1
|
Adu-Bredu TK, Ridwan R, Aditiawarman A, Ariani G, Collins SL, Aryananda RA. Three-dimensional volume rendering ultrasound for assessing placenta accreta spectrum severity and discriminating it from simple scar dehiscence. Am J Obstet Gynecol MFM 2024; 6:101321. [PMID: 38460827 DOI: 10.1016/j.ajogmf.2024.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/17/2024] [Accepted: 02/25/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Prenatal ultrasound discrimination between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta is challenging both prenatally and intraoperatively, which often leads to overtreatment. In addition, accurate prenatal prediction of surgical difficulty and morbidity in placenta accreta spectrum is difficult, which precludes appropriate multidisciplinary planning. The advent of advanced 3-dimensional volume rendering and contrast enhancement techniques in modern ultrasound systems provides a comprehensive prenatal assessment, revealing details that are not discernible in traditional 2-dimensional imaging. OBJECTIVE This study aimed to evaluate the use of 3-dimensional volume rendering ultrasound techniques in determining the severity of placenta accreta spectrum and distinguishing between placenta accreta spectrum and scar dehiscence with underlying nonadherent placenta. STUDY DESIGN A prospective, cohort study was conducted between July 2022 and July 2023 in the fetal medicine unit of Dr Soetomo Academic General Hospital, Surabaya, Indonesia. All pregnant individuals with anterior low-lying placenta or placenta previa with a previous caesarean section who were referred with suspicion of placenta accreta spectrum were consented and screened using the standardised 2-dimensional and Doppler ultrasound imaging. Additional 3-dimensional volumes were obtained from the sagittal section of the uterus with a filled urinary bladder. These were analyzed by rotating the region of interest to be perpendicular to the uterovesical interface. The primary outcomes were the clinical and histologic severity in the cases of placenta accreta spectrum and correct diagnosis of dehiscence with nonadherent placenta underneath. The strength of association between ultrasound and clinical outcomes was determined. Multivariate logistic regression analyses and diagnostic testing of accuracy were used to analyze the data. RESULTS A total of 70 patients (56 with placenta accreta spectrum and 14 with scar dehiscence) were included in the analysis. Multivariate logistic regression of all 2-dimensional and 3-dimensional signs revealed the 3-dimensional loss of clear zone (P<.001) and the presence of bridging vessels on 2-dimensional Doppler ultrasound (P=.027) as excellent predictors in differentiating scar dehiscence and placenta accreta spectrum. The 3-dimensional loss of clear zone demonstrated a high diagnostic accuracy with an area under the curve of 0.911 (95% confidence interval, 0.819-1.002), with a sensitivity of 89.3% (95% confidence interval, 78.1-95.97%) and specificity of 92.9% (95% confidence interval, 66.1-99.8%). The presence of bridging vessels on 2-dimensional Doppler demonstrated an area under the curve of 0.848 (95% confidence interval, 0.714-0.982) with a sensitivity of 91.1% (95% confidence interval, 80.4-97.0%) and specificity of 78.6% (95% confidence interval, 49.2-95.3%). A subgroup analysis among the placenta accreta spectrum group revealed that the presence of a 3-dimensional disrupted bladder serosa with obliteration of the vesicouterine space was associated with vesicouterine adherence (P<.001). CONCLUSION Three-dimensional volume rendering ultrasound is a promising tool for effective discrimination between scar dehiscence with underlying nonadherent placenta and placenta accreta spectrum. It also shows potential in predicting the clinical severity with urinary bladder involvement in cases of placenta accreta spectrum.
Collapse
Affiliation(s)
- Theophilus K Adu-Bredu
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (Mr Adu-Bredu and Prof Collins)
| | - Robert Ridwan
- Maternal Fetal Medicine, Obstetrics and Gynecology Department, Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia (Dr Ridwan, Dr Aditiawarman, and Dr Aryananda)
| | - Aditiawarman Aditiawarman
- Maternal Fetal Medicine, Obstetrics and Gynecology Department, Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia (Dr Ridwan, Dr Aditiawarman, and Dr Aryananda)
| | - Grace Ariani
- Anatomical Pathology Department, Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia (Dr Ariani)
| | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom (Mr Adu-Bredu and Prof Collins)
| | - Rozi A Aryananda
- Department of Obstetrics and Gynaecology, Erasmus, University Medical Center, Rotterdam, The Netherlands (Dr Aryananda).
| |
Collapse
|
2
|
Legesse AY, Teka H, Kiros S. Placenta Percreta Managed by Ultrasound-Guided Vertical Transfundal Uterine Incision with Hysterectomy: Case Report. Int Med Case Rep J 2023; 16:221-225. [PMID: 37012984 PMCID: PMC10066697 DOI: 10.2147/imcrj.s403052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Placenta accreta spectrum is an obstetrics complication in which the placenta has abnormally adhered to the decidua and uterine wall. Placenta percreta is the rarest and sternest variant of accreta syndrome. In this study, we present a case of placenta percreta where we have done ultrasound-guided trans fundal vertical uterine incision to deliver a healthy fetus and subsequent cesarean hysterectomy. Antepartum diagnosis, involvement of a multidisciplinary team, appropriate counseling of women and their families, ultrasound guidance for placental margin demarcation, and vertical transfundal uterine incision can be considered for patients with placenta percreta.
