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Levy RA, Diala PC, Rothschild HT, Correa J, Lehrman E, Markley JC, Poder L, Rabban J, Chen LM, Gras J, Sobhani NC, Cassidy AG, Chapman JS. Roadmap to safety: a single center study of evidence-informed approach to placenta accreta spectrum. Front Surg 2024; 11:1347549. [PMID: 38511075 PMCID: PMC10950927 DOI: 10.3389/fsurg.2024.1347549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Objective To assess the impact of an evidence-informed protocol for management of placenta accreta spectrum (PAS). Methods This was a retrospective cohort study of patients who underwent cesarean hysterectomy (c-hyst) for suspected PAS from 2012 to 2022 at a single tertiary care center. Perioperative outcomes were compared pre- and post-implementation of a standardized Multidisciplinary Approach to the Placenta Service (MAPS) protocol, which incorporates evidence-informed perioperative interventions including preoperative imaging and group case review. Intraoperatively, the MAPS protocol includes placement of ureteral stents, possible placental mapping with ultrasound, and uterine artery embolization by interventional radiology. Patients suspected to have PAS on prenatal imaging who underwent c-hyst were included in the analysis. Primary outcomes were intraoperative complications and postoperative complications. Secondary outcomes were blood loss, need for ICU, and length of stay. Proportions were compared using Fisher's exact test, and continuous variables were compared used t-tests and Mood's Median test. Results There were no differences in baseline demographics between the pre- (n = 38) and post-MAPS (n = 34) groups. The pre-MAPS group had more placenta previa (95% pre- vs. 74% post-MAPS, p = 0.013) and prior cesarean sections (2 prior pre- vs. 1 prior post-MAPS, p = 0.012). The post-MAPS group had more severe pathology (PAS Grade 3 8% pre- vs. 47% post-MAPS, p = 0.001). There were fewer intraoperative complications (39% pre- vs.3% post-MAPS, p < 0.001), postoperative complications (32% pre- vs.12% post-MAPS, p = 0.043), hemorrhages >1l (95% pre- vs.65% post-MAPS, p = 0.001), ICU admissions (59% pre- vs.35% post-MAPS, p = 0.04) and shorter hospital stays (10 days pre- vs.7 days post-MAPS, p = 0.02) in the post-MAPS compared to pre-MAPS patients. Neonatal length of stay was 8 days longer in the post-MAPS group (9 days pre- vs. 17 days post-MAPS, p = 0.03). Subgroup analyses demonstrated that ureteral stent placement and uterine artery embolization (UAE) may be important steps to reduce complications and ICU admissions. When comparing just those who underwent UAE, patients in the post-MAPS group experienced fewer hemorrhages greater five liters (EBL >5l 43% pre- vs.4% post-MAPS, p = 0.007). Conclusion An evidence-informed approach to management of PAS was associated with decreased complication rate, EBL >1l, ICU admission and length of hospitalization, particularly for patients with severe pathology.
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Affiliation(s)
- Rachel A. Levy
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Prisca C. Diala
- School of Medicine, University of California, San Francisco, CA, United States
| | | | - Jasmine Correa
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Evan Lehrman
- Department of Interventional Radiology, University of California, San Francisco, CA, United States
| | - John C. Markley
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, United States
| | - Liina Poder
- Department of Diagnostic Radiology, University of California, San Francisco, CA, United States
| | - Joseph Rabban
- Department of Pathology, University of California, San Francisco, CA, United States
| | - Lee-may Chen
- Divisionof Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Jo Gras
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Nasim C. Sobhani
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Arianna G. Cassidy
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Jocelyn S. Chapman
- Divisionof Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, United States
