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Abstract
Morbidly adherent placenta, which describes placenta accreta, increta, and percreta, implies an abnormal implantation of the placenta into the uterine wall. The incidence of placenta accreta has increased significantly over the past several decades, with the main risk factors include prior cesarean section and placental previa. Sonographic markers of placenta accreta can be present as early as the first trimester and include a low uterine implantation of a gestational sac, multiple vascular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and abnormality of the uterine serosa-bladder interface, among others. Ultrasound has high sensitivity and specificity for the diagnosis of placenta accreta and MRI should be reserved for rare cases in which the ultrasound is non-diagnostic. The optimum time for planned delivery for a patient with placenta accreta is around 34-35 weeks following a course of corticosteroid injection. The successful management of placenta accreta includes a multidisciplinary care team approach with the successful management relying heavily on the prenatal diagnosis of this entity and preparing for the surgical management in a multidisciplinary approach by assuring the most skilled team is available for those patients.
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Affiliation(s)
- Alfred Abuhamad
- Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Hofheimer Hall, 825 Fairfax Ave, Suite 310, Norfolk, VA 23507.
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302
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Abstract
Placenta accreta is an abnormal adherence of the placenta to the uterine wall that can lead to significant maternal morbidity and mortality. The incidence of placenta accreta has increased 13-fold since the early 1900s and directly correlates with the increasing cesarean delivery rate. The prenatal diagnosis of placenta accreta by ultrasound along with risk factors including placenta previa and prior cesarean delivery can aid in delivery planning and improved outcomes. Referral to a tertiary care center and the use of a multidisciplinary care team is recommended.
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Affiliation(s)
- Alison C Wortman
- Department of Maternal Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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303
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Hammad IA, Chauhan SP, Magann EF, Abuhamad AZ. Peripartum complications with cesarean delivery: a review of Maternal-Fetal Medicine Units Network publications. J Matern Fetal Neonatal Med 2013; 27:463-74. [DOI: 10.3109/14767058.2013.818970] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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304
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Pereira N, Yao R, Guilfoil DS, Richard SD, Plante LA. Placenta membranacea with placenta accreta: radiologic diagnosis and clinical implications. Prenat Diagn 2013; 33:1293-6. [DOI: 10.1002/pd.4224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/13/2013] [Accepted: 08/16/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Nigel Pereira
- Department of Obstetrics and Gynecology; Drexel University College of Medicine; Philadelphia PA USA
| | - Ruofan Yao
- Department of Obstetrics and Gynecology; Drexel University College of Medicine; Philadelphia PA USA
| | - Daniel S. Guilfoil
- Department of Obstetrics and Gynecology; Drexel University College of Medicine; Philadelphia PA USA
| | - Scott D. Richard
- Department of Obstetrics and Gynecology; Drexel University College of Medicine; Philadelphia PA USA
- Division of Gynecologic Oncology; Drexel University College of Medicine; Philadelphia PA USA
| | - Lauren A. Plante
- Department of Obstetrics and Gynecology; Drexel University College of Medicine; Philadelphia PA USA
- Division of Maternal Fetal Medicine; Drexel University College of Medicine; Philadelphia PA USA
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305
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306
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Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta: is sonography all we need? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1345-1350. [PMID: 23887942 DOI: 10.7863/ultra.32.8.1345] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Eliza M Berkley
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA 23507 USA.
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307
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Lo TK, Yung WK, Lau WL, Law B, Lau S, Leung WC. Planned conservative management of placenta accreta - experience of a regional general hospital. J Matern Fetal Neonatal Med 2013; 27:291-6. [PMID: 23796273 DOI: 10.3109/14767058.2013.818118] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are only a few series treating ≥10 cases of accreta conservatively, all from university teaching hospitals, with reported success rate of 60-85%. We reported the first series of accreta managed by planned uterine conservation in the setting of non-university district general hospital. METHODS Women with placenta previa overlying previous cesarean scar who desired uterine conservation were included. For cases with accreta confirmed during cesarean delivery, placenta was purposefully left behind, followed immediately by uterine artery embolization. Cases were followed in our special postnatal clinic. Charts were reviewed to retrieve clinical details. RESULTS Among 15 cases of placenta previa overlying cesarean scar opting for conservative management, 12 (80%) were confirmed to be accreta intra-operatively. They had 20-100% of the adherent placentae retained (median 90%) and their uterus preserved. Postpartum, abnormal vaginal bleeding and/or infection led to unscheduled readmission in 67% (8/12), all managed conservatively. Sonographic resolution of placenta took 2-13 months (median 6.6), and was later than menstrual return in 11 cases. CONCLUSIONS Successful planned conservative management of placenta accreta is feasible in the setting of district general hospital with facilities for interventional radiology.