Collapse
Affiliation(s)
- Awol Yemane Legesse
- Department of Obstetrics and Gynecology, Mekelle University, Mekelle, Tigray, Ethiopia
- Correspondence: Awol Yemane Legesse, Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Mekelle University, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Email
| | - Hale Teka
- Department of Obstetrics and Gynecology, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Sara Kiros
- Department of Pathology, Mekelle University, Mekelle, Tigray, Ethiopia
| |
Collapse
|
3
|
Jariyawattanarat W, Thiravit S, Suvannarerg V, Srisajjakul S, Sutchritpongsa P. Bladder involvement in placenta accreta spectrum disorder with placenta previa: MRI findings and outcomes correlation. Eur J Radiol 2023; 160:110695. [PMID: 36657210 DOI: 10.1016/j.ejrad.2023.110695] [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: 05/02/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Placental accreta spectrum (PAS) disorder with bladder involvement can be associated with maternal and neonatal morbidity. Magnetic resonance imaging (MRI) may provide accurate preoperative diagnoses. OBJECTIVE This study had 2 aims: to retrospectively review the MRI findings for bladder involvement in PAS with placental previa and to correlate bladder involvement with maternal and neonatal outcomes. MATERIALS AND METHODS MRI images of 48 patients with severe PAS (increta and percreta) with placenta previa/low-lying placenta were evaluated by 2 experienced radiologists blinded to the final diagnoses. Nine MRI findings and stepwise logistic regression analysis were assessed to identify predictive MRI findings for bladder involvement. The correlations between PAS patients with bladder involvement and clinical outcomes were analyzed using Fisher's exact test. RESULTS Of the 48 patients, 27 did not have bladder involvement, while 21 did. Logistic regression analysis identified 2 predictive MRI features for bladder involvement. They were abnormal vascularization (OR,6.94; 95 %CI,1.05-45.75) and loss of the chemical shift line at the uterovesical interface (OR, 4.41; 95 %CI, 0.63-30.98). The sensitivity and specificity of the combined MRI features were 38.1 % and 100 %, respectively (p = 0.001). A significant correlation was found between bladder involvement and massive blood loss during surgery (p = 0.022). CONCLUSIONS PAS with bladder involvement was significantly correlated with massive surgical blood loss. Prenatally, the disorder was predicted with high specificity by the combination of loss of chemical shift artifacts in the steady-state free precession sequence and abnormal vascularization at the uterovesical interface on MRI.
Collapse
Affiliation(s)
- Watchaya Jariyawattanarat
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Shanigarn Thiravit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Voraparee Suvannarerg
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Sitthipong Srisajjakul
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Pavit Sutchritpongsa
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| |
Collapse
|
4
|
Singh G, Sabnani S, Navriya SC, Panda S, Gaurav A. Monstrous Invasion of Placenta Percreta and Previa: Multidisciplinary Management of a Case, the Role of a Urologist, and a Literature Review. Cureus 2022; 14:e28537. [PMID: 36185834 PMCID: PMC9518697 DOI: 10.7759/cureus.28537] [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] [Accepted: 08/29/2022] [Indexed: 11/26/2022] Open
Abstract
In rare situations, pregnant women may experience life-threatening bleeding due to the placenta’s aberrant invasion of the bladder. A 28-year-old pregnant female with two previous cesarean deliveries presented with the chief complaint of abdominal pain at the earlier scar site. Ultrasound imaging was suggestive of placenta percreta with bladder invasion. The patient underwent elective cesarean section with a uterine-preservation strategy. A healthy male baby was delivered by classical cesarean section, and bilateral uterine artery ligation was done. The patient developed severe postoperative hemorrhage, for which she was re-explored, and the urology team was called for intraoperative assistance. The area of placental invasion into the bladder was resected entirely with bladder reconstruction. Placenta percreta is a life-threatening condition that can involve adjacent uterine structures. Successful management involves a multidisciplinary strategy involving experienced obstetricians, urologists, anesthesiologists, blood bank teams, and neonatologists.
Collapse
|
5
|
Chahal HS, Juneja SK, Kaur S, Kochar B, Sharma S, Makkar V. Pregnancy-related acute kidney injury and urological comorbidities in morbidly adherent placenta: A potential challenge to AKI-0by25. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:368-379. [PMID: 32394909 DOI: 10.4103/1319-2442.284011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pregnancy-related acute kidney injury (PRAKI) and urological complications can significantly increase the maternal morbidity and mortality, and morbidly adherent placenta (MAP) has been found to increase the risk of both. This is a four-year prospective study, conducted on patients with MAP. Baseline parameters (demographic/antenatal/perinatal), operative details (obstetric/urological/hemostatic), peri-operative complications (AKI/urological), and maternal/fetal outcomes were studied till six weeks after delivery. Statistical analysis was done using IBM SPSS Statistics version 21.0, and P <0.05 was considered statistically significant. Out of the 5475 deliveries conducted in the study period, 64 had adherent placentation. AKI occurred in 39.1% of patients, with severe AKI (AKIN-2, 3) in 10.9%, and significantly higher incidence in placenta percreta (P = 0.021, relative risk [RR] - 2.34), urological injuries (P = 0.001, RR - 2.86), and high blood loss (P = 0.001) on univariate analysis, but placenta percreta was the most statistically significant factor P = 0.049) on multivariate analysis. Urological involvement/injuries requiring intervention were encountered in 22 patients, with statistically significantly high incidence in placenta previa (P = 0.023, RR - 1.62), placenta percreta (P = 0.000, RR - 17.18), and patients undergoing hysterectomy (P = 0.000, RR - 2.01) on univariate analysis, but placenta percreta was most statistically significantly implicated on multivariate analysis (P = 0.017). AKI and urological injuries significantly increased the need for intensive care and days of hospitalization. On six-week follow-up, all AKI patients recovered completely; no urinary leak or vesico-vaginal fistula was seen in urologically intervened patients and no maternal mortality occurred. There is an alarmingly high incidence of PRAKI and urological complications in MAP, posing a great threat to their worldwide improving statistics. Awareness of this condition among renal fraternity can significantly improve the maternal renal and overall prognosis.