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Lucidi A, Jauniaux E, Hussein AM, Coutinho CM, Tinari S, Khalil A, Shamshirsaz A, Palacios-Jaraquemada JM, D'Antonio F. Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:633-643. [PMID: 37401769 DOI: 10.1002/uog.26299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS). METHODS MEDLINE, EMBASE and the Cochrane databases were searched electronically up to 1 November 2022. Studies reporting on the urological outcome of women undergoing Cesarean section for PAS were included. Two independent reviewers performed data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with disagreements resolved by consensus.The primary outcome was the overall occurrence of urological complications. Secondary outcomes were the occurrence of any cystotomy, intentional cystotomy, unintentional cystotomy, ureteral damage, ureteral fistula and vesicovaginal fistula. All outcomes were explored in the overall population of women undergoing surgery for PAS. In addition, we performed subgroup analyses according to the type of surgery (Cesarean hysterectomy, or conservative surgery or management), severity of PAS at histopathology (placenta accreta/increta and placenta percreta), type of intervention (planned vs emergency) and number of cases per year. Random-effects meta-analyses of proportions were used to analyze the data. RESULTS There were 62 studies included in the systematic review and 56 were included in the meta-analysis. Urological complications occurred in 15.2% (95% CI, 12.9-17.7%) of cases. Cystotomy complicated 13.5% (95% CI, 9.7-17.9%) of surgical operations. Intentional cystotomy was required in 7.7% (95% CI, 6.5-9.1%) of cases, while unintentional cystotomy occurred in 7.2% (95% CI, 6.0-8.5%) of cases. Urological complications occurred in 19.4% (95% CI, 16.3-22.7%) of cases undergoing hysterectomy and 12.2% (95% CI, 7.5-17.8%) of those undergoing conservative treatment. In the subgroup analyses, urological complications occurred in 9.4% (95% CI, 5.4-14.4%) of women with placenta accreta/increta and 38.5% (95% CI, 21.6-57.0%) of those described as having placenta percreta, and included mainly cystotomy (5.5% (95% CI, 0.6-15.1%) and 22.0% (95% CI, 5.4-45.5%), respectively). Urological complications occurred in 15.4% (95% CI, 8.1-24.6%) of cases undergoing a planned procedure and 24.6% (95% CI, 13.0-38.5%) of those undergoing an emergency intervention. In subanalysis of studies reporting on ≥ 12 cases per year, the incidence of urological complication was similar to that reported in the primary analysis. CONCLUSIONS Women undergoing surgery for PAS are at high risk of urological complication, mainly cystotomy. The incidence of these complications was particularly high in women described as having placenta percreta at birth and in those undergoing emergency surgical intervention. The high heterogeneity between the included studies highlights the need for a standardized protocol for the diagnosis of PAS to identify prenatal imaging signs associated with the increased risk of urological morbidity at delivery. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Lucidi
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - E Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - A M Hussein
- Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
| | - C M Coutinho
- Department of Gynecology and Obstetrics, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paolo, Brazil
| | - S Tinari
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - A Shamshirsaz
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Palacios-Jaraquemada
- CEMIC University Hospital and School of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Yara N, Kinjyo Y, Chinen Y, Kinjo T, Mekaru K. Placenta Accreta Spectrum with Ureteral Invasion due to Progression of Cesarean Scar Pregnancy. Case Rep Obstet Gynecol 2023; 2023:9065978. [PMID: 37840656 PMCID: PMC10576643 DOI: 10.1155/2023/9065978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023] Open
Abstract
Expectant management is not recommended for cesarean scar pregnancies because they are often associated with placenta accreta, cesarean hysterectomy, and massive life-threatening hemorrhages during delivery. Herein, we report a case of placenta accreta spectrum with ureteral invasion due to the progression of a cesarean scar pregnancy. Case. A 41-year-old woman, with a history of three cesarean sections and two miscarriages, was referred to our hospital at 25 weeks of gestation with a diagnosis of placenta accreta spectrum and bladder invasion. Although the gestational sac was located anterior to the lower uterine segment, a cesarean-scar pregnancy was not diagnosed. A cesarean hysterectomy was performed at 31 weeks of gestation with the placement of an aortic balloon. The placenta was found to adhere to the ureter with more than the expected parenchymal tissue displacement (FIGO Classification 3b). The ureter was not obstructed and was preserved by leaving the placenta slightly on the ureteral side. Postoperatively, a ureteral stent was placed because of the ureteral stricture in the area where the placenta had adhered. Two months after surgery, the ureteral stent was removed after observing an improvement in stenosis. An adherent placenta due to continued cesarean scar pregnancy should be managed by assuming placental invasion beyond the parenchyma into the ureter.
