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Boujenah J, Dupont-Bernabe C, Thuillier C, Sananes N, Bouhanna P, Rozenberg P. [Should we screen vasa praevia?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00210-1. [PMID: 38795831 DOI: 10.1016/j.gofs.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Jeremy Boujenah
- Département d'obstétrique, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France.
| | - Celine Dupont-Bernabe
- Département d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France
| | - Claire Thuillier
- Département d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France
| | - Nicolas Sananes
- Département d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France
| | - Philippe Bouhanna
- Département d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France
| | - Patrick Rozenberg
- Département d'obstétrique et gynécologie, hôpital américain de Paris, 92200 Neuilly-sur-Seine, France; Inserm, équipe U1018, épidémiologie clinique, CESP, université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
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2
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Tanaka ME, Keefe N, Caridi T, Kohi M, Salazar G. Interventional Radiology in Obstetrics and Gynecology: Updates in Women's Health. Radiographics 2023; 43:e220039. [PMID: 36729949 DOI: 10.1148/rg.220039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Interventional radiology has had an expanding role in women's health over the past few decades, with recent accelerated growth and development. Interventional radiology is fundamental in the treatment of multiple conditions that affect women, including pelvic venous disease, uterine fibroids, and adenomyosis, and in postpartum management. Patient workup, classification, and treatment techniques have continued to evolve as interventional radiology has become more prevalent in the treatment of patients affected by these conditions. The authors provide a review of the pathophysiology of, patient workup for, and treatment of pelvic venous disease and uterine artery embolization for various disease processes. The authors also highlight updates from the past 5-10 years in diagnosis, classification, and treatment strategies. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mari E Tanaka
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Nicole Keefe
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Theresa Caridi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Maureen Kohi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Gloria Salazar
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
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West S, Martin A, Copping R, Gard G, Maher R, Seeho S. Staged treatment of placenta accreta spectrum: A combined surgical and radiological approach. Aust N Z J Obstet Gynaecol 2023. [PMID: 36695433 DOI: 10.1111/ajo.13646] [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: 07/14/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. AIMS The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. METHODS AND MATERIALS Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. RESULTS Forty-six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. CONCLUSION This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity.
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Affiliation(s)
- Simon West
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Amy Martin
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia
| | - Ross Copping
- Liverpool Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Greg Gard
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia
| | - Richard Maher
- Royal North Shore Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Sean Seeho
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
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Wang N, Shi D, Li N, Qi H. Clinical value of serum VEGF and sFlt-1 in pernicious placenta previa. Ann Med 2021; 53:2041-2049. [PMID: 34927512 PMCID: PMC8725906 DOI: 10.1080/07853890.2021.1999492] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
This study was designed to explore the expression and the diagnostic value of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pernicious placenta previa (PPP) combined placental accreta/increta. A total of 140 PPP patients were enrolled and divided into two groups: 56 patients with placenta accreta/increta (PA group), and 84 patients without placenta accreta/increta (non-PA group). In the same period, 46 pregnant women without PPP who had undergone caesarean section were selected as controls. The levels of VEGF and sFlt-1 in serum were detected by enzyme-linked immunosorbent assay. Diagnostic efficiency of VEGF and sFlt-1 in serum were evaluated by receiver operating characteristics curve. It was found that both VEGF and sFlt-1 had diagnostic value for PPP and placenta accreta/increta combined PPP. In addition, the levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta. VEGF was negatively correlated with sFlt-1 in PPP patients. In summary, the levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.KEY POINTSThe levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta.VEGF is negatively correlated with sFlt-1 in PPP patients.The levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.