Collapse
Affiliation(s)
| | - Sunil Kumar Juneja
- Department of Obstetrics and Gynecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bakul Kochar
- Department of Obstetrics and Gynecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Sharma
- Department of Urology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vikas Makkar
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
6
|
Jain N, Patwardhan S, Jain H, Patil B. Surgical strategies for placenta percreta invading the bladder and review of literature. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00065-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hematuria in pregnant women may result from invasion of the bladder by the placenta. We present our experience with 18 cases of placenta percreta with suspected bladder invasion.
Methods
It is a retrospective single-center study conducted over a period of 3 years. Total 18 patients of radiologically diagnosed placenta percreta were included in the study. All patients who are at risk for placenta percreta underwent prenatal sonograms. Patients of Placenta Accreta Spectrum presenting electively also underwent MRI pelvis. Elective patients who were high risk of placenta percreta underwent bilateral placement of the balloon catheter in internal iliac artery. In case of doubt regarding bladder invasion, patient underwent anterior cystotomy and posterior wall of the bladder was examined and proximity of the ureteric orifice to the placenta and amount of involvement of bladder wall was assessed. Ureteric catheter placement was used as adjuncts depending on the proximity of placental invasion with ureteric orifice. Postoperative outcomes in the form of maternal morbidity, maternal mortality, fetal mortality, postoperative bleeding, bladder status, vesicovaginal fistula, bladder capacity were all evaluated.
Results
In our series, 17 cases all cases were diagnosed preoperatively by antenatal ultrasound and MRI. Only one patient presented with hematuria. Only in one patient, we attempted separation of placenta from bladder wall, and it resulted in profuse bleeding, and in rest, we excised the involved bladder. Partial cystectomy was done in 33.4% patients, 27% patients required bilateral placement of ureteric catheter due to proximity to the ureteric orifice. 33.4% patient underwent bilateral internal iliac artery ligation or balloon placement. Clot evaluation was needed in one patient. Intraoperatively—39% patients had uterus adhered to the bladder but no placental invasion into the bladder. One patient was managed with obstetric hysterectomy and methotrexate followed by clot evacuation and bilateral internal iliac artery ligation at a later date. One (5.6%) patient developed vesicovaginal fistula in postoperative period. There was one (5.6%) maternal mortality with no fetal mortality. On follow-up, patient had good bladder capacity, 3 weeks after the surgery.
Conclusion
MRI done preoperatively can help us guide regarding the extent or severity of placental invasion. Intraoperatively, anterior cystostomy should be done in suspected placenta percreta. Grade I or II accrete/percreta patients can be managed conservatively. Partial cystectomy with placement of bilateral ureteric catheter is safer and less morbid approach in tackling placenta percreta invading the bladder with mucosal involvement.
Collapse
|
7
|
Timor-Tritsch IE, D'Antonio F, Calí G, Palacios-Jaraquemada J, Meyer J, Monteagudo A. Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:156-163. [PMID: 30677186 DOI: 10.1002/uog.20225] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I E Timor-Tritsch
- NYU School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - F D'Antonio
- Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
| | - G Calí
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - J Palacios-Jaraquemada
- Centre for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina
| | - J Meyer
- NYU School of Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - A Monteagudo
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
8
|
Bourgioti C, Zafeiropoulou K, Fotopoulos S, Nikolaidou ME, Theodora M, Daskalakis G, Tzavara C, Chatoupis K, Panourgias E, Antoniou A, Konstantinidou A, Moulopoulos LA. MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders. J Magn Reson Imaging 2018; 50:602-618. [PMID: 30578609 DOI: 10.1002/jmri.26592] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. PURPOSE/HYPOTHESIS To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. STUDY TYPE Prospective. POPULATION One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. FIELD STRENGTH/SEQUENCE T2 -SSTSE (single-shot turbo spin echo), T2 -TSE, T1 -TSEFS (TSE images with fat-suppression) at 1.5T. ASSESSMENT Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5-minute APGAR score <7. STATISTICAL TESTS Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi-square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. RESULTS There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero-placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85-0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05-60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3-729.23), hysterectomy (OR: 72.5, 95% CI: 17.9-293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35-469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5-minute Apgar score (P = 0.078). DATA CONCLUSION Preoperative identification of specific MRI features may predict peripartum course in high-risk patients for PAS. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602-618.
