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Neef V, Flinspach AN, Eichler K, Woebbecke TR, Noone S, Kloka JA, Jennewein L, Louwen F, Zacharowski K, Raimann FJ. Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization. J Clin Med 2024; 13:1062. [PMID: 38398377 PMCID: PMC10888708 DOI: 10.3390/jcm13041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) disorders are a continuum of placental pathologies with increased risk for hemorrhage, blood transfusion and maternal morbidity. Uterine artery embolization (UAE) is a safe approach to the standardization of complex PAS cases. The aim of this study is to analyze anemia and transfusion rate, outcome and anesthesiological management of women who underwent caesarean delivery with subsequent UAE for the management of PAS. MATERIAL AND METHODS This retrospective observational study included all pregnant women admitted to the University Hospital Frankfurt between January 2012 and September 2023, with a diagnosis of PAS who underwent a two-step surgical approach for delivery and placenta removal. Primary procedure included cesarean delivery with subsequent UAE, secondary procedure included placenta removal after a minim of five weeks via curettage or HE. Maternal characteristics, anesthesiological management, complications, anemia rate, blood loss and administration of blood products were analyzed. RESULTS In total, 17 women with PAS were included in this study. Of these, 5.9% had placenta increta and 94.1% had placenta percreta. Median blood loss was 300 (200-600) mL during primary procedure and 3600 (450-5500) mL during secondary procedure. In total, 11.8% and 62.5% of women received red blood cell transfusion during the primary and secondary procedures, respectively. After primary procedure, postpartum anemia rate was 76.5%. The HE rate was 64.7%. Regional anesthesia was used in 88.2% during primary procedure. CONCLUSION The embolization of the uterine artery for women diagnosed with PAS is safe. Anemia management and the implementation of blood conservation strategies are crucial in women undergoing UAE for the management of PAS.
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Affiliation(s)
- Vanessa Neef
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Armin N. Flinspach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Katrin Eichler
- Department of Interventional Radiology, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;
| | - Tirza R. Woebbecke
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Stephanie Noone
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Jan A. Kloka
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Lukas Jennewein
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (L.J.); (F.L.)
| | - Frank Louwen
- Department of Obstetrics and Perinatal Medicine, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (L.J.); (F.L.)
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
| | - Florian J. Raimann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany; (A.N.F.); (T.R.W.); (S.N.); (J.A.K.); (K.Z.); (F.J.R.)
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Ghosh A, Lee S, Lim C, Vogelzang RL, Chrisman HB. Placenta Accreta Spectrum: An Overview. Semin Intervent Radiol 2023; 40:467-471. [PMID: 37927512 PMCID: PMC10622243 DOI: 10.1055/s-0043-1772815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Abheek Ghosh
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean Lee
- Touro College of Osteopathic Medicine, New York City, New York
| | - Christina Lim
- Creighton University School of Medicine, Omaha, Nebraska
| | - Robert L. Vogelzang
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Howard B. Chrisman
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Gatta LA, Weber JM, Gilner JB, Lee PS, Grotegut CA, Herbert KA, Bashir M, Pieper CF, Ronald J, Pabon-Ramos W, Habib AS, Strickland KC, Secord AA, James AH. Transfusion Requirements with Hybrid Management of Placenta Accreta Spectrum Incorporating Targeted Embolization and a Selective Use of Delayed Hysterectomy. Am J Perinatol 2022; 29:1503-1513. [PMID: 35973741 PMCID: PMC10035416 DOI: 10.1055/s-0042-1754321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study compares the number of units of red blood cells (RBCs) transfused in patients with placenta accreta spectrum (PAS) treated with or without a multidisciplinary algorithm that includes placental uterine arterial embolization (P-UAE) and selective use of either immediate or delayed hysterectomy. STUDY DESIGN This is a retrospective study of deliveries conducted at a tertiary care hospital from 2001 to 2018 with pathology-confirmed PAS. Those with previable pregnancies or microinvasive histology were excluded. To improve the equity of comparison, analyses were made separately among scheduled and unscheduled cases, therefore patients were assigned to one of four cohorts as follows: (1) scheduled/per-algorithm, (2) scheduled/off-algorithm, (3) unscheduled/per-algorithm, or (4) unscheduled/off-algorithm. Primary outcomes included RBCs transfused and estimated blood loss (EBL). Secondary outcomes included perioperative complications and disposition. RESULTS Overall, 95 patients were identified, with 87 patients meeting inclusion criteria: 36 treated per-algorithm (30 scheduled and 6 unscheduled) and 51 off-algorithm patients (24 scheduled and 27 unscheduled). Among scheduled deliveries, 9 (30.0%) patients treated per-algorithm received RBCs compared with 20 (83.3%) patients treated off-algorithm (p < 0.01), with a median (interquartile range [IQR]) of 3.0 (2.0, 4.0) and 6.0 (2.5, 7.5) units transfused (p = 0.13), respectively. Among unscheduled deliveries, 5 (83.3%) per-algorithm patients were transfused RBCs compared with 25 (92.6%) off-algorithm patients (p = 0.47) with a median (IQR) of 4.0 (2.0, 6.0) and 8.0 (3.0, 10.0) units transfused (p = 0.47), respectively. Perioperative complications were similar between cohorts. CONCLUSION A multidisciplinary algorithm including P-UAE and selective use of delayed hysterectomy is associated with a lower rate of blood transfusion in scheduled but not unscheduled cases. KEY POINTS · An algorithm with delayed hysterectomy had less transfusion in scheduled, but not unscheduled, cases.. · Over time, more cases were managed per algorithm; among scheduled cases, the transfusion rate and volume transfused decreased.. · There were similar transfusion outcomes among off-algorithm cases, regardless if delivery was scheduled..
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Affiliation(s)
- Luke A. Gatta
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina
| | - Jeremy M. Weber
- Department of Biostatistics and Bioinformatics, Duke University Hospital, Durham, North Carolina
| | - Jennifer B. Gilner
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina
| | - Paula S. Lee
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Gynecologic Oncology, Duke University Hospital, Durham, North Carolina
| | - Chad A. Grotegut
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina
| | | | - Mustafa Bashir
- Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina
| | - Carl F. Pieper
- Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina
| | - James Ronald
- Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina
| | - Waleska Pabon-Ramos
- Department of Radiology and Medicine, Duke University Hospital, Durham, North Carolina
| | - Ashraf S. Habib
- Department of Anesthesiology, Duke University Hospital, Durham, North Carolina
| | - Kyle C. Strickland
- Department of Pathology, Duke University Hospital, Durham, North Carolina
| | - Angeles Alvarez Secord
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Gynecologic Oncology, Duke University Hospital, Durham, North Carolina
| | - Andra H. James
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
- Division of Maternal-Fetal Medicine, Duke University Hospital, Durham, North Carolina
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Martadiansyah A, Bernolian N, Mirani P, Lestari PM, Dewi C, Pangemanan WT, Syamsuri AK, Ansori MH, Kesty C. Placenta accreta spectrum disorder in a primigravida with angular pregnancy: a case report. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.cr.226011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Placenta accreta spectrum (PAS) is characterized by abnormal invasion of placental tissue into the underlying uterine muscles and has an incidence of 1/533–1/251. The incidence of complications includes uterine rupture (14–29%), PAS (6–10%), and retained placenta or incomplete placenta removal (4%). Here, we described a rare case of PAS and angular pregnancy, including how to diagnose and manage it preoperatively. A 32-year-old primigravida diagnosed at 24 weeks of gestation with a right angular pregnancy was admitted due to preterm premature rupture of membrane (PPROM) with a singleton fetus. We decided to perform hysterotomy because of the PPROM and intrauterine infection. Intraoperatively, we found PAS in the right angular pregnancy; therefore, we performed uterine conservative management with wedge resection on the right uterine fundus. Intraoperative bleeding was 1,600 cc. Histopathological examination revealed placenta increta. The maternal prognosis was good, while the fetus was poor, with an APGAR score of 1/1/0.