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Affiliation(s)
- Nana Yara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Yoshino Kinjyo
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Yukiko Chinen
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Tadatsugu Kinjo
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Japan
| | - Keiko Mekaru
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Japan
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Horgan R, Hessami K, Hage Diab Y, Scaglione M, D'Antonio F, Kanaan C, Erfani H, Abuhamad A, Shamshirsaz AA. Prophylactic ureteral stent placement for the prevention of genitourinary tract injury during hysterectomy for placenta accreta spectrum: systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101120. [PMID: 37549736 DOI: 10.1016/j.ajogmf.2023.101120] [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: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE This study aimed to assess the effectiveness of prophylactic ureteral stent placement for the prevention of genitourinary tract injury at the time of cesarean hysterectomy for placenta accreta spectrum. The secondary objectives were to assess mean blood loss, operative time, number of packed red blood cells transfused, and rates of urinary tract infection among patients undergoing cesarean hysterectomy for placenta accreta spectrum with and without prophylactic ureteral stent placement. DATA SOURCES The search was performed using PubMed, Cochrane Library, and ClinicalTrials.gov from inception to February 2022 to December 2022. The protocol for this review was registered with the International Prospective Register of Systematic Reviews before data collection (registration number: CRD42022372817). STUDY ELIGIBILITY CRITERIA All studies that examined differences in the rate of genitourinary tract injury among women undergoing cesarean hysterectomy for prenatally suspected placenta accreta spectrum with and without placement of prophylactic ureteral stents were included. Genitourinary injury was defined as cystotomy, ureteral injury, and/or bladder fistula. Cases of both intentional and unintentional genitourinary injuries were included in the analysis. METHODS For all studies meeting the inclusion criteria, the following data were extracted: number of included patients, maternal demographic information, obstetrical history, type of invasive placentation, placement of stents (yes or no), type of stent placed, blood loss, operative time, genitourinary tract injury, and urinary tract infection. Pooled data analysis was completed using the Review Manager (version 5.3; Nordic Cochrane Centre, Copenhagen, Denmark; Cochrane Collaboration, 2014). The summary measures were reported as summary relative risk or as summary mean difference. The quality and risk of biases of the included studies were assessed according to the Newcastle-Ottawa Scale. RESULTS Overall, 9 studies, including 848 patients, fulfilled our inclusion criteria and were included in our analysis. Moreover, 523 patients (61.7%) had prophylactic ureteral stents placed, and 325 patients (38.3%) did not. Genitourinary injury occurred in 138 of 523 patients (26.4%) in the ureteral stent group vs 83 of 325 patients (25.5%) in the no ureteral stent group (relative risk, 0.94; 95% confidence interval, 0.74-1.20). The mean number of packed red blood cells transfused did not differ between the 2 groups. The pooled analysis demonstrated decreased blood loss among patients who received prophylactic ureteral stents, with a mean difference of 392 mL (95% confidence interval, 52.74-738.13). CONCLUSION Our systematic review and meta-analysis demonstrated no difference in the rates of genitourinary tract injury with the use of prophylactic ureteral stent placement among cases of prenatally suspected placenta accreta spectrum undergoing cesarean hysterectomy.
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Affiliation(s)
- Rebecca Horgan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Horgan, Diab, Kanaan, and Abuhamad).
| | - Kamran Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Hessami and Erfani); Maternal-Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA (Drs Hessami and Shamshirsaz)
| | - Yara Hage Diab
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Horgan, Diab, Kanaan, and Abuhamad)
| | - Morgan Scaglione
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT (Dr Scaglione)
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Centre for High-Risk Pregnancy and Fetal Care, University of Chieti, Chieti, Italy (Dr D'Antonio)
| | - Camille Kanaan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Horgan, Diab, Kanaan, and Abuhamad)
| | - Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Hessami and Erfani)
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Horgan, Diab, Kanaan, and Abuhamad)
| | - Alireza A Shamshirsaz
- Maternal-Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA (Drs Hessami and Shamshirsaz)
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Einerson BD, Sandlin AT, Afshar Y, Sharawi N, Fox KA, Newton JM, Shainker SA, Pezeshkmehr A, Carusi DA, Moroz L. General Management Considerations for Placenta Accreta Spectrum. Am J Perinatol 2023; 40:1026-1032. [PMID: 37336221 DOI: 10.1055/s-0043-1761915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The ideal management of a patient with placenta accreta spectrum (PAS) includes close antepartum management culminating in a planned and coordinated delivery by an experienced multidisciplinary PAS team. Coordinated team management has been shown to optimize outcomes for mother and infant. This section provides a consensus overview from the Pan-American Society for the Placenta Accreta Spectrum regarding general management of PAS.
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Affiliation(s)
| | - Adam T Sandlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arizona
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetric and Gynecology, Baylor College of Medicine (Texas Children's Hospital Pavilion for Women), Houston, Texas
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center Nashville, Tennessee
| | - Scott A Shainker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Amir Pezeshkmehr
- Department of Radiology Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Daniela A Carusi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Khoury-Collado F, Newton JM, Brook OR, Carusi DA, Shrivastava VK, Crosland BA, Fox KA, Khandelwal M, Karam AK, Bennett KA, Sandlin AT, Shainker SA, Einerson BD, Belfort MA. Surgical Techniques for the Management of Placenta Accreta Spectrum. Am J Perinatol 2023; 40:970-979. [PMID: 37336214 DOI: 10.1055/s-0043-1761636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The surgical management of placenta accreta spectrum (PAS) is often challenging. There are a variety of techniques and management options described in the literature ranging from uterine sparing to cesarean hysterectomy. Following the inaugural meeting of the Pan-American Society for Placenta Accreta Spectrum a multidisciplinary group collaborated to describe collective recommendations for the surgical management of PAS. In this manuscript, we outline individual components of the procedure and provide suggested direction at key points of a cesarean hysterectomy in the setting of PAS. KEY POINTS: · The surgical management of PAS requires careful planning and expertise.. · Multidisciplinary team care for pregnancies complicated by PAS can decrease morbidity and mortality.. · Careful surgical techniques can minimize risk of significant hemorrhage by avoiding pitfalls..
