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Yalınkaya A, Oğlak SC. A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon: PAS Disorders and Conservative Management. J Pregnancy 2024; 2024:9910316. [PMID: 38961859 PMCID: PMC11221975 DOI: 10.1155/2024/9910316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
Background: This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. Materials and Methods: This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Results: Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. Conclusions: We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.
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Affiliation(s)
- Ahmet Yalınkaya
- Department of Obstetrics and GynecologyDicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and GynecologyHealth Sciences UniversityGazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
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Dawood AS, Dawood AS, Shazly SA, Assar TM, Soliman AS. Retracted: A randomized controlled study comparing two uterine sparing techniques in conservative management of placenta accreta spectrum. Int J Gynaecol Obstet 2024; 165:1-8. [PMID: 35986615 DOI: 10.1002/ijgo.14419] [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: 11/02/2021] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of two uterine sparing techniques in conservative management of placenta accreta spectrum (PAS). METHODS This multicenter randomized controlled study was conducted from January 1, 2017 to December 31, 2020 at two university hospitals. Patients were randomly allocated into two groups; Group 1 was managed by Assar's technique and Group 2 was managed by Shehata's technique. Operative time, blood loss, operative complications (organ or vessel injury), and postoperative complications (early and late) were reported. Success of the technique, units of blood transfusion, and intensive care unit admissions were recorded. RESULTS Demographic data in both groups were not significantly different. The mean gestational age at the delivery time was 36 weeks in both groups. Operative time was 120 (100-140) minutes and 75 (60-100) minutes in Assar's and Shehata's techniques, respectively (P < 0.001). Blood loss was higher in Shehata's technique than in Assar's (P < 0.001). Intensive care unit admissions were minimal in both groups. Operative complications were comparable in both groups. The success of Assar's and Shehata's techniques in uterine preservation was 85% and 95%, respectively. CONCLUSION Both techniques were safe and successful in uterine sparing. Therefore, we recommend these techniques for conservative management of PAS. CLINICAL TRIAL REGISTRATION The trial was registered on UMIN-CTR and had the unique ID: UMIN000025315 on the following link: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029120.
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Holmes VJ, Skinner S, Silagy M, Rolnik DL, Mol BW, Kroushev A. Changes in practice and management of placenta accreta spectrum disorder: A 20-year retrospective cohort study. Aust N Z J Obstet Gynaecol 2023; 63:786-791. [PMID: 37345840 DOI: 10.1111/ajo.13724] [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: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Placenta accreta spectrum disorder is an increasingly prevalent cause of maternal morbidity in developed countries. AIMS This study aimed to review the management and outcomes of cases of placenta accreta spectrum, and compare blood loss and blood transfusion rates, over time after an institutional change in planned primary surgeon from gynaecological oncologists to experienced obstetricians. METHODS This retrospective cohort study included all cases of suspected or confirmed placenta accreta spectrum disorder (PASD) between 1999 and 2021 at Monash Health. Data were collected by reviewing medical records to obtain baseline characteristics, details of surgical planning and management and major maternal morbidity outcomes over a 20-year period. The primary surgical lead was recorded as either gynaecological oncologist or experienced obstetricians. The primary outcomes were estimated maternal blood loss and number of units of blood transfused. RESULTS A total of 88 patients were identified: 43 between 1999 and 2015 where gynaecological oncologists were the primary surgeon in 79% of cases and 45 between 2016 and 2021 where experienced obstetricians were the primary surgeon in 73.3% of cases. There was no statistically significant difference in the estimated blood loss between the two time periods (median: 2000 vs 2500 mL, P = 0.669). Hysterectomy rates were significantly reduced in the second time period, from 100 to 73.3%, P < 0.001. CONCLUSION Management of cases of PASDs has improved over time with changes in antenatal diagnosis and perioperative management, and management by experienced obstetricians has similar maternal outcomes compared to those whose management includes the presence of gynaecological oncologists.
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Affiliation(s)
- Victoria J Holmes
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Sasha Skinner
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Michael Silagy
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Annie Kroushev
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Maternal Fetal Medicine Unit, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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Pan W, Chen J, Zou Y, Yang K, Liu Q, Sun M, Li D, Zhang P, Yue S, Huang Y, Wang Z. Uterus-preserving surgical management of placenta accreta spectrum disorder: a large retrospective study. BMC Pregnancy Childbirth 2023; 23:615. [PMID: 37633887 PMCID: PMC10464453 DOI: 10.1186/s12884-023-05923-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The two-child policy implemented in China resulted in a surge of high-risk pregnancies among advanced maternal aged women and presented a window of opportunity to identify a large number of placenta accreta spectrum (PAS) cases, which often invoke severe blood loss and hysterectomy. We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning. METHODS Cross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL + CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018. RESULTS From a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL + CST had a significant reduction in intraoperative blood loss (β=-312 ml, P < .001), RBC transfusion (β=-1.08 unit, P = .001), but required more surgery time (β = 16.43 min, P = .01). MRI-measured placenta thickness, when above 50 mm, can increase blood loss (β = 315 ml, P = .01), RBC transfusion (β = 1.28 unit, P = .01), surgery time (β = 48.84 min, P < .001) and hospital stay (β = 2.58 day, P < .001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation. CONCLUSIONS A conservative surgical management approach of UAL + CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR2000035202.