Collapse
Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Konstantina Zafeiropoulou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Stavros Fotopoulos
- Department of Gynaecology and Obstetrics, IASO Maternity Hospital, Athens, Greece
| | | | - Marianna Theodora
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - George Daskalakis
- Department of Fetal and Maternal Medicine, First Department of Gynaecology and Obstetrics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Chara Tzavara
- Department of Health, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Chatoupis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Evangelia Panourgias
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Aristeidis Antoniou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| | - Anastasia Konstantinidou
- First Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, Athens, Greece
| |
Collapse
|
9
|
M. Russo R, Girda E, Chen H, Schloemerkemper N, D. Humphries M, Kennedy V. Management of High-Risk Obstetrical Patients with Morbidly Adherent Placenta in the Age of Resuscitative Endovascular Balloon Occlusion of the Aorta. Placenta 2018. [DOI: 10.5772/intechopen.78753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
10
|
Incidence of Pregnancy Related-Acute Kidney Injury and Urological Co-Morbidities in Morbidly Adherent Placenta: A Potential Challenge to AKI-0by25 Initiative. Nephrourol Mon 2018. [DOI: 10.5812/num.84496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Kingdom J, Silver R, Sentilhes L. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2018; 126:e1-e48. [PMID: 30260097 DOI: 10.1111/1471-0528.15306] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
12
|
MRI Features Predictive of Invasive Placenta With Extrauterine Spread in High-Risk Gravid Patients: A Prospective Evaluation. AJR Am J Roentgenol 2018; 211:701-711. [DOI: 10.2214/ajr.17.19303] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
13
|
Allen L, Jauniaux E, Hobson S, Papillon-Smith J, Belfort MA. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet 2018; 140:281-290. [PMID: 29405317 DOI: 10.1002/ijgo.12409] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa Allen
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Sebastian Hobson
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | | | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Pavilion for Women, Texas Medical Center, Houston, TX, USA
| | | |
Collapse
|
14
|
Alanwar A, Al-Sayed HM, Ibrahim AM, Elkotb AM, Abdelshafy A, Abdelhadi R, Abbas AM, Abdelmenam HS, Fares T, Nossair W, Abdallah AA, Sabaa H, Nawara M. Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study. J Matern Fetal Neonatal Med 2017; 32:1461-1467. [DOI: 10.1080/14767058.2017.1408069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ahmed Alanwar
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Helmy M. Al-Sayed
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Ibrahim
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Elkotb
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Abdelshafy
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Abdelhadi
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | - Tamer Fares
- Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Wael Nossair
- Faculty of Medicine, Zagazik University, Zagazik, Egypt
| | | | - Haitham Sabaa
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maii Nawara
- Ain Shams Maternity Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
15
|
Matsubara S, Takahashi H. Cesarean hysterectomy for abnormally invasive placenta: is urologists' participation in the surgery always necessary? Scand J Urol 2017; 51:496-497. [PMID: 28891357 DOI: 10.1080/21681805.2017.1373147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shigeki Matsubara
- a Department of Obstetrics and Gynecology , Jichi Medical University , Shimotsuke , Tochigi , Japan
| | - Hironori Takahashi
- a Department of Obstetrics and Gynecology , Jichi Medical University , Shimotsuke , Tochigi , Japan
| |
Collapse
|
16
|
Lekic Z, Ahmed E, Peeker R, Sporrong T, Karlsson O. Striking decrease in blood loss with a urologist-assisted standardized multidisciplinary approach in the management of abnormally invasive placenta. Scand J Urol 2017; 51:491-495. [DOI: 10.1080/21681805.2017.1352617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zeljka Lekic
- Department of Anesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ehab Ahmed
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ralph Peeker
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tommy Sporrong
- Department of Obstetrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ove Karlsson
- Department of Anesthesiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
17
|
Chu Q, Shen D, He L, Wang H, Zhao X, Chen Z, Wang Y, Zhang W. Anesthetic management of cesarean section in cases of placenta accreta, with versus without abdominal aortic balloon occlusion: study protocol for a randomized controlled trial. Trials 2017; 18:240. [PMID: 28549439 PMCID: PMC5446702 DOI: 10.1186/s13063-017-1977-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placenta accreta (PA), a severe complication during delivery, is closely linked with massive hemorrhage which could endanger the lives of both mother and baby. Moreover, the incidence of PA has increased dramatically with the increasing rate of cesarean deliveries in the past few decades. Therefore, studies evaluating the effects of different perioperative managements based on different modalities in the treatment of PA are necessary. Among the numerous treatment measures, prophylactic abdominal aortic balloon occlusion (AABO) in combination with cesarean section for PA seems to be more advantageous than others. However, up to now, all studies on AABO were almost retrospective. Current evidence is insufficient to recommend for or against routinely using the AABO technology for control intraoperative hemorrhage in patients with PA. Thus, we hope to carry out a prospective, randomized controlled trial (RCT) study to confirm the effectiveness of the AABO technology in patients with PA. METHODS/DESIGN This trial is an investigator-initiated, prospective RCT that will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. A total of 170 parturients with PA undergoing cesarean section will be randomized to receive either AABO in combination with cesarean section or the traditional hysterectomy following cesarean section. The primary outcome is estimated blood loss. The most important secondary outcome is the occurrence of cesarean hysterectomy during delivery; others include blood transfusion volume, operating time, neonate's Apgar scores (collected at 1, 5 and 10 min), length of stay in intensive care unit, total hospital stay, and balloon occlusion-relative data. DISCUSSION This prospective trial will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. It may provide strong evidence about the benefits and risks of AABO in combination with cesarean section for parturients with PA. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-INR-16008842 . Registered on 14 July 2016.