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Affiliation(s)
- Na Wang
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Dandan Shi
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Na Li
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Hongyuan Qi
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
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Dubois E, Bouet PE, Descamps P, May-Panloup P, Boucret L, Legendre G, Corroenne R. Impact of the type of endometrial oestrogen preparation for frozen-thawed embryo (vaginal or transdermal) on perinatal outcomes in an artificial cycle. J Gynecol Obstet Hum Reprod 2021; 50:102187. [PMID: 34157428 DOI: 10.1016/j.jogoh.2021.102187] [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] [Received: 02/18/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Serum oestradiol concentration at the time of frozen embryo transfer (FET) in artificial cycle are lower when using transdermal administration of oestrogen for endometrial preparation compared to the vaginal route. This difference could have consequences for placentation and establishment of maternal-foetal circulation. The aim of our study was to compare the birth weight of newborns and the perinatal issues after FET in an artificial cycle with regard to the route of administration of oestrogens. METHODS Retrospective monocentric cohort study in the medically assisted reproduction department of the University Hospital of Angers, France, between January 2017 and October 2020. Inclusion criteria were age >18 years old and one live birth after FET in an artificial cycle. The main outcome was the birth weight of the newborns. The choice of oestrogens administration (transdermal or vaginal) was left to the patient. RESULTS 804 FET in artificial cycle were included in our study. Oestrogens were administrated in 356/804(36.6%) patients using transdermal route and in 448/804(45.9%) patients using vaginal route. There were 68/345 (19.1%) live births in the transdermal group and 85/448 (19%) in the vaginal group. There was no difference in the birth weight of the newborns (3320[2100-4165] grams in the transdermal group vs 3327.5[915-4650] grams in the vaginal group, p=0.72). All the other perinatal issues were comparable between the two groups. CONCLUSION Birth weights and perinatal issues were comparable with regard to the route of administration of oestrogens (vaginal or transdermal) in the context of endometrial preparation before FET in an artificial cycle.
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Affiliation(s)
- Emeric Dubois
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | | | - Philippe Descamps
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Pascale May-Panloup
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Lisa Boucret
- Department of Reproductive Medicine, Angers University Hospital, Angers, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Romain Corroenne
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France.
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Soued M, Vivanti AJ, Smiljkovski D, Deffieux X, Benachi A, Le Gouez A, Mercier FJ. Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study. J Clin Med 2020; 10:jcm10010081. [PMID: 33379355 PMCID: PMC7795364 DOI: 10.3390/jcm10010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Invasive therapies (surgery or radiological embolization) are used to control severe post-partum hemorrhage. The intra-uterine tamponade balloon is a potential alternative, well documented after vaginal delivery. However, available data on its use after cesarean delivery remain scarce. This study assessed the efficacy of the intra-uterine tamponade balloon during post-partum hemorrhage in a cesarean delivery setting. Using a retrospective impact design, post-partum hemorrhage-related outcomes before (“pre-balloon” period) versus after implementation of intra-uterine tamponade balloon (“post-balloon” period) were compared. All women with post-partum hemorrhage requiring potent uterotonic treatment with prostaglandins after cesarean delivery over a 9-year period were eligible. The primary outcome was the rate of invasive procedure (conservative surgery, radiological embolization and/or hysterectomy). p < 0.05 was considered statistically significant. A total of 279 patients were included (140 vs. 139). Most baseline characteristics were comparable between the two studied periods. The success rate of the intra-uterine tamponade balloon was 82%, and no related complications occurred. Rates of invasive procedures and transfusion were significantly reduced (28.6% vs. 11.5%, p < 0.001 and 44.3% vs. 28.1%, p = 0.006 respectively) during the “post-balloon” period, and length of hospital stay was shorter (p < 0.001). Implementation of intra-uterine tamponade balloon during post-partum hemorrhage after cesarean delivery appears to be safe and effective, with a decrease in both invasive procedures and transfusion rates.
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Affiliation(s)
- Mickaël Soued
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
- Correspondence:
| | - Alexandre J. Vivanti
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Daniel Smiljkovski
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Xavier Deffieux
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Alexandra Benachi
- Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (A.J.V.); (X.D.); (A.B.)
| | - Agnès Le Gouez
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
| | - Frédéric J. Mercier
- Department of Anesthesia, Hôpital Antoine Béclère, APHP, Université Paris Saclay, 157 rue de la Porte de Trivaux, 92140 Clamart, France; (D.S.); (A.L.G.); (F.J.M.)
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7
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Differential Diagnosis of Cesarean Scar Pregnancies and Other Pregnancies Implanted in the Lower Uterus by Ultrasound Parameters. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8904507. [PMID: 33457421 PMCID: PMC7787742 DOI: 10.1155/2020/8904507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/01/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
Purpose Cesarean scar pregnancy is an extremely rare type of ectopic pregnancy implanted in the myometrium at the site of a previous cesarean section scar. On the other hand, pregnancies are considered low implantations if they are identified in the lower third of the uterus without the sac implanted into the scar and have a better prognosis. Early diagnosis of both types of pregnancies can help avoid serious complications. This study is aimed at investigating the significance of transvaginal ultrasound in the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Methods Ninety-three patients with an average age of 32.7 years (range, 24-43 years) were enrolled in this study, including 66 cesarean scar pregnancies and 27 other pregnancies implanted in the lower uterus, and they were examined by transvaginal ultrasound. Results We observed significant differences in the relationship between the cesarean sac and the scar, the source of the trophoblastic blood flow, and the thickness of the residual muscle between the cesarean scar pregnancy group and the lower uterus pregnancy group. We established the logistic model to improve the differential diagnosis of cesarean scar pregnancies and pregnancies implanted in the lower uterus. Conclusions Transvaginal ultrasound is recommended in early pregnancy, especially for patients who have undergone a previous cesarean section delivery.