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308
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Kawashima A, Sekizawa A, Ventura W, Koide K, Hori K, Okai T, Masashi Y, Furuya K, Mizumoto Y. Increased levels of cell-free human placental lactogen mRNA at 28-32 gestational weeks in plasma of pregnant women with placenta previa and invasive placenta. Reprod Sci 2013; 21:215-20. [PMID: 23744883 DOI: 10.1177/1933719113492209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the levels of cell-free human placental lactogen (hPL) messenger RNA (mRNA) in maternal plasma at 28 to 32 weeks of gestation between women with diagnosis of placenta previa or invasive placenta and women with an uneventful pregnancy. Sensitivity and specificity of hPL mRNA for the prediction of invasive placenta were further explored. Plasma hPL mRNA were quantified by real-time reverse-transcriptase polymerase chain reaction in women with placenta previa (n = 13), invasive placenta (n = 5), and normal pregnancies (n = 92). Median (range) hPL mRNA was significantly higher in women with placenta previa, 782 (10-2301) copies/mL of plasma, and in those with invasive placenta, 615 (522-2102) copies/mL of plasma, when compared to normal pregnancies, 90 (4-4407) copies/mL of plasma, P < .01 and P < .05, respectively. We found a sensitivity of 100% and a specificity of 61.5% for the prediction of invasive placenta among women with placenta previa. In conclusion, expression of hPL mRNA is increased in plasma of women with placenta previa and invasive placenta at 28 to 32 weeks of gestation.
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Affiliation(s)
- Akihiro Kawashima
- 1Department of Obstetrics and Gynecology, Self-Defense Forces Central Hospital, Tokyo, Japan
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309
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Chantraine F, Langhoff-Roos J. Abnormally invasive placenta--AIP. Awareness and pro-active management is necessary. Acta Obstet Gynecol Scand 2013; 92:369-71. [PMID: 23517216 DOI: 10.1111/aogs.12130] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 02/26/2013] [Indexed: 11/28/2022]
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310
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Chantraine F, Braun T, Gonser M, Henrich W, Tutschek B. Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity. Acta Obstet Gynecol Scand 2013; 92:439-44. [PMID: 23331024 DOI: 10.1111/aogs.12081] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 01/08/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or percreta. DESIGN Retrospective case series. SETTING Multicenter study. POPULATION Pregnant women with AIP. METHODS Chart review. MAIN OUTCOME MEASURES Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome. RESULTS Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hysterectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respectively. CONCLUSIONS AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ.
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311
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Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL, Herzog TJ, Schulkin J, D'Alton ME. Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. J Matern Fetal Neonatal Med 2013; 26:1602-9. [PMID: 23565991 DOI: 10.3109/14767058.2013.793662] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We surveyed obstetricians to determine their knowledge, patterns of care and treatment preferences for women with placenta accreta. METHODS A 27-item survey was mailed to fellows of the American College of Obstetricians and Gynecologists. The survey included demographics, questions regarding knowledge and items to examine practice patterns. RESULTS Among 994 surveyed practitioners 508 responded including 338 who practiced obstetrics. Among generalists, 23.8% of respondents referred patients with placenta accreta to a sub-specialist. Overall, 20.4% referred women to the nearest tertiary center, and 7.1% referred to a regional center. Delivery was recommended at 34-36 weeks by 41.2%. Adjuvant interventions including ureteral stents (26.3%), iliac artery embolization catheters (28.1%), and balloon occlusion catheters (20.1%) were used infrequently. Six or more units of blood were crossed for delivery by only 29.0% of practitioners. CONCLUSION There is widespread variation in the care of women with or at risk for placenta accreta.
