 2000 and January 2014 were analyzed. Results for 2000-2006 and 2007-2013 were compared to identify changing trends. Demographic and clinical factors associated with EPH were assessed. RESULTS During the 14-year study period, a total of 161,836 births occurred, out of which 104,783 (64.8%) were vaginal deliveries and 57,053 (35.2%) were cesarean section (CS). EPH was performed in 81 patients with an overall incidence of 0.5 in 1000 deliveries. The EPH rate in 2007-2013 (0.07%) was significantly higher than in 2000-2006 (0.03%). The major difference in the EPH populations between the two periods was the higher number of previous CS in 2007-2013 compared with 2000-2006 (p=0.01). Indications for EPH did not differ between the two periods. There were 7 (8.6%) maternal deaths in 2000-2013, with significantly fewer maternal deaths in 2007-2013 than in 2000-2006 (19.2% vs. 3.6%). CONCLUSION Rate of EPH increased considerably from 2000 to 2013. This increase was mostly related to the increasing rate of CS. Indications for EPH did not change over the study period, and the number of maternal deaths markedly decreased.
Collapse
Affiliation(s)
- Osman Temizkan
- Department of Obstetrics and Gynecology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Doğukan Angın
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Training and Research Hospital, İstanbul, Turkey
| | - Resul Karakuş
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Training and Research Hospital, İstanbul, Turkey
| | - İlhan Şanverdi
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Training and Research Hospital, İstanbul, Turkey
| | - Mesut Polat
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Training and Research Hospital, İstanbul, Turkey
| | - Ateş Karateke
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children’s Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
249
|
Selman AE. Caesarean hysterectomy for placenta praevia/accreta using an approach via the pouch of Douglas. BJOG 2015; 123:815-9. [PMID: 26642997 PMCID: PMC5064651 DOI: 10.1111/1471-0528.13762] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
Placenta praevia/accreta is associated with significant maternal morbidity and mortality and is a common cause of obstetric hysterectomy. This paper describes posterior retrograde abdominal hysterectomy, a new surgical technique for caesarean hysterectomy, in 11 women with placenta percreta, increta or accreta There were no intraoperative or postoperative maternal complications, and only one fetus required admission to the neonatal unit, for prematurity. Our technique in placenta praevia/accreta allows easy identification of the vagina and early uterine devascularisation, as well as safe resection of the involved urinary bladder in women with placenta percreta showing bladder penetration. Analytical studies are needed to confirm our findings. Tweetable abstract Posterior retrograde abdominal hysterectomy in women with placenta praevia/accreta may enable safer surgery. Posterior retrograde abdominal hysterectomy in women with placenta praevia/accreta may enable safer surgery.
Collapse
Affiliation(s)
- A E Selman
- Department of Obstetrics and Gynaecology, Clinical Hospital, Universidad de Chile, Santiago, Chile.,Department of Obstetrics and Gynaecology, Clínica las Condes, Santiago, Chile
| |
Collapse
|
250
|
|