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Riazanova OV, Reva VA, Fox KA, Romanova LA, Kulemin ES, Riazanov AD, Ioscovich A. Open versus endovascular REBOA control of blood loss during cesarean delivery in the placenta accreta spectrum: A single-center retrospective case control study. Eur J Obstet Gynecol Reprod Biol 2021; 258:23-28. [PMID: 33388487 DOI: 10.1016/j.ejogrb.2020.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare two vascular control options for blood loss prevention and hysterectomy during cesarean delivery (CD2): endovascular balloon occlusion of the aorta (REBOA3) and open bilateral common iliac artery occlusion (CIAO4) in women with extensive placenta accreta spectrum (PAS5). STUDY DESIGN This was retrospective comparison of cases of PAS using either CIAO (October 2017 through October 2018) or REBOA (November 2018 through November 2019) to prevent pathologic hemorrhage during scheduled CD. Women with confirmed placenta increta/percreta underwent either CD then intraoperative post-delivery, pre-hysterectomy open vascular control of both CIA6 (CIAO group) or pre-operative, ultrasound-guided, fluoroscopy-free REBOA followed by standard CD and balloon inflation after fetal delivery (REBOA group). Intraoperative blood loss, transfusion volumes, surgical time, blood pressure, maternal and neonatal outcomes, hospitalization length and postoperative complications were compared. RESULTS The REBOA and CIAO groups included 12 and 16 women, respectively, with similar median age of 35 years and gestational age of 34-35 weeks. All REBOA catheters were successfully placed into aortic zone three under ultrasound guidance. The quantitated median intraoperative blood loss was significantly lower for the REBOA group, (541 [IQR 300-750] mL) compared to the CIAO group (3331 [IQR 1150-4750] mL (P = 0.001). As a result, the total volume of fluid and blood replacement therapy was significantly lower in the REBOA group (P < 0.05). Median surgical time in the REBOA group was less than half as long: 76 [IQR 64-89] minutes compared to 168 [IQR 90-222] minutes in the CIAO group (P = 0.001). None of the women with REBOA required hysterectomy, while 8/16 women in the CIAO group did (P = 0.008). Furthermore, the post-anesthesia recovery and hospital discharge times in the REBOA-group were shorter (P < 0.05). One thromboembolic complication occurred in each group. The only REBOA-associated complication was non-occlusive femoral artery thrombosis, with no surgical management required. No maternal or neonatal deaths occurred in either group. CONCLUSION Fluoroscopy-free REBOA for women with PAS is associated with improved vascular control, perioperative blood loss, the need for transfusion and hysterectomy and reduces surgical time when compared to bilateral CIAO.
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Affiliation(s)
- Oksana V Riazanova
- D.O. Ott Research Institute of Obstetrics and Gynecology, Saint-Petersburg, Russian Federation
| | - Viktor A Reva
- Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
| | - Karin A Fox
- Baylor College of Medicine, Houston, TX, USA
| | - Larisa A Romanova
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
| | - Evgeniy S Kulemin
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
| | - Artem D Riazanov
- Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint-Petersburg, Russian Federation
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Khoiwal K, Gaurav A, Kapur D, Kumari O, Sharma P, Bhandari R, Chaturvedi J. Placenta percreta - a management dilemma: an institutional experience and review of the literature. J Turk Ger Gynecol Assoc 2020; 21:228-235. [PMID: 33274037 PMCID: PMC7726456 DOI: 10.4274/jtgga.galenos.2020.2020.0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Placenta percreta is an extremely high-risk obstetric condition often associated with significant maternal morbidity and mortality. To date, there is no consensus on its management. This article aimed to identify an optimum management option to improve maternal outcomes in patients with placenta percreta. Material and Methods This was an observational study conducted at a tertiary care institute from October 2019 to June 2020. A well-defined plan of preoperative, bilateral, uterine artery catheter placement, cesarean delivery (CD) of the baby followed by uterine artery embolization (UAE), and elective delayed hysterectomy after 2-4 weeks, was made by a multidisciplinary team. Demographic variables such as age, parity, period of gestation, presenting complaints, imaging findings, mode of management, intraoperative findings, blood loss, the requirement for blood and blood products, and complications were noted. Results We encountered seven cases of placenta percreta over a period of nine months. UAE was performed in 6/7 patients. UAE was not performed in one patient as she presented to the emergency department in shock. Elective delayed hysterectomy was performed after 2-4 weeks in three patients, three patients required emergency hysterectomy (two during CD and one on the seventh postoperative day) and one patient was managed conservatively by leaving the placenta in situ after CD and UAE. Patients who underwent UAE had notably less intraoperative blood loss and requirement of blood and blood products than the patient who could not receive UAE. During cesarean hysterectomy, blood loss was 1,700 mL in embolized (case 4) vs 3,000 mL in unembolized patient (case 7). In embolized patients, the median blood loss during CD (case 1,2,3,5,6) was 200 mL (interquartile range: 165-200 mL) and during delayed elective hysterectomy (case 1,3,5) was 150 mL (range: 125-225 mL). Blood loss in case 2 was 1,000 mL during emergency hysterectomy on the 7th day of CD and UAE. The blood loss was appreciably higher in patients who underwent immediate cesarean hysterectomy rather than elective delayed hysterectomy. Conclusion Placenta percreta, if not managed in a preplanned manner, may lead to disastrous maternal outcomes. Prophylactic devascularization during CD and leaving the placenta in situ followed by elective delayed hysterectomy, might be a reasonable management option in most severe cases of placenta percreta.