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Affiliation(s)
- Jason D Wright
- Columbia University College of Physicians and Surgeons , New York, NY , USA
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312
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A gravid development: should the desire to maintain fertility determine treatment for profuse bleeding in pregnancy? Am J Obstet Gynecol 2013; 208:332.e1-2. [PMID: 23313725 DOI: 10.1016/j.ajog.2013.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 10/22/2013] [Accepted: 01/07/2013] [Indexed: 11/22/2022]
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313
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Palacios-Jaraquemada JM. Caesarean section in cases of placenta praevia and accreta. Best Pract Res Clin Obstet Gynaecol 2013; 27:221-32. [DOI: 10.1016/j.bpobgyn.2012.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
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314
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315
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Pri-Paz S, Fuchs KM, Gaddipati S, Lu YS, Wright JD, Devine PC. Comparison between emergent and elective delivery in women with placenta accreta. J Matern Fetal Neonatal Med 2013; 26:1007-11. [DOI: 10.3109/14767058.2013.766711] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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316
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Goh W, Yamamoto SY, Thompson KS, Bryant-Greenwood GD. Relaxin, its receptor (RXFP1), and insulin-like peptide 4 expression through gestation and in placenta accreta. Reprod Sci 2013; 20:968-80. [PMID: 23302396 DOI: 10.1177/1933719112472735] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was designed to show whether placental relaxin (RLN), its receptor (RXFP1), or insulin-like peptide 4 (INSL4) might have altered expression in patients with placenta accreta. The baseline expression of their genes through gestation (n = 34) was quantitated in the placental basal plate (BP) and villous trophoblast (TR), and compared to their expression in placenta accreta (n = 6). The proteins were also immunolocalized and quantitated in the accreta tissues. The messenger RNAs (mRNAs) of matrix metalloproteinase 9, -2, and tissue inhibitors of matrix metalloproteinase (TIMP)-1 were also measured. Results demonstrated that the BP and TR expressed low levels of RLN/RXFP1 and INSL4 through gestation. In accreta, increased RLN gene and protein in BP were associated with antepartum bleeding whereas INSL4 expression decreased throughout the TR. There were no changes in mRNAs for MMPs, but TIMP-1 was increased only in the invasive TR.
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Affiliation(s)
- William Goh
- Department of Obstetrics, Gynecology and Women's Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96826, USA.
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317
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Uterine artery embolization for the management of secondary postpartum haemorrhage associated with placenta accreta. Clin Radiol 2012; 67:e71-6. [DOI: 10.1016/j.crad.2012.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 07/18/2012] [Accepted: 07/30/2012] [Indexed: 11/22/2022]
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318
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Cheung CSY, Chan BCP. The sonographic appearance and obstetric management of placenta accreta. Int J Womens Health 2012; 4:587-94. [PMID: 23239929 PMCID: PMC3516467 DOI: 10.2147/ijwh.s28853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Indexed: 11/23/2022] Open
Abstract
Placenta accreta is a condition of abnormal placental implantation in which the placental tissue invades beyond the decidua basalis. It may invade into or even through the myometrium and adjacent organs, such as the urinary bladder. The incidence has been rising in recent years. It is one of the important obstetric complications nowadays, leading to significant maternal morbidity and mortality. In the past, this condition was often diagnosed at the time of delivery when massive and unexpected hemorrhage occurred. Hysterectomy, associated with significant physical and psychological consequences, was usually the only management option. As more obstetricians have become aware of this condition, early identification with antenatal imaging diagnostic technology has become possible. Ultrasound scan plays an important role in the antenatal diagnosis. Various sonographic features with different specificity and sensitivity have been described in the literature. In equivocal cases, magnetic resonance imaging may be helpful. With such information, more accurate counseling can be offered to the mothers and their families before delivery. The delivery can also be arranged at a favorable time and in an institution where multidisciplinary support is available. Input from a hematologist, interventional radiologist, intensive care physician, urology surgeon, and/or other specialist are desirable. Apart from hysterectomy, various forms of conservative management can also be considered when the diagnosis is made prior to delivery. Fertility can therefore be preserved. After delivery, with or without hysterectomy performed, psychological support to the mothers and their families is essential.