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Affiliation(s)
- Wenxia Pan
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Juan Chen
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Yinrui Zou
- Havy International (Shanghai) Ltd, Building 25, No.1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Kun Yang
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Qingfeng Liu
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Meiying Sun
- Department of Obstetrics, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Dan Li
- Department of Radiology, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Ping Zhang
- Department of Ultrasound, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Shixia Yue
- Department of Nursery, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China
| | - Yuqiang Huang
- Department of Pediatric Cardiology, Linyi Maternal and Child Healthcare Hospital, NO.1, South Qinghe Road, Luozhuang District, Linyi City, 276016, Shandong Province, China.
| | - Zhaoxi Wang
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Kirstein 3, 02215, Boston, MA, USA
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Ioscovich A, Weiss A, Shatalin D. The anesthetic approach to a patient with placenta accreta spectrum. Curr Opin Anaesthesiol 2023; 36:263-268. [PMID: 36745077 DOI: 10.1097/aco.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. RECENT FINDINGS The use of resuscitative endovascular balloon occlusion of the aorta has been gaining popularity around the world. It has been shown to cause an equivocal reduction in perioperative bleeding in placenta accreta spectrum (PAS), reduce the rate of hysterectomies, and is a safe and relatively easy technique. There are other invasive radiology techniques that have also proven to be beneficial in bleeding prevention: balloon occlusion of hypogastric arteries intraoperatively, internal iliac artery embolization, and intraoperative ligation of the hypogastric or uterine arteries. SUMMARY Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with The Hebrew University, Jerusalem, Israel
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O'Rinn SE, Barrett JFR, Parsons JA, Kingdom JC, D'Souza R. Engaging pregnant individuals and healthcare professionals in an international mixed methods study to develop a core outcome set for studies on placenta accreta spectrum disorder (COPAS): a study protocol. BMJ Open 2023; 13:e060699. [PMID: 37185194 PMCID: PMC10151908 DOI: 10.1136/bmjopen-2021-060699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Placenta accreta spectrum (PAS) disorder is a life-threatening condition that may result in serious maternal complications, including mortality. The placenta which is pathologically adherent to the uterine wall, places individuals at high risk of major haemorrhage during the third stage of labour. Current research reports on PAS disorder outcomes have highly variable levels of information, which is therefore difficult for investigators to aggregate to inform practice. There is an urgent need to harmonise data collection in prospective studies to identify and implement best practices for management. One approach to standardise outcomes across any health area via the use of core outcome sets (COSs), which are consensus-derived standardised sets of outcomes that all studies for a particular condition should measure and report. This protocol outlines the steps for developing a COS for PAS disorder (COPAS). METHODS AND ANALYSIS This protocol outlines steps for the creation of COPAS. The first step, a systematic review, will identify all reported outcomes in the scientific literature. The second step will use qualitative one-on-one interviews to identify additional outcomes identified as important by patients and healthcare professionals that are not reported in the published literature. Outcomes from the first two steps will be combined to form an outcome inventory. This outcome inventory will inform the third step which is a Delphi survey that encourages agreement between patients and healthcare professionals on which outcomes are most important for inclusion in the COS. The fourth step, a consensus group meeting of representative participants, will finalise outcomes for inclusion in the PAS disorder COS. ETHICS AND DISSEMINATION This study has obtained Research Ethics Board approval from Sunnybrook Health Sciences Centre (#2338, #1488). We will aim to publish the study findings in an international peer-reviewed OBGYN journal. REGISTRATION DETAILS COMET Core Outcome Set Registration: https://www.comet-initiative.org/Studies/Details/1127. PROSPERO REGISTRATION NUMBER CRD42020173426.
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Affiliation(s)
- Susan E O'Rinn
- Outcomes & Evaluation, Institute of Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- DAN Women & Babies Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jon F R Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Janet A Parsons
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - John C Kingdom
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:49-58. [PMID: 36701609 DOI: 10.1097/aog.0000000000004976] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. METHODS OF STUDY SELECTION Abstracts (n=4,275) and full-text studies (n=599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. TABULATION, INTEGRATION, AND RESULTS Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I2=91%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n=220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes. CONCLUSION Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021240993.
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Enste R, Cricchio P, Dewandre PY, Braun T, Leonards CO, Niggemann P, Spies C, Henrich W, Kaufner L. Placenta accreta spectrum part I: anesthesia considerations based on an extended review of the literature. J Perinat Med 2022; 51:439-454. [PMID: 36181730 DOI: 10.1515/jpm-2022-0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
"Placenta accreta spectrum" (PAS) describes abnormal placental adherence to the uterine wall without spontaneous separation at delivery. Though relatively rare, PAS presents a particular challenge to anesthesiologists, as it is associated with massive peripartum hemorrhage and high maternal morbidity and mortality. Standardized evidence-based PAS management strategies are currently evolving and emphasize: "PAS centers of excellence", multidisciplinary teams, novel diagnostics/pharmaceuticals (especially regarding hemostasis, hemostatic agents, point-of-care diagnostics), and novel operative/interventional approaches (expectant management, balloon occlusion, embolization). Though available data are heterogeneous, these developments affect anesthetic management and must be considered in planed anesthetic approaches. This two-part review provides a critical overview of the current evidence and offers structured evidence-based recommendations to help anesthesiologists improve outcomes for women with PAS. This first part discusses PAS management in centers of excellence, multidisciplinary care team, anesthetic approach and monitoring, surgical approaches, patient safety checklists, temperature management, interventional radiology, postoperative care and pain therapy. The diagnosis and treatment of hemostatic disturbances and preoperative prepartum anemia, blood loss, transfusion management and postpartum venous thromboembolism will be addressed in the second part of this series.