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Affiliation(s)
- Kavita Khoiwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Amrita Gaurav
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Dhriti Kapur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Om Kumari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Sharma
- Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
| | - Rekha Bhandari
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, India
| | - Jaya Chaturvedi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesh, India
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Mei Y, Luo D, Wei S, Wang L, Liao X, Jing H, Lin Y, Zhao H. Comparison of emergency cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters in patients with placenta accreta spectrum. J Matern Fetal Neonatal Med 2020; 35:3190-3195. [PMID: 32954872 DOI: 10.1080/14767058.2020.1815187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to compare outcomes of women with placenta accreta spectrum(PAS) who underwent emergency cesarean hysterectomy with and without prophylactic intravascular balloon catheters. Methods Sixty-three cases who had emergency hysterectomy related to PAS disorders were retrospectively analyzed. Subjects with prophylactic intravascular balloon catheter placement plus hysterectomy were compared with those who had hysterectomy alone. The cases were divided into three groups: infrarenal aortic artery balloon occlusion (IAABC) group (who had IAABC plus hysterectomy, n = 31), internal iliac artery balloon occlusion (IIABOC) group (who had IIABOC plus hysterectomy, n = 17), and hysterectomy alone group (control group n = 15). RESULTS Outcome measures were not significantly different between the IIABOC group and the control group. IAABC plus hysterectomy resulted in a better outcome than hysterectomy alone, with less amount of estimated blood loss (EBL) during cesarean section (2000 vs 3000 ml, p = .011) and 24 h after cesarean section (2010 vs 4520 ml, p = .004), less operation time(90 vs 106 min, p = .01), and a lower rate of major blood loss(42 vs 93%, p = .029). IAABC plus hysterectomy resulted in better outcomes than IIABOC plus hysterectomy, with less amount of EBL during cesarean section (2000 vs 3000 ml, p = .005) and 24 h after cesarean section (2010 vs 3000 ml, p = .035), a lower rate of major blood loss(42 vs 100%, p < .001), less operation time (90 vs 100 min, p = .038), and less fetus radiation dose(1.9 mGy vs 22.4 mGy, p < .001). CONCLUSIONS IAABC was more effective in emergency cesarean hysterectomy related to PAS disorders.
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Affiliation(s)
- Youwen Mei
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Dan Luo
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Sumei Wei
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Liming Wang
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Xiaoyan Liao
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Huaibo Jing
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu Women and Children's central hospital Affiliated to University of Electronic Science and Technology of China, Chengdu City, Sichuan Province, China
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Management of abnormal invasive placenta in a low- and medium-resource setting. Best Pract Res Clin Obstet Gynaecol 2020; 72:117-128. [PMID: 32900599 DOI: 10.1016/j.bpobgyn.2020.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/22/2022]
Abstract
The purpose of this review is to describe the panorama of placenta accreta spectrum (PAS) disorder management in low- and middle-income countries, providing information that allows for the improvement of maternal and perinatal outcomes in the management of this pathology. This spectrum of disorders is associated with implications of high morbidity and mortality, both maternal and perinatal, which is why clinical practice guidelines based on management are produced in settings where there is a wide range of available resources. This situation often contrasts with what the reality is in low-resource countries. Prenatal diagnosis of placental accreta is essential to carry out adequate surgical planning in centres where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills.
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Soyer P, Barat M, Loffroy R, Barral M, Dautry R, Vidal V, Pellerin O, Cornelis F, Kohi MP, Dohan A. The role of interventional radiology in the management of abnormally invasive placenta: a systematic review of current evidences. Quant Imaging Med Surg 2020; 10:1370-1391. [PMID: 32550143 DOI: 10.21037/qims-20-548] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abnormally invasive placenta (AIP) is a potentially severe condition. To date, arterial embolization in women with postpartum hemorrhage due to AIP is the treatment option for which highest degrees of evidence are available. However, other techniques have been tested, including prophylactic catheter placement, balloon occlusion of the iliac arteries and abdominal aorta balloon occlusion. In this systematic review, we provide an overview of the currently reported interventional radiology procedures that are used for the treatment of postpartum hemorrhage due to AIP and suggest recommendations based on current evidences. Owing to a high rate of adverse events, prophylactic occlusion of internal iliac arteries should be used with caution and applied when the endpoint is hysterectomy. On the opposite, when a conservative management is considered to preserve future fertility, uterine artery embolization should be the preferred option as it is associated with a hysterectomy rate of 15.5% compared to 76.5% with prophylactic balloon occlusion of the internal iliac arteries and does not result in fetal irradiation. Limited data are available regarding the application of systematic prophylactic embolization and no comparative studies with arterial embolization are available.
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Affiliation(s)
- Philippe Soyer
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Maxime Barat
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, UFR des Sciences de Santé, Université de Bourgogne/Franche-Comté, Dijon, France
| | - Matthias Barral
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France.,Sorbonne University, Paris, France
| | - Raphael Dautry
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone APHM, LIIE, CERIMED Aix Marseille Univ, Marseille, France
| | - Olivier Pellerin
- Université de Paris, Descartes-Paris 5, Paris, France.,Department of Interventional Radiology, Hopital Européen Georges Pompidou, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Francois Cornelis
- Department of Radiology, Hopital Tenon, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Anthony Dohan
- Department of Radiology, Hopital Cochin, Assistance Publique - Hopitaux de Paris, Paris, France.,Université de Paris, Descartes-Paris 5, Paris, France
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10
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Conservative Management of Placenta Percreta: Three Cases and a Review of the Literature regarding Conservative Management of Placenta Accreta Spectrum (PAS) Disorders. Case Rep Obstet Gynecol 2020; 2020:9065342. [PMID: 32292617 PMCID: PMC7149411 DOI: 10.1155/2020/9065342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/29/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass. Conclusions Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.
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11
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Berhan Y, Urgie T. A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup. Ethiop J Health Sci 2020; 30:277-292. [PMID: 32165818 PMCID: PMC7060376 DOI: 10.4314/ejhs.v30i2.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
In the last three to four decades, the increasing caesarean delivery rate has contributed to several fold increment in the incidence of placenta accreta spectrum disorders globally. Placenta accreta spectrum with its subtypes (accreta, increta and percreta) is one of the devastating obstetric complications. As a result, it is the commonest indication for peripartum hysterectomy and common cause of severe maternal morbidity. However, in recent years, there is a growing interest in and practice of expectant management either to minimize emergency hysterectomy related maternal complications or to preserve the fertility potential of a woman with an intact uterus. A large body of observational research findings has demonstrated the success rate of expectant management in many of well selected cases. Similarly, the experience on delayed hysterectomy was encouraging in order to have less hemorrhage. For the best success of placenta accreta spectrum management, multidisciplinary team approach, antenatal diagnosis and managing such cases in a hospital with center of excellence has been strongly recommended. This literature review provides a robust synthesis of up-to-date knowledge and practice on the challenges and successes of placenta accreta spectrum disorders management. The currently practiced management options in the high and middle income countries are also summarized under seven categories. Therefore, the purpose of this review was to shed light on the applicability of the PAS disorder management modalities in our setup.
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Affiliation(s)
- Yifru Berhan
- St. Paul's Hospital Millennium Medical College Ethiopia, Addis Ababa
| | - Tadesse Urgie
- St. Paul's Hospital Millennium Medical College Ethiopia, Addis Ababa
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Yuan Q, Jin Y, Chen L, Ling L, Bai XM. Prophylactic uterine artery embolization during cesarean delivery for placenta previa complicated by placenta accreta. Int J Gynaecol Obstet 2019; 149:43-47. [PMID: 31778209 DOI: 10.1002/ijgo.13072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 10/02/2019] [Accepted: 11/26/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of prophylactic uterine artery embolization (UAE) during cesarean delivery for women with placenta previa complicated by placenta accreta. METHODS A retrospective analysis of women with placenta previa admitted to The Second Affiliated Hospital of Soochow University, Suzhou, China, for elective cesarean between February 2003 and July 2016. Postpartum estimated blood loss, blood transfusion, hysterectomy, disseminated intravascular coagulation (DIC) incidence, intensive care unit (ICU) duration, and postoperative stay were compared between control women who underwent cesarean delivery only and women who underwent prophylactic intraoperative UAE during cesarean. RESULTS There were 28 and 26 women in the UAE and control group, respectively. There were no differences in hysterectomy incidence (P=0.291), or duration of ICU stay (P=0.085), or postoperative hospitalization (P=0.668) between the groups; however, the incidence of DIC was lower in the UAE group (P=0.035). Mean estimated blood loss (P=0.018) and blood transfusion (P=0.011) were also lower in the UAE group. No serious complications were associated with the endovascular procedures. CONCLUSION Prophylactic intraoperative UAE seemed to effectively reduce blood loss, need for blood transfusion, and incidence of DIC among women with placenta previa complicated by placenta accreta.