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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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Sichitiu J, El-Tani Z, Mathevet P, Desseauve D. Conservative Surgical Management of Placenta Accreta Spectrum: A Pragmatic Approach. J INVEST SURG 2019; 34:172-180. [PMID: 31429327 DOI: 10.1080/08941939.2019.1623956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
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Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Zeina El-Tani
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Mathevet
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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10
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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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11
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Titapant V, Tongdee T, Pooliam J, Wataganara T. Retrospective analysis of 113 consecutive cases of placenta accreta spectrum from a single tertiary care center. J Matern Fetal Neonatal Med 2018; 33:3324-3331. [PMID: 30270695 DOI: 10.1080/14767058.2018.1530757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Placenta accreta spectrum (PAS) remains a major cause of maternal morbidity. We sought to assess the characteristics and treatment outcomes of PAS managed at a tertiary care center with high volume of PAS.Study design: Electronic medical records of all patients with diagnosis of PAS from June 2010 to October 2016 were reviewed. Details of obstetric backgrounds, predelivery diagnosis, peripartum management, and outcomes were analyzed.Results: One hundred thirteen women with PAS were identified from 50,448 deliveries during the study period. Vaginal delivery, emergency, and elective cesarean section were accomplished in 41.6, 30.1, and 28.3%, respectively. There was no maternal mortality. Approximately 41.6% of women with PAS had peripartum hysterectomy. There was a fair inverse correlation between intraoperative blood loss and gestational weeks at delivery (r = -0.311; p=.001), but not gestational weeks at diagnosis (p = .249). Cases with predelivery diagnosis (n = 29) had higher intraoperative blood loss than those diagnosed postdelivery (n = 84) (p<.001). Anterior PAS (n = 58) is associated with attachment to previous uterine scar, antepartum bleeding, and intraoperative blood loss compared to posterior PAS (n = 44) (p<.05). The PAS patients with previous uterine surgery had the highest chance of peripartum hysterectomy (p<.001).Conclusions: Contradictory to previous reports, our data suggest a more severe spectrum of PAS in those with predelivery detection earlier gestational weeks at delivery. Peripartum hysterectomy was highest in anterior PAS that attached to the previous uterine scar.
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Affiliation(s)
- Vitaya Titapant
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Trongtum Tongdee
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiology Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tuangsit Wataganara
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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da Cunha Castro EC, Popek E. Abnormalities of placenta implantation. APMIS 2018; 126:613-620. [DOI: 10.1111/apm.12831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/12/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Eumenia Costa da Cunha Castro
- Department of Pathology and Immunology; Texas Children's Hospital; Pavilion for Women; Baylor College of Medicine; Houston TX USA
| | - Edwina Popek
- Department of Pathology and Immunology; Texas Children's Hospital; Pavilion for Women; Baylor College of Medicine; Houston TX USA
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13
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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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14
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Verspyck E, de Vienne C, Muszynski C, Bubenheim M, Chanavaz-Lacheray I, Dreyfus M, Deruelle P, Benichou J. Maintenance nifedipine therapy for preterm symptomatic placenta previa: A randomized, multicenter, double-blind, placebo-controlled trial. PLoS One 2017; 12:e0173717. [PMID: 28333939 PMCID: PMC5363821 DOI: 10.1371/journal.pone.0173717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the impact of maintenance nifedipine therapy on pregnancy duration in women with preterm placenta previa bleeding. METHODS PPADAL was a randomized, double-blind, placebo-controlled trial conducted between 05/2008 and 05/2012 in five French hospitals. The trial included 109 women, aged ≥ 18 years, with at least one episode of placenta previa bleeding, intact membranes and no other pregnancy complication, at gestational age 24 to 34 weeks and after 48 hours of complete acute tocolysis. Women were randomly allocated to receive either 20 mg of slow-release nifedipine three times daily (n = 54) or placebo (n = 55) until 36 + 6 weeks of gestation. The primary outcome for the trial was length of pregnancy measured in days after enrolment. Main secondary outcomes were rates of recurrent bleeding, cesarean delivery due to hemorrhage, blood transfusion, maternal side effects, gestational age at delivery and adverse perinatal outcomes (perinatal death, chronic lung disease, neonatal sepsis, intraventricular hemorrhage > grade 2, perventricular leukomalacia > grade 1, or necrotizing enterocolitis). Analysis was by intention to treat. RESULTS Mean (SD) prolongation of pregnancy was not different between the nifedipine (n = 54) and the placebo (n = 55) group; 42.5 days ± 23.8 versus 44.2 days ± 24.5, p = 0.70. Cesarean due to hemorrhage performed before 37 weeks occurred more frequently in the nifedipine group in comparison with the placebo group (RR, 1.66; 95% confidence interval, 1.05-2.72). Adverse perinatal outcomes were comparable between groups; 3.8% for nifedipine versus 5.5% for placebo (relative risk, 0.52; 95% confidence interval 0.10-2.61). No maternal mortality or perinatal death occurred. CONCLUSION Maintenance oral nifedipine neither prolongs duration of pregnancy nor improves maternal or perinatal outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT00620724.