Collapse
Affiliation(s)
- Qinjun Chu
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Dan Shen
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Long He
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Hongwei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Xianlan Zhao
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Zhimin Chen
- Department of Obstetrics, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Yanli Wang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Jian She Dong Lu, No 1, Zhengzhou, 450052, Henan Province, China.
| |
Collapse
|
18
|
Polat I, Yücel B, Gedikbasi A, Aslan H, Fendal A. The effectiveness of double incision technique in uterus preserving surgery for placenta percreta. BMC Pregnancy Childbirth 2017; 17:129. [PMID: 28449642 PMCID: PMC5406983 DOI: 10.1186/s12884-017-1262-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 02/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placenta percreta is a life-threatening condition that places patients at risk of massive bleeding. It necessitates very complicated surgery and can result in mortality. Caesarean hysterectomy is the accepted procedure worldwide; however, recent studies discussing conservative treatment with segmental resections have been published. Foetal extraction and segmental resection can be performed through the same incision (single uterine incision) or through two different incisions (double uterine incision). In this study, we aimed to evaluate the effectiveness and results of the double incision technique. METHODS Twenty-two patients with a diagnosis of placenta percreta who underwent conservative surgery were included. Segmental resection was performed via single incision in ten patients and double incision in twelve patients. RESULTS There was no difference between the patients who underwent segmental resection via single and double incision in terms of age, gravida, number of previous caesarean deliveries, gestational age at delivery, or rate of elective surgeries. The operation time, transfusion requirement, intensive care unit admission, total hospitalization and success of conservative surgery were comparable between the groups. CONCLUSIONS Based on the outcomes of our study, double uterine incision allows for the safe extraction of the foetus during uterus-preserving surgery in patients with placenta percreta without worsening the results compared to single uterine incision. TRIAL REGISTRATION NCT02702024 , Date of registration: February 26, 2016, retrospectively registered.
Collapse
Affiliation(s)
- Ibrahim Polat
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Burak Yücel
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey.
| | - Ali Gedikbasi
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Halil Aslan
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Aysun Fendal
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
19
|
Macroscopic Hematuria due to Placenta Percreta: Report of Two Cases and Short Review. Case Rep Obstet Gynecol 2017; 2017:9863792. [PMID: 28698813 PMCID: PMC5494060 DOI: 10.1155/2017/9863792] [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: 01/08/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022] Open
Abstract
Herein we present two cases of pregnant women with placenta percreta and severe hematuria during the 24th and 35th weeks of pregnancy, respectively. A timely sonographic diagnosis was feasible in the first case and cesarean section was performed during the 29th week. During the operation, the placenta was invading the bladder wall and concomitant hysterectomy with cystotomy and bladder wall reconstruction was performed. The second case presented in our emergency department with vaginal bleeding during the 35th weeks of pregnancy. She underwent an emergency cesarean section with uterine preservation, cystotomy, and bladder reconstruction.
Collapse
|
20
|
Matsuzaki S, Yoshino K, Kumasawa K, Satou N, Mimura K, Kanagawa T, Ueda Y, Kimura T. Placenta percreta managed by transverse uterine fundal incision with retrograde cesarean hysterectomy: a novel surgical approach. Clin Case Rep 2014; 2:260-4. [PMID: 25548627 PMCID: PMC4270707 DOI: 10.1002/ccr3.108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 12/02/2022] Open
Abstract
Key Clinical Message Placenta percreta (with bladder invasion) is a rare obstetric condition with the risk of massive intraoperative hemorrhage. In these cases, the combination of a transverse uterine fundal incision and retrograde cesarean hysterectomy could be useful to minimize maternal hemorrhage and avoid severe bladder injury.
Collapse
Affiliation(s)
- Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Noriko Satou
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Takeshi Kanagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine Suita, Osaka, 565-0871, Japan
| |
Collapse
|
21
|
Rai V, Shariffuddin II, Chan YK, Muniandy RK, Wong KK, Singh S. Peri-operative management of hysterostomy in a parturient with complete heart block, placenta accreta and intrauterine death. BMC Anesthesiol 2014; 14:49. [PMID: 25002831 PMCID: PMC4083103 DOI: 10.1186/1471-2253-14-49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complete heart block in pregnancy has serious implications particularly during the period of delivery. This is more so if the delivery is an operative one as the presence of heart block may produce haemodynamic instability in the intra operative period. We report a unique case of a pregnant mother with complete heart block undergoing hysterostomy, complicated by placenta accreta and intrauterine death. CASE PRESENTATION A 37 year old Malaysian Chinese parturient was admitted at 25 weeks gestation following a scan which suggested intrauterine death and placenta accreta. She was diagnosed to have congenital complete heart block after her first delivery eight years previously but a pacemaker was never inserted. These medical conditions make her extremely likely to experience massive bleeding and haemodynamic instability. Among the measures taken to optimise her pre-operatively were the insertion of a temporary intravenous pacemaker and embolization of the uterine arteries to minimize peri-operative blood loss. She successfully underwent surgery under general anesthesia, which was relatively uneventful and was discharged well on the fourth post-operative day. CONCLUSION Congenital heart block in pregnancies in the presence of potential massive bleeding is best managed by a team, with meticulous pre-operative optimization. Suggested strategies would include insertion of a temporary pacemaker and embolization of the uterine arteries to reduce the risk of the patient getting into life threatening situations.