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Affiliation(s)
- Qiang Yuan
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yong Jin
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Ling
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu-Ming Bai
- Department of Interventional Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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El Gelany S, Mosbeh MH, Ibrahim EM, Mohammed M, Khalifa EM, Abdelhakium AK, Yousef AM, Hassan H, Goma K, Alghany AA, Mohammed HF, Azmy AM, Ali WA, Abdelraheim AR. Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study. BMC Pregnancy Childbirth 2019; 19:313. [PMID: 31455286 PMCID: PMC6712589 DOI: 10.1186/s12884-019-2466-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022] Open
Abstract
Background Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place. Results The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Trial registration Registered 28th October 2015, ClinicalTrials.gov NCT02590484.
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Affiliation(s)
- Saad El Gelany
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Mohammed H Mosbeh
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Emad M Ibrahim
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Mo'men Mohammed
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Eissa M Khalifa
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Ahmed K Abdelhakium
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Ayman M Yousef
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Heba Hassan
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Khaled Goma
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Ahmed Abd Alghany
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Hashem Fares Mohammed
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Ahmed M Azmy
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt
| | - Wegdan A Ali
- Department of Anaesthesia and Intensive care, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed R Abdelraheim
- Obstetrics and Gynaecology Department, Faculty of Medicine, Minia Maternity and Children University Hospital, Minia University, Minia, Egypt.
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Hussein AM, Kamel A, Elbarmelgy RA, Thabet MM, Elbarmelgy RM. Managing Placenta Accreta Spectrum Disorders (PAS) in Middle/Low-Resource Settings. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-00263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Karaçor T, Bülbül M, Nacar MC, Kirici P, Peker N, Sak S, Sak ME. The parameters affecting the success of uterus-sparing surgery in cases of placenta adhesion spectrum disorder. J Matern Fetal Neonatal Med 2019; 34:1091-1098. [PMID: 31177877 DOI: 10.1080/14767058.2019.1624719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the parameters affecting the treatment success of conservative surgery in cases with placental invasion anomaly. METHODS Archive files and digital image records of 67 patients with placental invasion anomaly were studied. The patients were divided into two groups, a conservative surgery group and a cesarean hysterectomy group. Demographic data, cervical length, placental localization, placental surface area adhering to previous cesarean section line, preoperative and postoperative hematocrit values, transfused blood products, and surgical complications were compared between the two groups. RESULTS In the conservative surgery group, the cervical length was longer (p < .001) and the surface area of the placenta in the previous cesarean scar line was smaller (p < .001). For cervical length, the sensitivity and specificity values were 97 and 81%, respectively, when the cut-off value was 35.5 mm. When the cut-off value for the placental surface area in the previous cesarean scar line was 85.5 cm2, the sensitivity and specificity values were 68 and 72%, respectively. In the caesarean hysterectomy group, the preoperative and postoperative hematocrit values were lower (p < .001, p = .003, respectively), and the amount of transfused erythrocyte suspension and fresh frozen plasma were higher (p < .001, p = .001, respectively). CONCLUSION In this study, it was concluded that the presence of the nondestructive intact cervical tissue, in the cases with placental invasion anomaly and/or the small size of the placental surface area adhering to the previous cesarean scar line, increase the feasibility of conservative surgery.
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Affiliation(s)
- Talip Karaçor
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mehmet Bülbül
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mehmet Can Nacar
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Pınar Kirici
- Department of Obstetrics and Gynecology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Nurullah Peker
- Department of Obstetrics and Gynecology, Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Sibel Sak
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
| | - Muhammet Erdal Sak
- Department of Obstetrics and Gynecology, Harran University School of Medicine, Şanlıurfa, Turkey
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Slaoui A, Talib S, Nah A, Moussaoui KE, Benzina I, Zeraidi N, Baydada A, Kharbach A. Placenta accreta in the department of gynaecology and obstetrics in Rabat, Morocco: case series and review of the literature. Pan Afr Med J 2019; 33:86. [PMID: 31489064 PMCID: PMC6711691 DOI: 10.11604/pamj.2019.33.86.17700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/11/2019] [Indexed: 11/11/2022] Open
Abstract
Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.
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Affiliation(s)
- Aziz Slaoui
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Sarah Talib
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Anass Nah
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Kamal El Moussaoui
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Intissar Benzina
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Najia Zeraidi
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Aziz Baydada
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Aicha Kharbach
- Gynaecology-Obstetrics and Endocrinology Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
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Collins SL, Alemdar B, van Beekhuizen HJ, Bertholdt C, Braun T, Calda P, Delorme P, Duvekot JJ, Gronbeck L, Kayem G, Langhoff-Roos J, Marcellin L, Martinelli P, Morel O, Mhallem M, Morlando M, Noergaard LN, Nonnenmacher A, Pateisky P, Petit P, Rijken MJ, Ropacka-Lesiak M, Schlembach D, Sentilhes L, Stefanovic V, Strindfors G, Tutschek B, Vangen S, Weichert A, Weizsäcker K, Chantraine F. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019; 220:511-526. [PMID: 30849356 DOI: 10.1016/j.ajog.2019.02.054] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Abstract
The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.
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Affiliation(s)
- Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; The Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK.