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319
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PALACIOS-JARAQUEMADA JOSÉMIGUEL, BRUNO CLAUDIOHERNÁN, MARTÍN EDUARDO. MRI in the diagnosis and surgical management of abnormal placentation. Acta Obstet Gynecol Scand 2012; 92:392-7. [DOI: 10.1111/j.1600-0412.2012.01527.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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320
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Peiffer S, Reinhard J, Reitter A, Louwen F. Conservative Management of Placenta Accreta/Increta after Vaginal Birth. Geburtshilfe Frauenheilkd 2012; 72:940-944. [PMID: 25308979 DOI: 10.1055/s-0032-1327827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/08/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022] Open
Abstract
Aim: Aim of the study was to show that conservative management with preservation of the uterus and of fertility is possible in patients with placenta accreta/increta after vaginal delivery. Method: A retrospective analysis of patients with placental attachment disorders after vaginal delivery was done in a perinatal centre between November 2009 and April 2011. The patient collective was identified using the ICD-10 codes for placenta accreta/increta/percreta, and patient records were analysed for risk factors, maternal morbidity, preservation of the uterus and of fertility, and neonatal outcome. Results: Three cases of placenta increta were identified in the last 1.5 years out of a total of 1457 vaginal deliveries, and all 3 cases were treated conservatively. Mean maternal age was 35.3 years; gestational age ranged from 39 to 41 weeks, and mean duration between delivery of the child and delivery of the placenta was 44.67 days (range: 14-100 days). Two patients developed symptoms of endomyometritis, including fever, leukocytosis and increased CRP levels. All 3 women were successfully managed with preservation of the uterus. Conclusion: In selected cases with placenta accreta/increta after vaginal delivery, it is possible to avoid surgical procedures, particularly hysterectomy procedures, and successfully manage these patients conservatively with preservation of the uterus.
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Affiliation(s)
- S Peiffer
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main
| | - J Reinhard
- St. Marienkrankenhaus, Obstetrics and Gynaecology Department, Frankfurt/Main
| | - A Reitter
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main
| | - F Louwen
- Obstetrics and Gynaecology Department, Johann Wolfgang Goethe University Frankfurt, Frankfurt/Main
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321
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Silver RM. Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. Semin Perinatol 2012; 36:315-23. [PMID: 23009962 DOI: 10.1053/j.semperi.2012.04.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rates of cesarean delivery have substantially increased worldwide during the past 30 years. Indeed, almost one-third of deliveries in the United States are cesareans. Most cesareans are safe, and major complications are uncommon. However, there is a "concealed" downside to cesarean deliveries. There are rare but life-threatening morbidities that may occur, which are often overlooked because most cesareans go well. In addition, subsequent pregnancies are fraught with an increased risk of both maternal and fetal complications. The worst of these are associated with placental problems such as previa, abruption, and accreta. The risk dramatically worsens in patients with multiple repeat cesarean deliveries. This article will summarize and highlight the implications of the rising cesarean rate on maternal and fetal morbidity and mortality.
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Affiliation(s)
- Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
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322
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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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323
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Sivasankar C. Perioperative management of undiagnosed placenta percreta: case report and management strategies. Int J Womens Health 2012; 4:451-4. [PMID: 23071415 PMCID: PMC3469234 DOI: 10.2147/ijwh.s35104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Placenta percreta is a rare pregnancy disorder in which the placenta penetrates the uterine myometrium and can invade surrounding organs. Because the rate of cesarean sections is increasing in developed countries, the incidence of placenta percreta is also rising. This condition significantly increases the risk of maternal and fetal morbidity and mortality, and is currently the most common indication for peripartum hysterectomy. Multidisciplinary management in a specialized center capable of providing massive transfusions can improve outcomes for the mother and baby. This team should include a surgeon specialized in pelvic surgery, an anesthesiologist experienced in obstetrics, a skilled urologist, a neonatologist, a blood bank team capable of administering multiple blood products, and an intensive care facility where the patient can be monitored. In this report, we present the case of a patient with preoperatively undiagnosed placenta percreta and discuss the relevant management methods. We also discuss the relevant obstetric and anesthetic management methods, as well as diagnostic and transfusion protocols.