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Affiliation(s)
- Rick Enste
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Patrick Cricchio
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pierre-Yves Dewandre
- Department of Anesthesia and Intensive Care Medicine, Université de Liège, Liege, Belgium
| | - Thorsten Braun
- Department of Obstetrics and 'Exp. Obstetrics', Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christopher O Leonards
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Phil Niggemann
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics and 'Exp. Obstetrics', Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lutz Kaufner
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Bloomfield V, Rogers S, Scattolon S, Morais M, Leyland N. Informing the spectrum of approaches: Institutional review of placenta accreta spectrum disorders management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:365-371. [PMID: 34740850 DOI: 10.1016/j.jogc.2021.10.013] [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: 07/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a condition defined by abnormal adherence of the placenta. Cesarean hysterectomy is the preferred management, but practice patterns vary based on local resources and expertise. We retrospectively reviewed the clinical course of patients diagnosed antenatally with PAS who underwent surgical management in our centre. METHODS We conducted a retrospective records review involving patients with an antenatal diagnosis of PAS between 2014 and 2019. The primary outcome was a composite score of maternal morbidity, and secondary outcomes were total estimated blood loss and composite neonatal morbidity. Patients were stratified based on the presence or absence of PAS on final pathology. Antenatal diagnosis by ultrasound and magnetic resonance imaging (MRI) was compared with final histologic diagnosis. RESULTS A total of 34 patients were diagnosed with PAS antenatally and managed at our institution. Final histology confirmed PAS in 29 patients. The overall composite morbidity rate was 44%, with no significant difference between patients with and without PAS on pathology (P = 0.355). Intraoperative blood loss was similar between the 2 groups (2374 ± 2212 mL vs. 1080 ± 852 mL; P = 0.232). The rate of composite neonatal morbidity was 47%. Ultrasound achieved a high positive predictive value in the diagnosis of PAS (96%) and more accurately predicted pathology than MRI. CONCLUSIONS PAS is associated with high rates of morbidity. Dissemination of our local experience serves to inform best practices in the management of this complex condition.
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Affiliation(s)
- Valerie Bloomfield
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Stacey Rogers
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Sarah Scattolon
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Michelle Morais
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Nicholas Leyland
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8.
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Hobson SR, Kingdom JCP, Windrim RC, Murji A, Milligan N, Pacheco JF, Lu C, Steckham KE, Kajal D, Pantazi S, Carvalho JCA, Parks WT, Allen LM. Safer outcomes for placenta accreta spectrum disorders: A decade of quality improvement. Int J Gynaecol Obstet 2021; 157:130-139. [PMID: 33890292 DOI: 10.1002/ijgo.13717] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/13/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the evolution and evaluation of protocol-based multidisciplinary quality improvement (QI) in women undergoing cesarean hysterectomy for radiologically suspected and pathologically confirmed placenta accreta spectrum (PAS) disorders. METHODS A single-center, retrospective cohort study was conducted of all patients undergoing cesarean hysterectomy for PAS disorders between March 2009 and June 2018. Two distinct periods were defined to compare outcomes: 2009-2011 (initial period) and 2017-2018 (current period). Primary outcomes included blood loss and administration of blood products. Secondary outcomes included perioperative levels of hemoglobin, adverse events and complications, time to mobilization, and length of hospitalization. RESULTS Among the 105 consecutive patients identified, there were 26 in the initial period and 32 in the current period. With the implementation of all QI care bundles, median estimated surgical blood loss halved from 2000 ml in the initial period to 1000 ml in the current period, and fewer patients required allogenic blood transfusion (61.5% vs 25%). Patients in the current period demonstrated improved postoperative levels of hemoglobin compared to those in the initial period (101 g/L vs 89 g/L) and had a shorter median postoperative hospital stay (3 days vs 5 days). CONCLUSION These results support the implementation of a multifaceted QI and patient care initiative for women with PAS disorders.
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Affiliation(s)
- Sebastian R Hobson
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - John C P Kingdom
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada.,Department of Diagnostic Imaging, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Rory C Windrim
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Natasha Milligan
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Jessica F Pacheco
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Catherine Lu
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Katherine E Steckham
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Dilkash Kajal
- Department of Diagnostic Imaging, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Sophia Pantazi
- Department of Diagnostic Imaging, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Jose C A Carvalho
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada.,Department of Anaesthesia, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - W Tony Parks
- Department of Pathology & Laboratory Medicine, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
| | - Lisa M Allen
- Department of Obstetrics & Gynaecology, University of Toronto & Mount Sinai Hospital, Toronto, ON, Canada
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Cojocaru L, Lankford A, Galey J, Bharadwaj S, Kodali BS, Kennedy K, Goetzinger K, Turan OM. Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. J Matern Fetal Neonatal Med 2020; 35:4496-4505. [PMID: 33272057 DOI: 10.1080/14767058.2020.1852213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of our surgical approach, referred to in the text as Linear Cutter Vessel Sealing System (LCVSS) technique, will improve perioperative outcomes in patients with placenta accreta spectrum (PAS), specifically by reducing blood loss and blood transfusion rates at the time of cesarean hysterectomy (C-HYST). The LCVSS technique integrates the following: (1) hysterotomy performed using the Linear Cutter, (2) no placental manipulation, (3) cauterization of anatomically prominent vascular anastomosis using the handheld vessel sealing system, and (4) completion of bladder dissection until the cervico-vaginal junction before ligation and division of uterine arteries. MATERIALS AND METHODS This is a retrospective cohort study that analyzed perioperative outcomes in patients undergoing C-HYST for PAS at a tertiary care center from 1 July 2014 to 1 December 2019. Comparisons were performed between cases managed with the use of the LCVSS technique (designated as LCVSS cohort) and those managed without the use of the LCVSS technique (designated as no technique cohort). The primary outcomes were cumulative blood loss (CBL) and total perioperative blood transfusion of ≥4 and ≥6 units of PRBCs. The secondary outcomes were intra- and postoperative complications. Continuous and categorical variables were compared according to the sample size and distribution. Binary logistic regression analysis was performed to predict confounders for blood transfusion of ≥4 units of PRBCs. RESULTS A total of 69 prenatally diagnosed PAS cases underwent C-HYST at the time of delivery. Forty-four cases that were performed using the LCVSS technique comprised the LCVSS cohort. The remaining 25 were marked as no technique cohort. CBL was significantly lower in the LCVSS cohort (1124 ml [300-4100] vs 3500 ml [650-10600]; p < .001). The rate of urinary tract injuries was similar (16%). The rate of postoperative complications and reoperation for intra-abdominal bleeding were lower but not significantly different in LCVSS cohort (9 vs 20% and 0 vs 8%, p = .26 and p = .12, respectively). There were no differences in neonatal outcomes. CONCLUSION Implementation of this advanced surgical approach for PAS management resulted in reduced blood loss and blood transfusion rates in comparison with no technique cohort.