| | - Bahrin Alemdar
- Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden
| | | | - Charline Bertholdt
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, France
| | - Thorsten Braun
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Pavel Calda
- Department of Obstetrics and Gynecology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Pierre Delorme
- Port-Royal Maternity Unit, Cochin Hospital, Paris-Descartes University, DHU Risk and Pregnancy, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lene Gronbeck
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Gilles Kayem
- Department of Obstetrics and Gynecology, Hôpital Trousseau, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Louis Marcellin
- Department of Gynecology Obstetrics II and Reproductive Medicine, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, APHP; Sorbonne Paris Cité, Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Olivier Morel
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, France
| | - Mina Mhallem
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maddalena Morlando
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy; Department of Women, Children and of General and Specialized Surgery, University "Luigi Vanvitelli", Naples, Italy
| | - Lone N Noergaard
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Denmark
| | - Andreas Nonnenmacher
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Petra Pateisky
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Philippe Petit
- Department of Obstetrics and Gynecology, CHR Citadelle, University of Liege, Liege, Belgium
| | - Marcus J Rijken
- Vrouw & Baby, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mariola Ropacka-Lesiak
- Department of Perinatology and Gynecology, University of Medical Sciences, Poznan, Poland
| | - Dietmar Schlembach
- Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Fetomaternal Medical Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Gita Strindfors
- Department of Obstetrics and Gynecology, South General Hospital, Stockholm, Sweden
| | - Boris Tutschek
- Prenatal Zurich, Zürich, Switzerland; Heinrich Heine University, Düsseldorf, Germany
| | - Siri Vangen
- Division of Obstetrics and Gynaecology, Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Rikshospitalet and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexander Weichert
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Katharina Weizsäcker
- Departments of Obstetrics and Division of Experimental Obstetrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Frederic Chantraine
- Department of Obstetrics and Gynecology, CHR Citadelle, University of Liege, Liege, Belgium
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Mei Y, Zhao H, Zhou H, Jing H, Lin Y. Comparison of infrarenal aortic balloon occlusion with internal iliac artery balloon occlusion for patients with placenta accreta. BMC Pregnancy Childbirth 2019; 19:147. [PMID: 31046694 PMCID: PMC6498491 DOI: 10.1186/s12884-019-2303-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was designed to compare the role of infrarenal aortic artery balloon occlusion (IAABC) with internal iliac artery balloon occlusion (IIABOC). METHODS One hundred seventy-four cases with placenta accreta were retrospectively analyzed.74 cases who had IAABC were in group A, while the others who had IIABOC were in group B. RESULTS Amount of estimated blood loss (EBL), the rate of major blood loss, the rate of blood transfusion and uterine packing, length of hospitalization were not different in both groups. The rate of uterine artery embolization (UAE), balloon occlusion time, operation time and fetus radiation dose in group A were less than those in group B. CONCLUSIONS IAABC resulted in better clinical outcomes than IIABOC.
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Affiliation(s)
- Youwen Mei
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hu Zhao
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Hui Zhou
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Huaibo Jing
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China
| | - Yonghong Lin
- Department of Obstetrics and Gynecology, Chengdu's Women and Children's Central Hospital, Chengdu, Sichuan Province, China.
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MacGibbon A, Ius YM. Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Foetal Demise. Case Rep Obstet Gynecol 2018; 2018:7478437. [PMID: 30405926 PMCID: PMC6204162 DOI: 10.1155/2018/7478437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/07/2018] [Accepted: 09/30/2018] [Indexed: 11/18/2022] Open
Abstract
We present the case of a midtrimester intrauterine foetal demise (IUFD) in the context of abnormally invasive placentation. This was a grade 4 placenta previa with placenta increta in a patient requesting fertility conservation and was managed conservatively without immediate surgical intervention. The patient spontaneously delivered the fetus after 33 days, followed by a large obstetric haemorrhage requiring immediate laparotomy and hysterotomy. Her uterus was preserved and she went on to recover without further significant complication. While conservative management of morbidly adherent placentas has been well documented, there are no published cases of this strategy in the context of IUFD and fertility preservation.
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Affiliation(s)
- A. MacGibbon
- Department of Obstetrics and Gynaecology, John Hunter Hospital. Newcastle, New South Wales, Australia
| | - Y. M. Ius
- Department of Obstetrics and Gynaecology, John Hunter Hospital. Newcastle, New South Wales, Australia
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Fluhr H. Plazentaretention – Management mit Fokus auf die Fertilität. GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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A Case of Placenta Percreta Managed with Sequential Embolisation Procedures. Case Rep Obstet Gynecol 2018; 2018:7213689. [PMID: 29736284 PMCID: PMC5874981 DOI: 10.1155/2018/7213689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/23/2017] [Accepted: 01/23/2018] [Indexed: 12/03/2022] Open
Abstract
Background The incidence of morbidly adherent placenta, including placenta percreta, has increased significantly over recent years due to rising caesarean section rates. Historically, abnormally invasive placenta has been managed with caesarean hysterectomy; however nonsurgical interventions such as uterine artery embolisation (UAE) are emerging as safe alternative management techniques. UAE can be utilised to decrease placental perfusion and encourage placental resorption, thereby reducing the risk of haemorrhage and other morbidities. Case We describe one of the very few reported cases of placenta percreta which was successfully treated primarily with sequential artery embolisation. Our patient underwent four embolisation procedures over a period of 248 days, with no major morbidity or complications. Conclusion Repeat UAE may be a beneficial primary management modality in cases of placenta percreta with bladder involvement.
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Zhang C, Li H, Zuo C, Wang X. Retrospective analysis: Conservative treatment of placenta increta with methotrexate. J Obstet Gynaecol Res 2018; 44:907-913. [PMID: 29484784 DOI: 10.1111/jog.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Chunhua Zhang
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Hongyan Li
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Changting Zuo
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Xietong Wang
- Department of Obstetrics and Gynecology; Provincial Hospital Affiliated to Shandong University; Jinan China
- Key Laboratory of Birth Regulation and Control Technology of National Health and Family Planning Commission of China; Jinan China
- Maternal and Child Health Care of Shandong Province; Jinan China
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Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management,. Int J Gynaecol Obstet 2018; 140:291-298. [DOI: 10.1002/ijgo.12410] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Loïc Sentilhes
- Department of Obstetrics and Gynecology; Bordeaux University Hospital; Bordeaux France
| | - Gilles Kayem
- Department of Obstetrics and Gynecology; Trousseau Hospital AP-HP; Paris France
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology; St George's University Hospitals NHS Foundation Trust; London UK
| | | | - Eric Jauniaux
- EGA Institute for Women's Health; Faculty of Population Health Sciences; University College London; London UK
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24
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Endovascular interventional modalities for haemorrhage control in abnormal placental implantation deliveries: a systematic review and meta-analysis. Eur Radiol 2018; 28:2713-2726. [DOI: 10.1007/s00330-017-5222-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 11/27/2022]
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25
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Pala Ş, Atilgan R, Başpınar M, Kavak EÇ, Yavuzkır Ş, Akyol A, Kavak B. Comparison of results of Bakri balloon tamponade and caesarean hysterectomy in management of placenta accreta and increta: a retrospective study. J OBSTET GYNAECOL 2017; 38:194-199. [DOI: 10.1080/01443615.2017.1340440] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Şehmus Pala
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Remzi Atilgan
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Melike Başpınar
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Ebru Çelik Kavak
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Şeyda Yavuzkır
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Alparslan Akyol
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
| | - Burçin Kavak
- Department of Obstetrics and Gynecology, Firat University School of Medicine, Elazig, Turkey
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26
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Mei Y, Luo D, Lin Y. Clinical application of prophylactic internal iliac artery balloon occlusion combined with uterine artery embolization in patients with abnormally invasive placenta. J Matern Fetal Neonatal Med 2017; 31:3287-3292. [PMID: 28818012 DOI: 10.1080/14767058.2017.1368485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study is to investigate the role of prophylactic internal iliac artery balloon occlusion combined with uterine artery embolization (UAE) in patients with abnormally invasive placenta. METHODS Forty cases with abnormally invasive placenta who visited our hospital were analyzed retrospectively from May 2014 to September 2015. Twenty cases who had prophylactic balloon occlusion of internal iliac artery with/without UAE were in the study group, while the other 20 cases in the control group. Volume of estimated blood loss and blood transfusion, rate of hysterectomy, surgery duration, postoperative complication and length of hospitalization were compared between two groups. RESULTS The mean estimated blood loss in the study group (800 ml,500-1800 ml) was less than that in the control group (1875 ml, 500-7600 ml) (p = .01). Only two cases had blood transfusion in the study group, while 12 cases in the control group. No case was performed hysterectomy in the study group, while one case had the operation in the control group. There was no significant difference in surgery duration, postoperative complications and length of hospitalization between two groups. CONCLUSION Prophylactic balloon occlusion of internal iliac artery combined with UAE is effective and safe for patients with abnormally invasive placenta.