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324
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Abnormal vascular architecture at the placental-maternal interface in placenta increta. Am J Obstet Gynecol 2012; 207:188.e1-9. [PMID: 22939721 DOI: 10.1016/j.ajog.2012.06.083] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/23/2012] [Accepted: 06/28/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of the study was to characterize the vascular architecture at the placental-maternal interface in pregnancies complicated by placenta increta and normal pregnancies. STUDY DESIGN Vessel numbers and cross-section area density and spatial and area distributions in 13 placenta-increta placental beds were compared with 9 normal placental beds using computer-assisted image analysis of whole-slide CD31 immunolabeled sections. RESULTS The total areas occupied by vessels in normal and placenta-increta placental beds were comparable, but vessels were significantly sparser and larger in the latter. Moreover, placenta-increta-vessel distributions (area and distance from the placental-myometrial junction) were more heterogeneous. CONCLUSION Size and spatial organization of the placenta-increta vascular architecture at the placental-maternal interface differed from normal and might partially explain the severe hemorrhage observed during placenta-increta deliveries.
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325
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Complete hydatidiform mole presenting as a placenta accreta in a twin pregnancy with a coexisting normal fetus: case report. Case Rep Obstet Gynecol 2012; 2012:405085. [PMID: 22928132 PMCID: PMC3424659 DOI: 10.1155/2012/405085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/22/2012] [Indexed: 11/30/2022] Open
Abstract
A twin pregnancy with a complete hydatidiform mole and a coexisting normal fetus (CHMF) is a rare clinical scenario, and it carries many associated pregnancy and postnatal risks. Limited numbers of case studies exist reporting an outcome of live birth, and only three prior cases report the presentation of a hydatidiform mole as a placenta previa. We report a case of CHMF with the molar component presenting antenatally as a placenta previa, which ultimately resulted in placenta accreta at the time of delivery. A live male infant was delivered at 34 weeks' gestation via planned cesarean section, and a hysterectomy was performed following unsuccessful removal of the molar component. We additionally utilized previously described methods of placing internal iliac balloons and ureteral stents prior to delivery. In such a high-risk pregnancy with a known molar previa component, these surgical preparation measures may be of benefit.
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326
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327
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Nishida R, Yamada T, Akaishi R, Kojima T, Ishikawa S, Takeda M, Morikawa M, Yamada T, Minakami H. Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall. J Obstet Gynaecol Res 2012; 39:91-5. [DOI: 10.1111/j.1447-0756.2012.01921.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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328
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Umemura K, Ishioka SI, Endo T, Ezaka Y, Takahashi M, Saito T. Roles of microRNA-34a in the pathogenesis of placenta accreta. J Obstet Gynaecol Res 2012; 39:67-74. [PMID: 22672425 DOI: 10.1111/j.1447-0756.2012.01898.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM MicroRNA-34a (miR-34a) is associated with invasion and metastasis of various cancers. The trophoblastic cells of placenta accreta invade into the myometrium in a similar way to the invasion of cancers. We studied the roles of miR-34a in the pathogenesis of placenta accreta. METHODS The human choriocarcinoma cell line JAR was used for in vitro experiments as a model of trophoblasts, and placental tissues from the operative specimen of patients with or without placenta accreta were used for experiments in vivo. Morpholino antisense oligomer against miR-34a (miR-34a Morpho/AS) was added to JAR, and the expression of miR-34a and plasminogen activator inhibitor-1 (PAI-1) was determined by real time PCR. The effects of antisense, interleukin (IL)-6 and IL-8 in the process of invasion were studied with an invasion assay. Expression of miR-34a in vivo was studied with the use of fluorescent in situ hybridization (FISH). RESULTS Expression of miR-34a was inhibited by 65% with the administration of antisense, and a slight increase in miR-34a expression was observed with the addition of IL-6 and IL-8. PAI-1 expression decreased with the addition of IL-6 and IL-8, and increased with the administration of antisense. There was an increase in invasive capacity through the inhibition of miR-34a expression. Strong FISH expression of miR-34a was observed in trophoblast cells of non-placenta accreta, and a clear decrease in miR-34a expression was observed in those of placenta accreta. CONCLUSIONS Expression of miR-34a was downregulated in placenta accreta. In vitro experiments also showed that the invasive potential of JAR increased by suppressing miR-34a, probably through the expression of PAI-1.