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Affiliation(s)
- Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allison Lankford
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica Galey
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shobana Bharadwaj
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bhavani S Kodali
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Kennedy
- Department of Obstetrics, Gynecology and Reproductive Science, Center for Advanced Fetal Care, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Elkhouly NI, Solyman AE, Anter ME, Sanad ZF, El Ghazaly AN, Ellakwa HE. A new conservative surgical approach for placenta accreta spectrum in a low-resource setting. J Matern Fetal Neonatal Med 2020; 35:3076-3082. [PMID: 32842821 DOI: 10.1080/14767058.2020.1808616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a new surgical approach for uterine preservation among patients with placenta accreta spectrum in a low-resource setting. METHODS The present prospective cohort included 63 women diagnosed with placenta accreta spectrum undergoing cesarean deliveries who desired future fertility at the obstetrics department of Menoufia University Hospital from January 2018 to November 2019. Surgical management involved direct bilateral uterine arteries clamping below placental bed after broad ligament opening by round ligaments division and ligation and gentle downward dissection of vesical from myometrial tissues from lateral aspect toward trigone of the bladder. Outcomes included intraoperative and postoperative adverse events, hysterectomy rate, and postoperative hospitalization. RESULTS Mean operative blood loss was 1860 ± 537 mL (range, 1040-3111 mL) and the incidence of bladder and ureteric injuries were 6.3% (n = 4) and 0%, respectively. The mean length of hospital stay was 4.46 ± 1.39 days. Overall, 7 patients (11.1%) required postoperative blood transfusion, and 2 patients (3.2%) required ICU admission. Five patients required peripartum hysterectomy (7.9%). CONCLUSION Our conservative surgical approach is a safe alternative to peripartum hysterectomy with high uterine preservation rate, less intraoperative and postoperative morbidity and less need for blood transfusion in low resource settings. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; NCT04161521.
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Affiliation(s)
- Nabih I Elkhouly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ayman E Solyman
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed E Anter
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Zakaria F Sanad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Alaa N El Ghazaly
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Hamed E Ellakwa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
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Olsthoorn AV, Figueiro-Filho EA, Li YE, Farine D, Sobel ML. Counselling Patients for Trial of Labour after Cesarean (TOLAC) and Invasive Placentation: Are We Missing the Mark? The Importance of Local Data and Informed Choice. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:306-312. [PMID: 33127379 DOI: 10.1016/j.jogc.2020.07.009] [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: 05/24/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Rates of cesarean delivery are increasing, and these procedures carry potential complications, like the risk of invasive placentation, which increases with each cesarean. A trial of labour after cesarean (TOLAC) is a viable option for patients; however, it has been associated with uterine rupture, a complication with maternal and fetal risks. To better counsel patients considering TOLAC, we aimed to determine local uterine rupture rates and maternal and neonatal outcomes with TOLAC and compare these with outcomes related to invasive placentation. METHODS A 4-year retrospective chart review was conducted at our tertiary centre of all patients with a history of a previous cesarean delivery. We assessed rates of TOLAC, vaginal delivery after cesarean (VBAC), and uterine rupture, as well as maternal and neonatal outcomes associated with invasive placentation. Cases of uterine rupture from 1988 to the present were also reviewed, and their outcomes were compared with those of invasive placentation. RESULTS Our uterine rupture rate was 0.44% and VBAC rate was 73.8%. We identified 8 cases of uterine rupture since 1988 and 67 invasive placentas during the 4-year chart review. Invasive placentation was associated with a significantly increased risk of neonatal respiratory morbidity, hysterectomy, maternal complications, and longer length of maternal hospital stay when compared with uterine rupture. CONCLUSION While uterine rupture remains a potential complication of TOLAC, it is rare with overall excellent maternal and neonatal outcomes. Invasive placentation, the risk of which increases with cesarean delivery, carries potentially higher complication rates than uterine rupture. Local complication data is important for individual sites offering TOLAC. The implications of invasive placentation cannot be overlooked when counselling patients considering TOLAC.