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Affiliation(s)
- Youwen Mei
- a Chengdu's Women and Children's Central Hospital , Chengdu , China
| | - Dan Luo
- a Chengdu's Women and Children's Central Hospital , Chengdu , China
| | - Yonghong Lin
- a Chengdu's Women and Children's Central Hospital , Chengdu , China
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27
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Chamsuddin A, Noufaily A, Achou R, Ashram M, Mokbel M, Dabaj E, Snaifer E. Uterine artery embolization for management of placenta accreta, a single-center experience and literature review. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2017. [DOI: 10.4103/2542-7075.199572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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28
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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
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29
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Wu Q, Liu Z, Zhao X, Liu C, Wang Y, Chu Q, Wang X, Chen Z. Outcome of Pregnancies After Balloon Occlusion of the Infrarenal Abdominal Aorta During Caesarean in 230 Patients With Placenta Praevia Accreta. Cardiovasc Intervent Radiol 2016; 39:1573-1579. [PMID: 27439624 PMCID: PMC5052309 DOI: 10.1007/s00270-016-1418-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/07/2016] [Indexed: 12/02/2022]
Abstract
Purpose To explore the efficacy and safety of prophylactic temporary balloon occlusion of the infrarenal abdominal aorta during caesarean for the management of patients with placenta praevia accreta. Methods Two hundred and sixty-eight cases of placenta praevia accreta from January 2012 to June 2015 were retrospectively reviewed. Group A included two hundred and thirty patients who underwent prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section. Group B included thirty-eight patients who underwent caesarean without endovascular intervention. The parameters including operating room time, estimated blood loss, blood transfusion volume, PT (prothrombin time) during operation, days in the intensive care unit, and total hospital days were compared between the two groups. Results The operating room time, estimated blood loss, PT, the incidence of hysterectomy, blood transfusion volume, postpartum haemorrhage, and days in intensive care unit were lower in group A than in group B, with statistical significance (P < 0.05). There was no significant difference in the Apgar scores of the neonates and the incidences of thrombosis in lower limbs between the two groups (P > 0.05). No patient in the group with prophylactic temporary balloon occlusion of the infrarenal abdominal aorta was performed hysterectomy, while three patients in group B were performed hysterectomy because of uncontrollable haemorrhage. Conclusions The results indicate that prophylactic temporary balloon occlusion of infrarenal abdominal aorta followed by caesarean section is safe and effective to control intraoperative blood loss and greatly decreases the risk of hysterectomy in patients with placenta praevia accreta.
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Affiliation(s)
- Qinghua Wu
- Departments of Prenatal Diagnosis, and Obstetrics, Obstetric Critical Treatment Center of Henan Province, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Zhuan Liu
- Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Xianlan Zhao
- Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China.
| | - Cai Liu
- Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Yanli Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Qinjun Chu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Xiaojuan Wang
- Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
| | - Zhimin Chen
- Obstetric Critical Treatment Center of Henan Province, Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou City, Henan Province, China
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30
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Soro MAP, Denys A, de Rham M, Baud D. Short & long term adverse outcomes after arterial embolisation for the treatment of postpartum haemorrhage: a systematic review. Eur Radiol 2016; 27:749-762. [PMID: 27229338 DOI: 10.1007/s00330-016-4395-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Arterial embolisation (AE) plays a major role in current practice in the management of postpartum haemorrhage (PPH) that fails to respond to conservative treatment. While its benefit is well known, long-term outcomes of AE have been poorly investigated. The objective of this review is to assess its potential complications and long-term effects on the patients' quality of life. METHODS Using the terms "embolisation" and "postpartum haemorrhage", we searched the Cochrane Central Register of Controlled Trials, Medline and PubMed for published studies. We limited the search to articles in English and French reporting "complications", "fertility", "menstruation" or "menstrual cycle" in humans. To ensure completeness, the references of extracted articles and review articles were also searched. RESULTS The fertility rate in patients attempting another pregnancy reaches 70-80 %. Pregnancies following AE for PPH are not associated with a higher rate of intrauterine growth restriction. Pathological placentation (placenta accreta/increta/percreta) occurs more frequently after AE than in the general population. Psychological wellbeing, post-traumatic stress and sexual dysfunction after a life-threatening PPH requiring AE will require further investigation. CONCLUSION AE does not appear to adversely affect menstrual cycle, fertility and subsequent pregnancies, but may affect placentation. The experience of a life-threatening PPH, however, might prevent couples from pursuing another pregnancy. KEY POINTS • Embolisation for PPH does not adversely affect menstrual cycle and fertility • Experience of life-threatening PPH might prevent couples from pursuing another pregnancy • Pathological placentation seems to occur more frequently after embolisation for PPH.
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Affiliation(s)
- Marie-Aimée Päivi Soro
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.,Department of Radiology, University Hospital, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology, University Hospital, 1011, Lausanne, Switzerland
| | - Maud de Rham
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland
| | - David Baud
- Materno-Fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
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31
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Greenbaum S, Khashper A, Leron E, Ohana E, Meirovitz M, Hershkovitz R, Erez O. Escalating placenta invasiveness: repeated placenta accreta at the limit of viability. Int J Womens Health 2016; 8:119-23. [PMID: 27143953 PMCID: PMC4846064 DOI: 10.2147/ijwh.s100321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Placenta percreta is an obstetric condition in which the placenta invades through the myometrium. This is the most severe form of placenta accreta and may result in spontaneous uterine rupture, a rare complication that threatens the life of both mother and fetus. In this case report, we describe a 32-year-old woman in her fourth pregnancy, diagnosed with repeated placenta accreta, which was eventually complicated by spontaneous uterine rupture at 24 weeks’ gestation. This patient had a history of abnormal placentation in prior pregnancies and previous uterine injuries. This case demonstrates a pattern of escalating placental invasiveness, and raises questions regarding the process of abnormal placentation and the manifestation of uterine rupture in scarred uteri.
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Affiliation(s)
- Shirley Greenbaum
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Alla Khashper
- Department of Radiology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Elad Leron
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eric Ohana
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Mihai Meirovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Reli Hershkovitz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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32
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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.
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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.
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33
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Endovascular management of postpartum hemorrhage of placental origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, Huls C, Abuhamad A, Simhan H, Barton J, Wright J, Silver R, Belfort MA. Conservative management of morbidly adherent placenta: expert review. Am J Obstet Gynecol 2015; 213:755-60. [PMID: 25935779 DOI: 10.1016/j.ajog.2015.04.034] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/24/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
Over the last century, the incidence of placenta accreta, increta, and percreta, collectively referred to as morbidly adherent placenta, has risen dramatically. Planned cesarean hysterectomy at the time of cesarean delivery is the standard recommended treatment in the United States. Recently, interest in conservative management has resurged, especially in Europe. The aims of this review are the following: (1) to provide an overview of methods used for conservative management, (2) to discuss clinical implications for both clinicians and patients, and (3) to identify areas in need of further research.