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Affiliation(s)
- Kota Umemura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
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329
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Abstract
The decision of when to deliver a patient for medical or obstetric complication directly affects the neonatal outcome. When the fetus is in danger due to suspected utero-placental insufficiency, the decision to deliver is thought to benefit the neonate. However, the opposite may be true when a normally developing fetus needs to be delivered for a maternal indication such as a persistently bleeding placenta praevia. These decisions are made daily by obstetric providers. The following is a review of obstetric decision-making for moderate and late preterm pregnancies.
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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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331
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Continuous spinal anesthesia for Cesarean hysterectomy and massive hemorrhage in a parturient with placenta increta. Can J Anaesth 2012; 59:473-7. [DOI: 10.1007/s12630-012-9681-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022] Open
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332
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333
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334
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335
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WONG HS, CHEUNG YK, WILLIAMS E. Antenatal ultrasound assessment of placental/myometrial involvement in morbidly adherent placenta. Aust N Z J Obstet Gynaecol 2012; 52:67-72. [DOI: 10.1111/j.1479-828x.2011.01400.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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336
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Lathrop E, Schreiber C. Controversies in family planning: management of second-trimester pregnancy terminations complicated by placenta accreta. Contraception 2012; 85:5-8. [DOI: 10.1016/j.contraception.2011.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 08/17/2011] [Indexed: 11/26/2022]
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337
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de Campos FPF, Simões RS, Felipe-Silva A, Gonzales MD, Ilário EN. Placental polyp: a rare cause of iron deficiency anemia. AUTOPSY AND CASE REPORTS 2011; 1:51-56. [PMID: 31528553 PMCID: PMC6735561 DOI: 10.4322/acr.2011.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/14/2011] [Indexed: 11/23/2022] Open
Abstract
Placental polyps are defined as pedunculated or polypoid fragments of placenta or ovular membranes retained for an indefinite period of time into the uterus after abortion or child birth. An important cause of retention is placental accretism, an abnormal adherence of the placenta into the uterine wall. Chronic cases are rarely reported in the literature. In these cases, the placental retention in the immediate postpartum is not followed by heavy bleeding what makes the diagnosis challenging. We report a rare case of iron-deficiency anemia in a multiparous 29-year-old female patient two years after the last delivery. She sought medical care with clinical symptoms of anemia and recent menses alterations. There was no history of abortion. On gynecological examination, there was a twofold enlarged uterus, and the pelvic ultrasound revealed an image compatible with an endometrial polyp. She underwent open hysterectomy because of uncontrollable bleeding followed by hypotension after curettage. The histolopathologic examination revealed a partially hyalinized and necrotic placental polyp.
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Affiliation(s)
| | - Ricardo Santos Simões
- Hospital das Clínicas - Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service - Hospital Universitário, Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Eder Nisi Ilário
- Hospital das Clínicas - Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
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338
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Utility of Ultrasound and MRI in Prenatal Diagnosis of Placenta Accreta: A Pilot Study. AJR Am J Roentgenol 2011; 197:1506-13. [DOI: 10.2214/ajr.11.6858] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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339
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Stirnemann JJ, Chalouhi GE, Forner S, Saidji Y, Salomon LJ, Bernard JP, Ville Y. First-trimester uterine scar assessment by transvaginal ultrasound. Am J Obstet Gynecol 2011; 205:551.e1-6. [PMID: 21893310 DOI: 10.1016/j.ajog.2011.06.104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/15/2011] [Accepted: 06/28/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. STUDY DESIGN Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset. RESULTS The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists. CONCLUSION First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications.
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Affiliation(s)
- Julien J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, Université Paris Descartes, Paris, France
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340
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Cutting-edge advances in the medical management of obstetrical hemorrhage. Am J Obstet Gynecol 2011; 205:526-32. [PMID: 21816382 DOI: 10.1016/j.ajog.2011.06.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/11/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
Hemorrhagic shock is the most common form of shock encountered in obstetric practice. Interventions that may limit transfusion requirements include normovolemic hemodilution, use of recombinant activated factor VII, selective embolization of pelvic vessels by interventional radiology, and the use of the cell saver intraoperatively. Current understanding of the mechanisms of acute coagulopathy calls into question the current transfusion guidelines, leading to a tendency to apply massive transfusion protocols based on hemostatic resuscitation despite lack of prospective data.