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Affiliation(s)
- Alisha V Olsthoorn
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
| | | | - Yujin E Li
- Faculty of Medicine, University of Toronto, Toronto, ON
| | - Dan Farine
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Faculty of Medicine, University of Toronto, Toronto, ON; Mount Sinai Hospital, Toronto, ON
| | - Mara L Sobel
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; Faculty of Medicine, University of Toronto, Toronto, ON; Mount Sinai Hospital, Toronto, ON
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Papillon-Smith J, Hobson S, Allen L, Kingdom J, Windrim R, Murji A. Prophylactic internal iliac artery ligation versus balloon occlusion for placenta accreta spectrum disorders: A retrospective cohort study. Int J Gynaecol Obstet 2020; 151:91-96. [PMID: 32506473 DOI: 10.1002/ijgo.13256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/08/2020] [Accepted: 06/01/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare surgical outcomes between women undergoing prophylactic internal iliac artery ligation or preoperative placement of balloon-occlusive devices at cesarean hysterectomy for placenta accreta spectrum (PAS) disorders. METHODS A retrospective cohort study was conducted at a tertiary-care referral center for PAS disorders in Ontario, Canada. Eligible electronic records were reviewed of women undergoing cesarean hysterectomy for PAS disorders between November 2012 and June 2018. Outcomes for the ligation and balloon groups were compared primarily on procedure-related complications and secondarily on total procedure time, bleeding and transfusion metrics, and intraoperative and postoperative complications. RESULTS Of the 79 cases of cesarean hysterectomy, 47 underwent balloon placement and 32 underwent ligation. Baseline characteristics between the groups were similar except for more emergency procedures in the ligation group (37.5% vs 12.8%, P=0.014). The balloon-related complication rate was 5/47 (10.6%), with no reported complications in the ligation group (P=0.077). Procedural time was longer in the balloon group (353 ± 14 vs 227 ± 13 minutes, P<0.001). Estimated blood loss was similar (1874 ± 245 mL vs 1713 ± 181 mL, P=0.590). CONCLUSION Women undergoing prophylactic placement of endovascular balloons at caesarean hysterectomy for PAS disorders had a 10.6% procedure-related complication rate and increased total procedure time, with no decrease in blood loss compared to those undergoing surgical ligation.
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Affiliation(s)
- Jessica Papillon-Smith
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Sebastian Hobson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Lisa Allen
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - John Kingdom
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Ally Murji
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Ou J, Peng P, Teng L, Li C, Liu X. Management of patients with placenta accreta spectrum disorders who underwent pregnancy terminations in the second trimester: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2019; 242:109-113. [PMID: 31580962 DOI: 10.1016/j.ejogrb.2019.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/19/2019] [Accepted: 09/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To analyse the management of patients with placenta accreta spectrum (PAS) disorders who underwent 2nd trimester pregnancy terminations. METHOD The records of patients with PAS disorders who underwent 2nd trimester pregnancy terminations were collected and analysed. RESULTS Twenty-eight patients were included; 8 (28.6%) patients received prenatal diagnoses and 20 (71.4%) patients received postnatal diagnoses. In the prenatal diagnosis group, scheduling hysterotomy and placenta removal were performed in 5 patients with complete placenta previa and previous caesarean delivery without hysterectomy or postpartum haemorrhage, and medical termination was performed in 3 patients, 2 of whom retained the placenta in situ. In the postnatal diagnosis group, the placenta remained in situ in 11 patients, and in 13 (46.4%) patients overall, adjuvant treatments were applied to the patients, and the abnormally implanted placenta was passed 43.5 (range: 7-102) days after termination. A complication associated with the placenta left in situ included intrauterine infection in one case. Uterus preservation was achieved in all the patients. CONCLUSIONS For patients with PAS disorders with complete placenta previa and previous caesarean delivery, hysterotomy is a safe choice for terminating a 2nd trimester pregnancy. When it is impossible to manually remove the placenta, leaving the placenta in situ with the administration of adjuvant treatment is a good choice for uterus preservation.
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Affiliation(s)
- Jie Ou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China.
| | - Ping Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China.
| | - Lirong Teng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China.
| | - Chunying Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China.
| | - Xinyan Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Acadey of Medical Sciences, Beijing, People's Republic of China.
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Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JC, Singh SS, Ziegler C, Birch C, Frecker E, Lim K, Cargill Y, Allen LM. No 383 – Dépistage, diagnostic et prise en charge des troubles du spectre du placenta accreta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1050-1066. [DOI: 10.1016/j.jogc.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JC, Singh SS, Ziegler C, Birch C, Frecker E, Lim K, Cargill Y, Allen LM. No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1035-1049. [DOI: 10.1016/j.jogc.2018.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Karacaer F, Biricik E, Ilgınel M, Tunay D, Sucu M, Ünlügenç H. Retrospective Analysis of Eighty-Nine Caesarean Section Cases with Abnormal Placental Invasion. Turk J Anaesthesiol Reanim 2019; 47:112-119. [PMID: 31080952 DOI: 10.5152/tjar.2018.31799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/12/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Abnormal placental invasion (API) is defined as an abnormal adherence of the placenta to the underlying uterine wall. Undiagnosed API may result in catastrophic maternal haemorrhage during delivery. In the present retrospective analysis, anaesthetic and surgical records were evaluated in patients with API who had undergone caesarean delivery (CD). Methods Clinical records of 89 patients with API who had undergone CD were retrospectively reviewed in our clinic between April 2010 and February 2017. Results Amongst the patients, 87 (97.8%) had a history of previous CD and 68 (76.4%) had placenta previa. In regression analysis, weak positive correlation was found between an increase in packed red blood cell (PRBC) (r=0.420, p=0.001) and fresh frozen plasma (FFP) (r=0.476, p=0.022) transfusions and time of hospital stay. PRBC and FFP consumptions were significantly greater in intensive care unit (ICU) patients than in non-ICU patients (p<0.001). ICU requirement were significantly greater in patients who had more than average crystalloid (p=0.004) and colloid (p<0.001) infusions. Elective CD was performed in 81 (91%) patients and emergency CD in 8 (9%). PRBC transfusions were 7±4.3 U in patients undergoing emergency CD and 3.85±3 U in patients undergoing elective CD (p=0.034). The number of patients requiring care in ICU was 4 (50%), who underwent emergency CD and 12 (14%) who underwent elective CD, (p=0.032). Conclusion It is crucial that the anaesthesiologist should be familiar with the risk factors and diagnosis of API because of the potential risk of massive haemorrhage. Multidisciplinary approach with surgery and blood bank decreases the amount of bleeding, blood transfusion requirement, ICU and hospital stay in patients with API.