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Affiliation(s)
- Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Claire de Vienne
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Charles Muszynski
- Department of Obstetrics and Gynecology, Amiens University Hospital, Amiens, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | | | - Michel Dreyfus
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Lille University, EA 4489—Environnement Périnatal et Santé, Lille, France
| | - Jacques Benichou
- Inserm U657, University of Rouen and Biostatistics, Rouen, France
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15
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Hennetier C, Daudruy Brasseur M, Patrier S, Clavier E, Thibault ML, Verspyck E. [Conservative placenta percreta management using uterine arterial embolization procedure: A series of 12 cases]. J Gynecol Obstet Hum Reprod 2017; 46:297-299. [PMID: 28403929 DOI: 10.1016/j.jogoh.2016.10.010] [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: 05/18/2016] [Revised: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
We report a retrospective series of 12 placentas percreta with bladder invasion and for which an expected initially multidisciplinary conservative surgical treatment associated with uterine artery embolization was programmed. Conservative surgical treatment was only performed in 7 women. Radical surgical treatment was necessary during the caesarean section and complicated by massive hemorrhage in three women and secondary in two other women for infectious diseases. Radical surgical treatment was associated with partial cystectomy complicated with urinary disorder sequelae in three women. Maternal morbidity of the placenta percreta bladder remains high despite the establishment of a multidisciplinary care protocol.
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Affiliation(s)
- C Hennetier
- Clinique gynécologique et obstétricale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - M Daudruy Brasseur
- Service de radiologie pédiatrique, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - S Patrier
- Service d'anatomo-pathologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - E Clavier
- Service de radiologie interventionnelle, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - M L Thibault
- Service d'anesthésie réanimation, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France
| | - E Verspyck
- Clinique gynécologique et obstétricale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Daney de Marcillac F, Lecointre L, Guillaume A, Sananes N, Fritz G, Viville B, Boudier E, Nisand I, Gaudineau A, Langer B, Akladios C. Morbimortalité maternelle associée au traitement conservateur d’un placenta anormalement adhérent (accreta) diagnostiqué en anténatal. À propos d’une série continue de 15 cas. ACTA ACUST UNITED AC 2016; 45:849-858. [DOI: 10.1016/j.jgyn.2016.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
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Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2016; 198:12-21. [DOI: 10.1016/j.ejogrb.2015.12.012] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 12/31/2022]
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Findeklee S, Costa SD. Placenta Accreta and Total Placenta Previa in the 19th Week of Pregnancy. Geburtshilfe Frauenheilkd 2015; 75:839-843. [PMID: 26366004 DOI: 10.1055/s-0035-1557763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/17/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022] Open
Abstract
Placentation disorders are the result of impaired embedding of the placenta in the endometrium. The prevalence of these disorders is estimated to be around 0.3 %. A history of previous prior uterine surgery (especially cesarean section and curettage) is the most common risk factor. Impaired placentation is differentiated into deep placental attachment; marginal, partial and total placenta previa; and placenta accreta, increta and percreta. Treatment depends on the severity of presentation and ranges from expectant management to emergency hysterectomy. In most cases, preterm termination of pregnancy is necessary. We report here on the case of a 39-year-old woman with placenta accreta and total placenta previa who underwent hysterectomy in the 19th week of pregnancy.