Collapse
Affiliation(s)
- Vineya Rai
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ina I Shariffuddin
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoo K Chan
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rajesh K Muniandy
- Department of Medicine Based, School of Medicine, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Kang K Wong
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sukcharanjit Singh
- Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
22
|
Smith ZL, Sehgal SS, Van Arsdalen KN, Goldstein IS. Placenta Percreta With Invasion into the Urinary Bladder. Urol Case Rep 2014; 2:31-2. [PMID: 26955539 PMCID: PMC4733000 DOI: 10.1016/j.eucr.2013.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/24/2022] Open
Abstract
Placenta percreta is a rare condition, which can lead to significant morbidity and potentially mortality. We present a case of a 38-year-old woman who presented at 24 weeks gestation with vaginal bleeding and was found to have complete placenta previa with placenta percreta invading the urinary bladder. Her hospital course was complicated by bilateral pulmonary emboli. She underwent an exploratory laparotomy, repeat Caesarean section, and total abdominal hysterectomy. Because of placental invasion into the bladder, the procedure was complicated by bladder and ureteral injuries for which urology carried out repair. Postoperatively, the patient had a persistent bladder leak until postoperative day #39.
Collapse
Affiliation(s)
- Zachary L Smith
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Shailen S Sehgal
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Keith N Van Arsdalen
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Irwin S Goldstein
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
23
|
Kume K, M. Tsutsumi Y, Soga T, Sakai Y, Kambe N, Kawanishi R, Hamaguchi E, Kawahara T, Kasai A, Nakaji Y, T. Horikawa Y, Nakayama S, Kaji T, Irahara M, Tanaka K. A case of placenta percreta with massive hemorrhage during cesarean section. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:208-12. [DOI: 10.2152/jmi.61.208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Tomohiro Soga
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital
| | - Noriko Kambe
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | | | - Eisuke Hamaguchi
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | | | - Asuka Kasai
- Department of Anesthesiology, Tokushima University Hospital
| | - Yoshimi Nakaji
- Department of Anesthesiology, Tokushima University Hospital
| | - Yousuke T. Horikawa
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Souichiro Nakayama
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Katsuya Tanaka
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| |
Collapse
|
24
|
Palacios-Jaraquemada JM. Caesarean section in cases of placenta praevia and accreta. Best Pract Res Clin Obstet Gynaecol 2013; 27:221-32. [DOI: 10.1016/j.bpobgyn.2012.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/11/2012] [Indexed: 10/27/2022]
|
25
|
Tam Tam KB, Dozier J, Martin JN. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review. J Matern Fetal Neonatal Med 2013; 25:329-34. [PMID: 23003574 DOI: 10.3109/14767058.2011.576720] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A systematic review of the literature was conducted to answer the following question: are there enhancements to standard peripartum hysterectomy technique that minimize unintentional urinary tract (UT) injury in pregnancies complicated by invasive placental attachment (INPLAT)? METHODS A PubMed search of English language articles on INPLAT published by June 2010 was conducted. Data regarding the following parameters was required for inclusion in the quantitative analysis of the review's objective: (1) type of INPLAT, (2) details pertaining to medical and surgical management of INPLAT, and (3) complications, if any, associated with management. An attempt was made to identify approaches that may lower the risk of unintentional UT injury. RESULTS Most cases (285 of 292) were managed by hysterectomy. There were 83 (29%) cases of unintentional UT injury. Antenatal diagnosis of INPLAT lowered the rate of UT injury (39% vs. 63%; P = 0.04). Information regarding surgical technique or medical management was available for 90 cases; 14 of these underwent a standard hysterectomy technique. Methotrexate treatment and 11 modifications of the surgical technique were associated with 16% unintentional UT injury rate as opposed to 57% for standard hysterectomy (P = 0.002). The use of ureteral stents reduced risk of urologic injury (P = 0.01). Multiple logistic regression analysis identified antenatal diagnosis as the significant predictor of an intact UT. CONCLUSIONS Antenatal diagnosis of INPLAT is paramount to minimize UT injury. Utilization of management modifications identified in this review may reduce urologic injury due to INPLAT.