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Affiliation(s)
- Feride Karacaer
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Ebru Biricik
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Murat Ilgınel
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Demet Tunay
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Mete Sucu
- Department of Gynecology and Obstetrics, Çukurova University School of Medicine, Adana, Turkey
| | - Hakkı Ünlügenç
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
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Mitric C, Desilets J, Balayla J, Ziegler C. Surgical Management of the Placenta Accreta Spectrum: An Institutional Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1551-1557. [PMID: 30948337 DOI: 10.1016/j.jogc.2019.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The incidence of placenta accreta spectrum (PAS) has risen over the past decades, primarily in response to increasing Caesarean section rates. The surgical management of PAS is associated with significant morbidity, including hemorrhage and intensive care unit (ICU) admission. This study sought to evaluate the surgical outcomes of a PAS operative approach. METHODS A single-centre retrospective chart review of all Caesarean hysterectomies for PAS by an assigned surgeon over a 16-year period was performed. Surgical outcomes were described (Canadian Task Force Classification II-2). RESULTS The described surgical approach involves a midline skin incision, high midline hysterotomy, a rapid single-layer uterine closure with no placental removal attempt, constant cephalad uterine traction, and liberal choice of subtotal hysterectomy. A total of 47 patients were included: 19 (40.4%) with placenta accreta, 14 (29.8%) with placenta increta, and 14 (29.8%) with placenta percreta. Mean estimated blood loss was 1416 ± 699 mL, and mean operative time was 112 ± 49 minutes. Overall, 16 patients (34.0%) required blood transfusion, and 4 patients (8.5%) required ICU admission. The average hospitalization was 5.2 days, with no re-admission within 30 days. The use of internal iliac balloons did not result in a difference in blood loss or operative time (P > 0.05). Patients with placenta percreta had significantly more blood loss (P = 0.02) and longer operative time (P = 0.007) compared with those with placenta accreta and increta. CONCLUSION The current surgical model for planned Caesarean hysterectomy for PAS exhibits a low complication rate. Further research is needed for developing a standardized approach to the management of PAS.
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Affiliation(s)
- Cristina Mitric
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Jade Desilets
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Jacques Balayla
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC
| | - Cleve Ziegler
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
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Dawood AS, Elgergawy AE, Elhalwagy AE. Evaluation of three-step procedure (Shehata's technique) as a conservative management for placenta accreta at a tertiary care hospital in Egypt. J Gynecol Obstet Hum Reprod 2018; 48:201-205. [PMID: 30316906 DOI: 10.1016/j.jogoh.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the benefits and risks of three-step technique as a conservative treatment for women with placenta accreta and desiring future fertility. STUDY DESIGN This study is a retrospective study where the files of 91 cases of placenta accreta managed by three-step technique were reviewed. This study was conducted at Tanta University Hospitals in the period from June 1, 2015 to May 31, 2017. All demographic and operative data were extracted and recorded. RESULTS The mean age was 32.44±2.72 years; the mean operative time was 81.65±15.68min. The mean gestational age at operation was 35.67±1.19 weeks. The technique succeeded to preserve the uterus in 86 cases and failed in 5 cases. There was no cases required ICU admission with mean hospital stay of 3.065±1.04 days. The postoperative morbidities were mild and in the form of fever (n=9) and wound sepsis (n=4), pyometra (n=1) and secondary hemorrhage (n=1). CONCLUSION The three-step procedure is effective as a uterine sparing technique in management of placenta accreta with success rate of 94.5%. The operative and postoperative complications were minimal and expected in such case.
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Diagnostic accuracy of magnetic resonance imaging in assessing placental adhesion disorder in patients with placenta previa: Correlation with histological findings. Eur J Radiol 2018; 106:77-84. [DOI: 10.1016/j.ejrad.2018.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
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Cui R, Li M, Lu J, Bai H, Zhang Z. Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study. BMC Pregnancy Childbirth 2018; 18:298. [PMID: 29996794 PMCID: PMC6042202 DOI: 10.1186/s12884-018-1935-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background The unique clinical features of pregnancy termination in the second trimester with concurrent placenta accreta spectrum (PAS) disorders place obstetricians in a complex and delicate situation. However, there are limited data on this rare and dangerous condition. The objective of this research was to investigate and evaluate the clinical management strategies of this patient group. Methods The medical records of patients who were diagnosed and treated in our hospital from December 2005 and December 2015 were retrospectively reviewed. Results A total of 29 patients were included in this analysis. A prenatal diagnosis was suspected in 8 (27.6%) patients, and the remaining 21 (72.4%) patients were diagnosed after pregnancy termination in the second trimester. In the subgroup with a prenatal diagnosis, a planned hysterotomy was performed in 7 patients who had total placenta previa and previous cesarean delivery. The remaining patient received medical termination. A subtotal hysterectomy was performed in 3 (10.3%) patients for life-threatening bleeding during hysterotomy, and the uterus was preserved with an in situ placenta in the remaining 5 patients. In the subgroup with a postnatal diagnosis, the implanted placenta remained partly or completely in situ in all 21 patients under informed consent. Ultimately, the implanted placenta remained partly or completely in situ in 26 (89.7%) patients in the two subgroups. With the application of adjuvant treatments, including uterine artery embolization and medication followed by curettage under ultrasound guidance, the implanted placenta was passed 76.6 (range: 19 to 192) days after termination. Uterus preservation was achieved in all 26 patients. The complications associated with conservative management included delayed postnatal hemorrhaging (2 cases, 7.7%), fever (6 cases, 23.1%), G1 transaminase disorder (4 cases, 15.4%), and myelosuppression (1 case, 3.8%). Seven women (26.9%) had a spontaneous pregnancy after conservative management, and no patient experienced recurrent PAS disorders. Conclusions Leaving the implanted placenta in situ is the preferred choice for patients with PAS disorders who underwent pregnancy termination in the second trimester and desired fertility preservation. Multiple adjuvant treatment modalities, either alone or in combination, may help to promote the passing or absorption of the implanted placenta under close monitoring.