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Affiliation(s)
| | | | | | | | - Paula Lee
- Duke University Medical Center, Durham, NC
| | - Ozhan M Turan
- University of Maryland School of Medicine, Baltimore, MD
| | - Christopher Huls
- Phoenix Perinatal Associates/Medivax, Banner Good Samaritan Medical Center, University of Arizona, Phoenix, AZ
| | | | - Hyagriv Simhan
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Jason Wright
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Robert Silver
- University of Utah Medical School, Salt Lake City, UT
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35
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D'Souza DL, Kingdom JC, Amsalem H, Beecroft JR, Windrim RC, Kachura JR. Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization. Can Assoc Radiol J 2015; 66:179-84. [DOI: 10.1016/j.carj.2014.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 10/23/2022] Open
Abstract
Purpose The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery. Methods Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity. Results All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%. Conclusion Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.
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Affiliation(s)
- Donna L. D'Souza
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
- University of Minnesota, Minneapolis, Minnesota, USA
| | - John C. Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John R. Beecroft
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rory C. Windrim
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John R. Kachura
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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36
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Soyer P, Dohan A, Dautry R, Guerrache Y, Ricbourg A, Gayat E, Boudiaf M, Sirol M, Ledref O. Transcatheter Arterial Embolization for Postpartum Hemorrhage: Indications, Technique, Results, and Complications. Cardiovasc Intervent Radiol 2015; 38:1068-81. [DOI: 10.1007/s00270-015-1054-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/07/2015] [Indexed: 12/21/2022]
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37
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Kelekci S, Ekmekci E, Aydogmus S, Gencdal S. A comprehensive surgical procedure in conservative management of placenta accreta: a case series. Medicine (Baltimore) 2015; 94:e529. [PMID: 25700315 PMCID: PMC4554183 DOI: 10.1097/md.0000000000000529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to present a combined surgical procedure in conservative treatment of placenta accreta based on surgical outcomes in our cohort of patients. The study was designed as a prospective cohort series study. The setting involved two education and research hospitals in Turkey. This study included 12 patients with placenta accreta who were prenatally diagnosed and managed. We offered the patients the choice of conservative or nonconservative treatment. We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. One patient preferred nonconservative treatment, the others opted for our procedure.We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes. We operated on 11 patients using this surgical procedure that we have developed for placenta accreta cases. We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients. No patient presented any septic complication or secondary vaginal bleeding.Our surgical procedure seems to be effective and useful in the conservative treatment of placenta accreta.
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Affiliation(s)
- Sefa Kelekci
- From the Department of Obstetrics and Gynecology (SK, EE, SA), School of Medicine, Izmir Katip Celebi University, Izmir; and Department of Obstetrics and Gynecology (SG), School of Medicine, Kafkas University, Kars, Turkey
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Malhotra V, Bhuria V, Nanda S, Chauhan M, Rani A. Placenta Accreta: Five-Year Experience at a Tertiary-Care Center. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vani Malhotra
- Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India
| | - Vandana Bhuria
- Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India
| | - Smiti Nanda
- Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India
| | - Meenakshi Chauhan
- Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India
| | - Anju Rani
- Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India
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Bajwa SK, Singh A, Bajwa SJS. Contemporary issues in the management of abnormal placentation during pregnancy in developing nations: An Indian perspective. Int J Crit Illn Inj Sci 2014; 3:183-9. [PMID: 24404455 PMCID: PMC3883196 DOI: 10.4103/2229-5151.119197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The gap between the developed and developing nations with regards to maternal mortality and morbidity may have narrowed but still a lot of dedicated work is required to bridge these differences. Obstetrical haemorrhage is the leading cause of maternal deaths in these developing nations especially in India. The most common causes of this fatal haemorrhage are the placental abnormalities which rarely get detected before delivery. Numerous factors have been incremental in the causation of this abnormal placental implantation with resultant complications. The present article is an attempt to review possible predictors of abnormal placental implantation. Also, a genuine attempt has been made to enumerate possible measures to identify the predictors of abnormal placentation during early pregnancy and their suitable prevention and management.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Anita Singh
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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40
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Perez-Delboy A, Wright JD. Surgical management of placenta accreta: to leave or remove the placenta? BJOG 2013; 121:163-9; discussion 169-70. [DOI: 10.1111/1471-0528.12524] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A Perez-Delboy
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York NY USA
| | - JD Wright
- Department of Obstetrics and Gynecology; Columbia University College of Physicians and Surgeons; New York NY USA
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Hequet D, Morel O, Soyer P, Gayat E, Malartic C, Barranger E. Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placentaaccreta. Aust N Z J Obstet Gynaecol 2013; 53:580-3. [DOI: 10.1111/ajo.12138] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Delphine Hequet
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
| | - Olivier Morel
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
- Obstetrics and Gynecology unit; Maternité Universitaire de Nancy; Université Nancy I Henri Poincaré; Nancy France
| | - Philippe Soyer
- Department of Body & Interventional Radiology; Lariboisière Hospital - APHP; Université Diderot Paris 7; Paris France
| | - Etienne Gayat
- Anesthesiology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
| | - Cécile Malartic
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
- Obstetrics and Gynecology unit; Maternité Universitaire de Nancy; Université Nancy I Henri Poincaré; Nancy France
| | - Emmanuel Barranger
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
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Khan M, Sachdeva P, Arora R, Bhasin S. Conservative management of morbidly adherant placenta – A case report and review of literature. Placenta 2013; 34:963-6. [DOI: 10.1016/j.placenta.2013.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/11/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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Gizzo S, Saccardi C, Patrelli TS, Di Gangi S, Breda E, Fagherazzi S, Noventa M, D'Antona D, Nardelli GB. Fertility rate and subsequent pregnancy outcomes after conservative surgical techniques in postpartum hemorrhage: 15 years of literature. Fertil Steril 2013; 99:2097-107. [PMID: 23498891 DOI: 10.1016/j.fertnstert.2013.02.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the most appropriate surgical technique for optimizing hemostasis and preservation of subsequent fertility after postpartum hemorrhage (PPH). DESIGN Systematic review of the literature. SETTING Not applicable. PATIENT(S) None. INTERVENTION(S) Review of MEDLINE, EMBASE, ScienceDirect, and the Cochrane Library. MAIN OUTCOME MEASURE(S) Comparison of the effectiveness of conservative surgical techniques, separately or together, with respect to success rate (ability to stop bleeding and preserve the uterus), fertility rate (subsequent pregnancies or the return of regular menstrual cycles), complication rate of the procedure, and the outcomes of subsequent pregnancies in terms of type of delivery and eventual delivery complications. RESULT(S) Compressive sutures and vessel embolization may be considered life-saving procedures by achieving the best hemostatic efficacy. Data on restoration of menses and pregnancy rates after these procedures are limited by short-term follow-up and by the paucity of studies, especially for vascular ligation. CONCLUSION(S) Pelvic vessel embolization and compressive sutures are associated with high rates of restoration of regular menses and successive pregnancies, even if the former is burdened by an increased rate of placental disorders and fetal growth restriction and the latter by an increased risk of cesarean deliveries and PPH recurrence. Randomized trials would be desirable to define the best management of PPH.