Collapse
Affiliation(s)
- Kiran Babu Tam Tam
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA
| | | | | |
Collapse
|
26
|
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
| |
Collapse
|
27
|
Al-Omari W, Elbiss HM, Hammad FT. Placenta percreta invading the urinary bladder and parametrium. J OBSTET GYNAECOL 2012; 32:396-7. [DOI: 10.3109/01443615.2012.665518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
28
|
Anand AK, Gupta S, Gupta A. Placenta percreta causing spontaneous rupture of the uterus. J Obstet Gynaecol India 2012; 63:64-5. [PMID: 24431603 DOI: 10.1007/s13224-012-0132-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 11/17/2010] [Indexed: 12/01/2022] Open
Affiliation(s)
- Amandeep K Anand
- Department of Obstetrics and Gynecology, Government Medical College and Associated Hospitals (SMGS), Jammu, J&K India
| | - Shashi Gupta
- Department of Obstetrics and Gynecology, Government Medical College and Associated Hospitals (SMGS), Jammu, J&K India
| | - Amita Gupta
- Department of Obstetrics and Gynecology, Government Medical College and Associated Hospitals (SMGS), Jammu, J&K India
| |
Collapse
|
29
|
Thomas AA, Thomas AZ, Campbell SC, Palmer JS. Urologic emergencies in pregnancy. Urology 2010; 76:453-60. [PMID: 20451969 DOI: 10.1016/j.urology.2010.01.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 01/17/2010] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
Abstract
The management of urological emergencies during pregnancy presents unique clinical challenges for the treating physician. Clinical signs and symptoms are often subtle while diagnostic and therapeutic options are limited in treating patients to avoid fetal morbidity. A high index of suspicion with early diagnosis and treatment are essential for the management of genitourologic emergencies in pregnant women. It is essential for patients to be managed on an individual basis using a multidisciplinary approach.
Collapse
Affiliation(s)
- Anil A Thomas
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| | | | | | | |
Collapse
|
30
|
Ng MK, Jack GS, Bolton DM, Lawrentschuk N. Placenta Percreta With Urinary Tract Involvement: The Case for a Multidisciplinary Approach. Urology 2009; 74:778-82. [DOI: 10.1016/j.urology.2009.01.071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 11/16/2022]
|
31
|
Matsubara S, Ohkuchi A, Yashi M, Izumi A, Ohwada M, Kuwata T, Usui R, Kuwata Y, Nakata M, Suzuki M. Opening the bladder for cesarean hysterectomy for placenta previa percreta with bladder invasion. J Obstet Gynaecol Res 2009; 35:359-63. [PMID: 19335801 DOI: 10.1111/j.1447-0756.2008.00941.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cesarean hysterectomy for placenta previa percreta with bladder invasion often induces not only massive hemorrhage but also severe bladder/ureter injuries. A 37-year-old woman with previous cesarean delivery suffered placenta previa percreta with bladder invasion. At the 34th week, we performed cesarean hysterectomy. Without separating the bladder from the uterus/cervix, we incised the bladder lateral wall using an automatic stapling/cutting device, leaving the bladder posterior wall adhering to the uterus and resecting it with the uterus. The bladder was easily repaired without urological sequelae. We suggest a new, simple and safe technique for cesarean hysterectomy for this disease.
Collapse
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Yakushiji Shimotsuke, Tochigi, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Prenatal Detection of Bladder Wall Involvement in Invasive Placentation with Sequential Two-dimensional and Adjunctive Three-dimensional Ultrasonography. Taiwan J Obstet Gynecol 2009; 48:38-45. [DOI: 10.1016/s1028-4559(09)60033-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
33
|
|
34
|
Borekci B, Ingec M, Kumtepe Y, Gundogdu C, Kadanali S. Difficulty of the surgical management of a case with placenta percreta invading towards parametrium. J Obstet Gynaecol Res 2008; 34:402-4. [PMID: 18588614 DOI: 10.1111/j.1447-0756.2008.00780.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 37-year-old woman was admitted due to vaginal bleeding at 25 weeks of gestation to our gynecology unit. Placenta percreta, which stems from posterior wall of the uterus, forming a mass in Douglas cavity and invading towards right parametrium was clinically diagnosed by exploration. Bilateral internal iliac artery ligation and supracervical hysterectomy could not prevent bleeding. A right radical parametrectomy was necessary to remove invaded parametrium and to control bleeding. The placenta percreta invading parametrium may need an extended hysterectomy procedure. Excess bleeding may be prevented by leaving the placenta in situ during surgery if the placenta percreta is diagnosed before termination of pregnancy, A classical incision may help leaving placenta is situ during operation.
Collapse
Affiliation(s)
- Bunyamin Borekci
- Departments of Obstetrics and Gynecology, Ataturk University Faculty of Medicine, Erzurum, Turkey.
| | | | | | | | | |
Collapse
|
35
|
Mok M, Heidemann B, Dundas K, Gillespie I, Clark V. Interventional radiology in women with suspected placenta accreta undergoing caesarean section. Int J Obstet Anesth 2008; 17:255-61. [DOI: 10.1016/j.ijoa.2007.11.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Accepted: 11/01/2007] [Indexed: 11/25/2022]
|
36
|
Wong HS, Parker S. Ultrasonographic findings in conservatively treated placenta percreta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:580-1. [PMID: 16184504 DOI: 10.1002/uog.2583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
|
37
|
Esmans A, Gerris J, Corthout E, Verdonk P, Declercq S. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: Case report. Hum Reprod 2004; 19:2401-3. [PMID: 15298972 DOI: 10.1093/humrep/deh421] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Reports on placenta percreta in early pregnancy leading to a spontaneous rupture of the uterus are rare. We report a case of this potentially life-threatening complication in the 14th week of pregnancy in an otherwise healthy woman who underwent a manual extraction of the placenta during a previous delivery but who had no history of severe pathology that could have potentially resulted in uterine damage. The occurrence of severe abdominal pain and the presence of a large quantity of free fluid in the abdomen necessitated an emergency laparotomy, revealing a haemoperitoneum due to rupture of the uterus, which was followed by a hysterectomy. This case demonstrates that in patients with a history of placenta accreta and subsequent manual extraction of the placenta, a close investigation of the uterine wall and placentation should be performed in the first trimester in order to anticipate a placenta percreta.