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Affiliation(s)
- Ran Cui
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Menghui Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Junli Lu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China
| | - Huimin Bai
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China.
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No.8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China.
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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: 179] [Impact Index Per Article: 29.8] [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
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Abstract
Hysterectomy at the time of an obstetric delivery or postpartum is an uncommon time to perform one of the most common gynecologic procedures. Hysterectomy associated with pregnancy is often unplanned and undesired. Postpartum complications associated with the need for hysterectomy carry significant risks, which pose challenges for mother-infant bonding and can signify an unexpected end to fertility. The most common indication for hysterectomy is postpartum hemorrhage. Postpartum hemorrhage is caused by uterine atony, genital tract laceration, uterine rupture, invasive placentation, infection, or coagulopathy. Multidisciplinary teams improve outcomes and are capable of managing complex medical and surgical complications that occur postpartum.
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Affiliation(s)
- Christopher Kevin Huls
- Department of Obstetrics and Gynecology, Banner University Medical Center, 1111 E McDowell, Phoenix, AZ, USA; Department of Obstetrics and Gynecology, University of Arizona, Phoenix, AZ, USA; Phoenix Perinatal Associates of Mednax, Inc., 1840 South Stapley Drive, Suite 131, Mesa, AZ 85204, USA.
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Taylor N, Russell R. Anaesthesia for abnormally invasive placenta: a single-institution case series. Int J Obstet Anesth 2017; 30:10-15. [DOI: 10.1016/j.ijoa.2017.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
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Patenaude Y, Pugash D, Lim K, Morin L. Utilisation de l'imagerie par résonance magnétique en obstétrique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S418-S425. [PMID: 28063554 DOI: 10.1016/j.jogc.2016.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Walker MG, Pollard L, Talati C, Carvalho JC, Allen LM, Kachura J, Murji A, Kingdom JC, Windrim R. Obstetric and Anaesthesia Checklists for the Management of Morbidly Adherent Placenta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:1015-1023. [DOI: 10.1016/j.jogc.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
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Windrim R, Kingdom J, Jang HJ, Burns PN. Contrast enhanced ultrasound (CEUS) in the prenatal evaluation of suspected invasive placenta percreta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:975-978. [DOI: 10.1016/j.jogc.2016.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
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Nguyen-Lu N, Carvalho JCA, Kingdom J, Windrim R, Allen L, Balki M. Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases. Can J Anaesth 2016; 63:1233-44. [DOI: 10.1007/s12630-016-0695-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 12/22/2022] Open
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Ioscovich A, Shatalin D, Butwick AJ, Ginosar Y, Orbach-Zinger S, Weiniger CF. Israeli survey of anesthesia practice related to placenta previa and accreta. Acta Anaesthesiol Scand 2016; 60:457-64. [PMID: 26597396 DOI: 10.1111/aas.12656] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/12/2015] [Accepted: 09/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair). Each director surveyed provided information about the anesthetic and transfusion management in their labor and delivery units for three types of abnormal placentation based on antenatal placental imaging: PP, low suspicion for PA, and high suspicion for PA. The primary outcome was use of neuraxial or general anesthesia for PP and PA Cesarean delivery. Univariate statistics were used for survey responses using counts and percentages. RESULTS The response rate was 100%. Spinal anesthesia is the preferred anesthetic mode for PP cases, used in 17/26 (65.4%) of labor and delivery units. By comparison, most representatives reported that they perform general anesthesia for patients with PA: 18/26 (69.2%) for all low suspicion cases of PA and 25/26 (96.2%) for all high suspicion cases of PA. Although a massive transfusion protocol was available in the majority of hospitals (84.6%), the availability of thromboelastography and cell salvage was much lower (53.8% and 19.2% hospitals respectively). CONCLUSIONS In our survey, representatives of anesthesia labor and delivery services in Israel are almost exclusively using general anesthesia for women with high suspicion for PA; however, almost two-thirds use spinal anesthesia for PP without suspicion of PA. Among representatives, we found wide variations in anesthesia practice patterns with regard to anesthesia mode, multidisciplinary management, and hemorrhage anticipation strategies.