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341
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Stirnemann JJ, Mousty E, Chalouhi G, Salomon LJ, Bernard JP, Ville Y. Screening for placenta accreta at 11-14 weeks of gestation. Am J Obstet Gynecol 2011; 205:547.e1-6. [PMID: 21907956 DOI: 10.1016/j.ajog.2011.07.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/29/2011] [Accepted: 07/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to describe the potential value of 11-14 weeks' screening for placenta accreta (PA). STUDY DESIGN Patients with a history of lower segment cesarean section were prospectively included between 11-13+6 weeks over a 1.5-year period. The first 258 were offered standard screening whereas the following 105 underwent screening for PA. Women were considered high-risk when the trophoblast overlapped the scar visualized by transvaginal ultrasound and low-risk otherwise. RESULTS The group screened for PA did not differ from the nonscreened group for demographic characteristics. In all, 6 of 105 (5.8%) women were considered high-risk. In the nonscreened group, 1 case of PA was discovered during an elective repeat cesarean. In the screened population, 1 case of PA occurred in a high-risk patient allowing a conservative planned management at 35 weeks. CONCLUSION At 11-14 weeks, ultrasound may help risk stratification for PA with a specific follow-up. Early recognition of patients at risk might improve the perinatal outcome of PA.
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342
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Fishman SG, Chasen ST. Risk factors for emergent preterm delivery in women with placenta previa and ultrasound findings suspicious for placenta accreta. J Perinat Med 2011; 39:693-6. [PMID: 21801091 DOI: 10.1515/jpm.2011.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To identify factors associated with emergent preterm delivery in women with placenta previa and suspected accreta. METHODS Pregnancies with placenta previa and ultrasound findings suspicious for accreta were identified. Demographic information and obstetric and neonatal outcomes were obtained from electronic medical records. Mann-Whitney U, Fisher's exact test, and Kaplan-Meier analysis were used. Continuous data are expressed as median (interquartile range). RESULTS Twenty-one patients with placenta previa and suspicion for accreta delivered at a median of 34 weeks [32-37]. Fourteen bled prior to delivery, 10 at <32 weeks. Fifty-seven percentage of deliveries were planned at a median gestational age of 36.5 weeks [34-37] vs. 32 weeks [29.5-32.5] for emergent deliveries (P<0.001). Emergent delivery was associated with transfusion of a median of nine units packed red blood cells (PRBCs) [4-16] compared to 4.5 units [1-7] with planned delivery (P=0.05). CONCLUSION Planned late perterm delivery is reasonable and likely women with placenta previa and ultrasound findings suspicious for placenta accreta who do not experience antepartum bleeding. Those women with multiple episodes of antepartum bleeding or bleeding prior to 32 weeks gestation are at increased risk of emergent preterm delivery.
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Affiliation(s)
- Shira G Fishman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.
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343
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Abstract
The purpose of this article is to review the risks and benefits of scheduled preterm delivery in patients with placenta accreta, increta, and percreta and to provide guidance regarding timing of delivery in such cases. Relevant documents for this opinion were identified through a search of the English literature for publications, including one or more of the keywords "accreta" or "increta" or "percreta" and "preterm" and "delivery time" by the use of PubMed (U.S. National Library Of Medicine, January 1990-January 2010), with results limited to studies involving humans. Additional information was obtained from references identified from within selected articles, from additional review articles, and from guidelines by organizations, including the American College of Obstetricians & Gynecologists. Each included article was evaluated according to study design and quality in accordance with scheme outlined by the U.S. Preventative Services Task Force, and final recommendations are provided based on the level of published evidence. On the basis of this search, we found that abnormal placentation, encompassing placenta accreta, increta, and percreta, is increasingly common. We also found that randomized controlled trials and well-controlled observational studies that can be used to define best practice in delivery time are lacking. Optimal delivery time must be determined from available case series, retrospective reviews and decision analysis studies. Given the best-available evidence, optimal time for delivery is believed to be between 34 and 35 weeks in most cases.