Collapse
Affiliation(s)
- A Esmans
- Department of Obstetrics and Gynecology, Lindendreef 1, 2020 Antwerp, Belgium
| | | | | | | | | |
Collapse
|
38
|
Takai N, Eto M, Sato F, Mimata H, Miyakawa I. Placenta percreta invading the urinary bladder. Arch Gynecol Obstet 2004; 271:274-5. [PMID: 15791478 DOI: 10.1007/s00404-004-0651-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 05/06/2004] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Placenta percreta is a rare obstetric complication causing life-threatening hemorrhage. CASE REPORT The case of a woman with a placenta percreta invading the urinary bladder treated by cesarean hysterectomy and partial bladder resection is presented. Overall estimated blood loss was 11,130 ml, and 59 units of various blood products were transfused. CONCLUSION Obstetricians and urologists should be aware of this rare condition.
Collapse
Affiliation(s)
- Noriyuki Takai
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Hasama-machi, Oita 879-5593, Japan.
| | | | | | | | | |
Collapse
|
39
|
Palacios Jaraquemada JM, Pesaresi M, Nassif JC, Hermosid S. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand 2004; 83:738-44. [PMID: 15255846 DOI: 10.1111/j.0001-6349.2004.00517.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND To describe an accurate approach, hemostatic procedures and uterine repair in patients with anterior placenta percreta. METHODS A total of 68 patients with anterior placenta percreta were included. A large retrovesical and parametrial dissection was performed in all cases. Hemostasis was achieved with selective vascular ligature or with surgical myometrial compression. The anterior wall defect was repaired using a myometrial suture, fibrin glue and polyglycolic mesh. Finally, a nonadherent cellulose layer was applied over this reconstruction. Hysteroscopy and T2 magnetic resonance imaging (MRI) were performed as a reconstruction control at 90 days after discharge. RESULTS Elective surgery was performed in 49 patients and emergency surgery in 19. In 59 midline incisions were performed and in nine lower transverse incisions. Forty-nine patients underwent fundal hysterotomy and 19 transplacental segmental uterine approaches. The uteri of 50 patients with anterior placenta percreta were repaired. Of the 18 hysterectomies performed in this series, 16 were indicated due to massive destruction and two were secondary to coagulopathies. The following surgical complications developed: pelvic hemorrhage (one), coagulopathies (two), uterine infection (three), low ureteral ligations (two), iatrogenic foreign bodies (two) and collection (three). Uterine conservation was highly significant between the upper and lower invasion areas. Ten pregnancies were reported after the repair, resulting in uncomplicated cesarean delivery. CONCLUSION This approach has allowed an adequate uterine repair in patients with anterior placenta percreta. Based on these results it is valid to assume that a functional and anatomic uterine repair has been successfully performed.
Collapse
Affiliation(s)
- José M Palacios Jaraquemada
- Department of Obstetrics and Gynecology, Durand Hospital and the School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
| | | | | | | |
Collapse
|
40
|
Jaswal TS, Singh S, Nanda S, Sangwan K, Chauhan M, Marwah N. Cervical ectopic pregnancy with placenta percreta and bladder wall invasion. Acta Obstet Gynecol Scand 2002; 81:991-2. [PMID: 12366495 DOI: 10.1034/j.1600-0412.2002.811018.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- T S Jaswal
- Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak (Haryana), India
| | | | | | | | | | | |
Collapse
|
41
|
Affiliation(s)
- P N Schlegel
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, USA
| |
Collapse
|
42
|
Kume K, M. Tsutsumi Y, Soga T, Sakai Y, Kambe N, Kawanishi R, Hamaguchi E, Kawahara T, Kasai A, Nakaji Y, T. Horikawa Y, Nakayama S, Kaji T, Irahara M, Tanaka K. <b>A case of placenta percreta with massive hemorrhage </b><b>during cesarean section </b>. THE JOURNAL OF MEDICAL INVESTIGATION 2000. [DOI: 10.2152/jmi.40.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Yasuo M. Tsutsumi
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Tomohiro Soga
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Yoko Sakai
- Department of Anesthesiology, Tokushima University Hospital
| | - Noriko Kambe
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | | | - Eisuke Hamaguchi
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | | | - Asuka Kasai
- Department of Anesthesiology, Tokushima University Hospital
| | - Yoshimi Nakaji
- Department of Anesthesiology, Tokushima University Hospital
| | - Yousuke T. Horikawa
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Souichiro Nakayama
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Takashi Kaji
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Minoru Irahara
- Department of Obstetrics and Gynecology, Institute of Health Bioscience, the University of Tokushima Graduate School
| | - Katsuya Tanaka
- Department of Anesthesiology, Institute of Health Bioscience, the University of Tokushima Graduate School
| |
Collapse
|