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Affiliation(s)
- S Findeklee
- Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
| | - S D Costa
- Gynecology and Obstetrics, Universitätsklinikum Magdeburg, Magdeburg
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Pelage JP, Fohlen A, Le Pennec V. Place de l’embolisation artérielle en cas d’hémorragie du post-partum. ACTA ACUST UNITED AC 2014; 43:1063-82. [DOI: 10.1016/j.jgyn.2014.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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20
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Parant O, Guerby P, Bayoumeu F. Spécificités obstétricales et anesthésiques de la prise en charge d’une hémorragie du post-partum (HPP) associée à la césarienne. ACTA ACUST UNITED AC 2014; 43:1104-22. [DOI: 10.1016/j.jgyn.2014.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Haumonté JB, Sentilhes L, Macé P, Cravello L, Boubli L, d’Ercole C. Prise en charge chirurgicale d’une hémorragie du post-partum. ACTA ACUST UNITED AC 2014; 43:1083-103. [DOI: 10.1016/j.jgyn.2014.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Rossignol M, Rozenberg A. Modalités d’un transfert inter-hospitalier dans le cadre d’une hémorragie sévère du post-partum. ACTA ACUST UNITED AC 2014; 43:1123-32. [DOI: 10.1016/j.jgyn.2014.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Aya AG, Ducloy-Bouthors AS, Rugeri L, Gris JC. [Anesthetic management of severe or worsening postpartum hemorrhage]. ACTA ACUST UNITED AC 2014; 43:1030-62. [PMID: 25447392 DOI: 10.1016/j.jgyn.2014.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Risk factors of maternal morbidity and mortality during postpartum hemorrhage (PPH) include non-optimal anesthetic management. As the anesthetic management of the initial phase is addressed elsewhere, the current chapter is dedicated to the management of severe PPH. METHODS A literature search was performed using PubMed and Medline databases, and the Cochrane Library, for articles published from 2003 up to and including 2013. Several keywords related to anesthetic and critical care practice, and obstetrical management were used, in various combinations. Guidelines from several societies and organisations were also read. RESULTS When PPH worsens, one should ask for additional team personnel (professional consensus). Patients should be monitored for heart rate, blood pressure, skin and mucosal pallor, bleeding at skin puncture sites, diuresis and the volume of genital bleeding (grade B). Because of the possible rapid worsening of coagulapathy, patients should undergo regular evaluation of coagulation status (professional consensus). Prevention and management of hypothermia should be considered (professional consensus), by warming intravenous fluids and blood products, and by active body warming (grade C). Antibiotics should be given, if not already administered at the initial phase (professional consensus). Vascular fluids must be given (grade B), the choice being left at the physician discretion. Blood products transfusion should be decided based on the clinical severity of PPH (professional consensus). Priority is given to red blood cells (RBC) transfusion, with the aim to maintain Hb concentration>8g/dL. The first round of products could include 3 units of RBC (professional consensus), and the following round 3 units of RBC, and 3 units of fresh frozen plasma (FFP). The FFP:RBC ratio should be kept between 1:2 and 1:1 (professional consensus). Depending on the etiology of PPH, the early administration of FFP is left at the discretion of the physician (professional consensus). Platelet count should be maintained at>50 G/L (professional consensus). During massive PPH, fibrinogen concentration should be maintained at>2g/L (professional consensus). Fibrinogen can be given without prior fibrinogen measurement in case of massive bleeding (professional consensus). General anesthesia should be considered in case of hemodynamic instability, even when an epidural catheter is in place (professional consensus). CONCLUSION The anesthetic management aims to restore and maintain optimal respiratory state and circulation, to treat coagulation disorders, and to allow invasive obstetrical and radiologic procedures. Clinical and instrumental monitoring are needed to evaluate the severity of PPH, to guide the choice of therapeutic options, and to assess treatments efficacy.
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Affiliation(s)
- A G Aya
- Département anesthésie-douleur, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France.
| | - A-S Ducloy-Bouthors
- Pôle d'anesthésie-réanimation, CHU Lille, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - L Rugeri
- Unité d'hémostase clinique, hôpital Édouard-Herriot, pavillon E 5, place d'Arsonval, 69003 Lyon, France
| | - J-C Gris
- Laboratoire et consultations d'hématologie, groupe hospitalo-universitaire Caremeau, place du Pr.-Debré, 30029 Nîmes cedex 09, France; EA2992, faculté de médecine Montpellier-Nîmes, 186, chemin du Carreau-de-Lanes, 30029 Nîmes cedex 2, France
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