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Affiliation(s)
- Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
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Shields LE, Smalarz K, Reffigee L, Mugg S, Burdumy TJ, Propst M. Comprehensive maternal hemorrhage protocols improve patient safety and reduce utilization of blood products. Am J Obstet Gynecol 2011; 205:368.e1-8. [PMID: 22083059 DOI: 10.1016/j.ajog.2011.06.084] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/02/2011] [Accepted: 06/22/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effectiveness of instituting a comprehensive protocol for the treatment of maternal hemorrhage. STUDY DESIGN The protocol was separated into 4 stages, designated 0-3, based on the degree of blood loss and the patient response to interventions. Key components included admission risk assessment, measurement of blood loss, early but limited use of uterotonic agents, early presence of obstetrical and anesthesia staff, and transfusion with fixed ratios of blood products. Data were collected retrospectively and prospectively relative to the start of the protocol. RESULTS We noted a significant shift toward resolution of maternal bleeding at an earlier stage (P < .01), use of fewer blood products (P < .01), and a 64% reduction in the rate of disseminated intravascular coagulation. In addition, there were significant improvements in staff and physician perceptions of patient safety (P < .01). CONCLUSION Comprehensive maternal hemorrhage treatment protocols improve patient safety and reduce utilization of blood products.
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Affiliation(s)
- Laurence E Shields
- Department of Obstetrics and Gynecology, Marian Medical Center, Santa Maria, CA, USA
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345
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Abstract
The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity and mortality, and affects more than half a million births in the United States each year. In some situations, however, a late-preterm or early-term birth is the optimal outcome for the mother, child, or both owing to conditions that can result in worse outcomes if pregnancy is allowed to continue. These conditions may be categorized as placental, maternal, or fetal, including conditions such as placenta previa, preeclampsia, and multiple gestations. Some risks associated with early delivery are common to all conditions, including prematurity-related morbidities (eg, respiratory distress syndrome and intraventricular hemorrhage) as well as maternal intrapartum morbidities such as failed induction and cesarean delivery. However, when continuation of the pregnancy is associated with more risks such as hemorrhage, uterine rupture, and stillbirth, preterm delivery maybe indicated. In February 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop titled "Timing of Indicated Late Preterm and Early Term Births." The goal of the workshop was to synthesize the available information regarding conditions that may result in medically indicated late-preterm and early-term births to determine the potential risks and benefits of delivery compared with continued pregnancy, determine the optimal gestational age for delivery of affected pregnancies when possible, and inform future research regarding these issues. Based on available data and expert opinion, optimal timing for delivery for specific conditions was determined by consensus.
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346
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Uterine-sparing surgical management of postpartum hemorrhage: is it always effective? Arch Gynecol Obstet 2011; 285:925-30. [DOI: 10.1007/s00404-011-2083-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 09/05/2011] [Indexed: 11/25/2022]
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347
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Abstract
Premature delivery of an infant is occasionally performed because of complications of pregnancy. This article reviews common medical indications for preterm delivery and the available evidence supporting delivery before 37 weeks of gestation. In many conditions, few data exist to guide optimal timing of delivery and management is guided by expert opinion. Ultimately, an individual assessment must be made in each case to weigh the risks that pregnancy continuation poses to the mother and/or fetus with the risks of prematurity and its associated morbidities.
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Affiliation(s)
- Amy E Wong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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348
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Tikkanen M, Stefanovic V, Paavonen J. Placenta previa percreta left in situ - management by delayed hysterectomy: a case report. J Med Case Rep 2011; 5:418. [PMID: 21867547 PMCID: PMC3177929 DOI: 10.1186/1752-1947-5-418] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Placenta percreta is an obstetric emergency often associated with massive hemorrhage and emergency hysterectomy. CASE PRESENTATION We present the case of a 30-year-old African woman, gravida 7, para 5, with placenta percreta managed by an alternative approach: the placenta was left in situ, methotrexate was administered, and a delayed hysterectomy was successfully performed. CONCLUSIONS Further studies are needed to develop the most appropriate management option for the most severe cases of abnormal placentation. Delayed hysterectomy may be a reasonable strategy in the most severe cases.
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Affiliation(s)
- Minna Tikkanen
- Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki, Finland.
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349
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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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350
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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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