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Affiliation(s)
- A. Ioscovich
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - D. Shatalin
- Department of Anesthesiology; Perioperative Medicine and Pain Treatment; Shaare Zedek Medical Center; Hebrew University; Jerusalem Israel
| | - A. J. Butwick
- Department of Anesthesia; Stanford University School of Medicine; Stanford California USA
| | - Y. Ginosar
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
| | - S. Orbach-Zinger
- Department of Anesthesia; Rabin Medical Center (Beilinson Campus); Petah Tikvah; Tel Aviv University; Tel Aviv Israel
| | - C. F. Weiniger
- Department of Anesthesiology and Critical Care Medicine; Hadassah-Hebrew University Medical Center; Ein Kerem Jerusalem Israel
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Aitken K, Allen L, Pantazi S, Kingdom J, Keating S, Pollard L, Windrim R. MRI Significantly Improves Disease Staging to Direct Surgical Planning for Abnormal Invasive Placentation: A Single Centre Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:246-251.e1. [DOI: 10.1016/j.jogc.2016.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/01/2015] [Indexed: 11/30/2022]
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Dannheim K, Shainker SA, Hecht JL. Hysterectomy for placenta accreta; methods for gross and microscopic pathology examination. Arch Gynecol Obstet 2016; 293:951-8. [DOI: 10.1007/s00404-015-4006-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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Shetty MK, Dryden DK. Morbidly Adherent Placenta: Ultrasound Assessment and Supplemental Role of Magnetic Resonance Imaging. Semin Ultrasound CT MR 2015; 36:324-31. [DOI: 10.1053/j.sult.2015.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, Ballas J, Chen Q, Van Veen TR, Javadian P, Sangi-Haghpeykar H, Zacharias N, Welty S, Cassady CI, Moaddab A, Popek EJ, Hui SKR, Teruya J, Bandi V, Coburn M, Cunningham T, Martin SR, Belfort MA. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212:218.e1-9. [PMID: 25173187 DOI: 10.1016/j.ajog.2014.08.019] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/25/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to test the hypothesis that a standardized multidisciplinary treatment approach in patients with morbidly adherent placenta, which includes accreta, increta, and percreta, is associated with less maternal morbidity than when such an approach is not used (nonmultidisciplinary approach). STUDY DESIGN A retrospective cohort study was conducted with patients from 3 tertiary care hospitals from July 2000 to September 2013. Patients with histologically confirmed placenta accreta, increta, and percreta were included in this study. A formal program that used a standardized multidisciplinary management approach was introduced in 2011. Before 2011, patients were treated on a case-by-case basis by individual physicians without a specific protocol (nonmultidisciplinary group). Estimated blood loss, transfusion of packed red blood cells, intraoperative complications (eg, vascular, bladder, ureteral, and bowel injury), neonatal outcome, and maternal postoperative length of hospital stay were compared between the 2 groups. RESULTS Of 90 patients with placenta accreta, 57 women (63%) were in the multidisciplinary group, and 33 women (37%) were in the nonmultidisciplinary group. The multidisciplinary group had more cases with percreta (P = .008) but experienced less estimated blood loss (P = .025), with a trend to fewer blood transfusions (P = .06), and were less likely to be delivered emergently (P = .001) compared with the nonmultidisciplinary group. Despite an approach of indicated preterm delivery at 34-35 weeks of gestation, neonatal outcomes were similar between the 2 groups. CONCLUSION The institution of a standardized approach for patients with morbidly adherent placentation by a specific multidisciplinary team was associated with improved maternal outcomes, particularly in cases with more aggressive placental invasion (increta or percreta), compared with a historic nonmultidisciplinary approach. Our standardized approach was associated with fewer emergency deliveries.
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Affiliation(s)
- Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Bahram Salmanian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Concepcion R Diaz-Arrastia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Wesley Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - B Wycke Baker
- Department of Anesthesiology and Obstetric and Gynecologic Anesthesiology, Texas Children's Hospital, Houston, TX
| | - Jerasimos Ballas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Qian Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Teelkien R Van Veen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Pouya Javadian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Haleh Sangi-Haghpeykar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Nicholas Zacharias
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Stephen Welty
- Department of Neonatology, Texas Children's Hospital, Houston, TX
| | | | - Amirhossein Moaddab
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Edwina J Popek
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Shiu-ki Rocky Hui
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jun Teruya
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Venkata Bandi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Michael Coburn
- Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Stephanie R Martin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Michael A Belfort
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Eur J Obstet Gynecol Reprod Biol 2014; 180:111-5. [DOI: 10.1016/j.ejogrb.2014.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022]
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Aitken K, Cram J, Raymond E, Okun N, Allen L, Windrim R. “Mobile” Medicine: A Surprise Encounter with Placenta Percreta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:377. [DOI: 10.1016/s1701-2163(15)30579-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Médecine « mobile » : Constatation surprise d’un placenta percreta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Patenaude Y, Pugash D, Lim K, Morin L, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S. The Use of Magnetic Resonance Imaging in the Obstetric Patient. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:349-63. [DOI: 10.1016/s1701-2163(15)30612-5] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patenaude Y, Pugash D, Lim K, Morin L, Lim K, Bly S, Butt K, Cargill Y, Davies G, Denis N, Hazlitt G, Morin L, Naud K, Ouellet A, Salem S. Archivée: Utilisation de l’imagerie par résonance magnétique en obstétrique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matsubara S. Letter to the editor: web-based education for placental complications of pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:881-882. [PMID: 24165053 DOI: 10.1016/s1701-2163(15)30807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shigeki Matsubara
- Department of Obstetrics and Gynecology, Jichi Medical University, Japan
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Windrim RC, Walker MG, Kingdom JCP. Letter to the editor: in response. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:882. [PMID: 24165054 DOI: 10.1016/s1701-2163(15)30808-2] [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]
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Allen V. All for one. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:403-404. [PMID: 23756270 DOI: 10.1016/s1701-2163(15)30929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Allen V. Tous pour un. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013. [DOI: 10.1016/s1701-2163(15)30930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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