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Affiliation(s)
- Salvatore Gizzo
- Department of Woman and Child Health, University of Padua, Padua, Italy.
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Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births. Am J Obstet Gynecol 2013; 208:219.e1-7. [PMID: 23313722 DOI: 10.1016/j.ajog.2012.12.037] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/14/2012] [Accepted: 12/31/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We sought to evaluate risk factors and perinatal outcomes of pregnancies complicated with placenta accreta and to study perinatal outcomes in subsequent pregnancies. STUDY DESIGN A retrospective study comparing all singleton cesarean deliveries (CD) of women with and without placenta accreta was conducted. In addition, a retrospective comparison of all subsequent singleton CD of women with a previous placenta accreta, with CD of women with no such history, was performed during the years 1988 through 2011. Stratified analysis using multiple logistic regression models was performed to control for confounders. RESULTS During the study period, there were 34,869 CD, of which 0.4% (n = 139) were complicated with placenta accreta. Using a multivariable analysis with backward elimination, year of birth (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.03-1.09; P < .001), previous CD (aOR, 5.11; 95% CI, 3.42-7.65; P < .001), and placenta previa (aOR, 50.75; 95% CI, 35.57-72.45; P < .001) were found to be independently associated with placenta accreta. There were 30 subsequent pregnancies of women with placenta accreta. Recurrent accreta occurred in 4 patients (13.3%). Previous placenta accreta was significantly associated with uterine rupture (3.3% vs 0.3%, P < .01) peripartum hysterectomy (3.3% vs 0.2%, P < .001), and the need for blood transfusions (16.7% vs 4%, P < .001). Nevertheless, increased risk for adverse perinatal outcomes such as low Apgar scores at 1 and 5 minutes and perinatal mortality was not found in these patients. CONCLUSION Prior CD and placenta previa are independent risk factors for placenta accreta. A pregnancy following a previous placenta accreta is at increased risk for adverse maternal outcomes such as recurrent accreta, uterine rupture, and peripartum hysterectomy. However, adverse perinatal outcomes were not demonstrated.
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Tan SEG, Jobling TW, Wallace EM, Mcneilage LJ, Manolitsas T, Hodges RJ. Surgical management of placenta accreta: a 10-year experience. Acta Obstet Gynecol Scand 2013; 92:445-50. [DOI: 10.1111/aogs.12075] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/18/2012] [Indexed: 11/24/2022]
Affiliation(s)
- SE Grace Tan
- Maternal Fetal Medicine Unit; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | - Thomas W Jobling
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | | | - L Jane Mcneilage
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
| | - Thomas Manolitsas
- Department of Gynaecological Oncology; Monash Medical Centre; Southern Health; Clayton; Victoria; Australia
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Héquet D, Ricbourg A, Sebbag D, Rossignol M, Lubrano S, Barranger E. [Placenta accreta: screening, management and complications]. ACTA ACUST UNITED AC 2013; 41:31-7. [PMID: 23291052 DOI: 10.1016/j.gyobfe.2012.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/15/2022]
Abstract
Abnormal placental invasion can result in major obstetric haemorrhage during delivery. The most important risk factors are the following: previous caesarean delivery, placenta praevia maternal age over 35, smoking, previous myomectomy, dilatation and curettage. When placenta accreta is suspected on ultrasound, an RMI can complete the diagnostic. Therefore, patients must be managed, as far as possible, in a reference centre, by a trained medical team. Birth must be planned in order to decrease complications rate. Treatment can consist in radical management (caesarean-hysterectomy) or conservative management (preservation of both uterus and placenta). Conservative management allows patients to keep fertility but can also decrease blood loss during delivery. Side effects of this therapy are secondary haemorrhage, sepsis, long-term follow-up and vaginal loss. There are few studies describing fertility after conservative management, but it seems to be a secure treatment for future pregnancies. Embolization can be a very useful, already demonstrated, help when massive haemorrhage occurs. Management of placenta accreta is multidisciplinary and patients must be informed of all options. Treatment is decided regarding history of the patients, operative findings and peri-partum blood loss.
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Affiliation(s)
- D Héquet
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Paris, 2 rue Ambroise-Paré, Paris, France.
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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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Skinner BD, Golichowski AM, Raff GJ. Laparoscopic-assisted vaginal hysterectomy in a patient with placenta percreta. JSLS 2012; 16:143-7. [PMID: 22906343 PMCID: PMC3407435 DOI: 10.4293/108680812x13291597717022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Placenta percreta is a problem encountered with increasing frequency due to the rising rate of cesarean delivery. Conservative management of this condition is associated with decreased perioperative morbidity. When hysterectomy is necessary, a laparoscopic approach can provide additional benefits. We present the case of a woman with placenta percreta with bladder invasion who was undergoing conservative management and then required delayed hysterectomy. Laparoscopic-assisted vaginal hysterectomy was successfully performed. We review the techniques used to ensure a good outcome and the advantages of a minimally invasive approach to hysterectomy in this patient with placenta percreta.
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Affiliation(s)
- Bethany D Skinner
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Omar HR, Karlnoski R, Mangar D, Patel R, Hoffman M, Camporesi E. Staged Endovascular Balloon Occlusion versus Conventional Approach for Patients with Abnormal Placentation: A Literature Review. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hesham R. Omar
- Department of Internal Medicine, Mercy Hospital and Medical Center, Chicago, Illinois
| | - Rachel Karlnoski
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Devanand Mangar
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Rita Patel
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
| | - Mitchel Hoffman
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Enrico Camporesi
- Department of Surgery, University of South Florida, Tampa, Florida
- Florida Gulf-to-Bay Anesthesiology, Tampa, Florida
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Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation. Eur Radiol 2012; 23:262-71. [PMID: 22760345 DOI: 10.1007/s00330-012-2573-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the potential of magnetic resonance (MR) imaging in evaluating placental vascularity and predicting placental resorption delay after conservative management of invasive placenta. METHODS MR examinations of 23 women with conservative management of invasive placenta were reviewed. Twelve women had pelvic embolisation because of postpartum haemorrhage (Group 1) and 11 had no embolisation (Group 2). Comparisons between the two groups were made with respect to the delay for complete placental resorption at follow-up MR imaging and degree of placental vascularity 24 h after delivery on early (30s) and late (180 s) phase of dynamic gadolinium chelate-enhanced MR imaging. RESULTS The median delay for complete placental resorption in the cohort study was 21.1 weeks (range, 1-111 weeks). In Group 1, the median delay for complete placental resorption was shorter than in Group 2 (17 vs 32 weeks) (P = 0.036). Decreased placental vascularity on the early phase was observed in Group 1 by comparison with Group 2 (P = 0.003). Significant correlation was found between the degree of vascularity on early phase of dynamic MR imaging and the delay for complete placental resorption (r = 0.693; P < 0.001). CONCLUSIONS MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.
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