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Affiliation(s)
- Fady Khoury-Collado
- Division of Gynecologic Oncology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, New York
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vineet K Shrivastava
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Memorial Care Miller Children's & Women's Hospital, University of California Irvine, Irvine, California
| | - Brian A Crosland
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Karin A Fox
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Meena Khandelwal
- Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Amer K Karam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Kelly A Bennett
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam T Sandlin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Scott A Shainker
- Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Brett D Einerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Michael A Belfort
- Departments of Obstetrics and Gynecology, Surgery, Anesthesiology and Neurosurgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Abstract
Placenta accreta spectrum is a group of disorders involving abnormal trophoblastic invasion to the deep layers of endometrium and myometrium. Placenta accrete spectrum is one of the major causes of severe maternal morbidity, with increasing incidence in the past decade mainly secondary to an increase in cesarean deliveries. Severity varies depending on the depth of invasion, with the most severe form, known as percreta, invading uterine serosa or surrounding pelvic organs. Diagnosis is usually achieved by ultrasound, and MRI is sometimes used to assess invasion. Management usually involves a hysterectomy at the time of delivery. Other strategies include delayed hysterectomy or expectant management.
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Affiliation(s)
- Mahmoud Abdelwahab
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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8
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Scaglione MA, Allshouse AA, Canfield DR, Mclaughlin HD, Bruno AM, Hammad IA, Branch DW, Maurer KA, Dood RL, Debbink MP, Silver RM, Einerson BD. Prophylactic Ureteral Stent Placement and Urinary Injury During Hysterectomy for Placenta Accreta Spectrum. Obstet Gynecol 2022; 140:806-811. [PMID: 36201777 PMCID: PMC10069290 DOI: 10.1097/aog.0000000000004957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the association between prophylactic ureteral stent placement at the time of hysterectomy for placenta accreta spectrum and genitourinary injury. METHODS We conducted a retrospective cohort study of patients with placenta accreta spectrum who underwent hysterectomy at two referral centers from 2001 to 2021. The exposure was prophylactic ureteral stent placement. The primary outcome, genitourinary injury, was a composite of bladder injury, ureteral injury, or vesicovaginal fistula. Secondary outcomes included components of the primary outcome. We evaluated differences between groups using χ 2 and t test. To evaluate differences in the primary outcome, we reported odds ratios (ORs) and adjusted odds ratios (aORs) using multivariable logistic regression analyses to control for potential confounding variables. We used a Cochran-Armitage χ 2 trend test to evaluate difference in stent use and injury over time. RESULTS In total, 236 patients were included. Prophylactic ureteral stents were used in 156 surgeries (66%). Overall, genitourinary injury occurred less frequently in the stent group compared with the no stent group (28% vs 51%, OR 0.37, 95% CI 0.21-0.65). This association persisted after controlling for urgency of delivery, three or more prior cesarean deliveries, and whether a gynecologic oncologist was present (aOR 0.27, 95% CI 0.14-0.52). Unintentional bladder injury occurred less frequently in the stent group compared with the no stent group (13% vs 25%, P =.018), as did ureteral injury (2% vs 9%, P =.019). CONCLUSION Prophylactic ureteral stent placement was associated with a decreased risk of genitourinary injury during hysterectomy for placenta accreta spectrum.
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Affiliation(s)
- Morgan A Scaglione
- Division of Maternal Fetal Medicine and the Division of Gynecologic Oncology, University of Utah Health, and Intermountain Healthcare, Salt Lake City, Utah
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9
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Crocetto F, Barone B, Bonito E, Maggi M, Caputo VF, di Girolamo A, Trama F, di Spiezio Sardo A, Zizolfi B. Psychological impact of abnormally invasive placenta: an underestimated and hidden morbidity. J Basic Clin Physiol Pharmacol 2022; 33:649-653. [PMID: 35388654 DOI: 10.1515/jbcpp-2021-0384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/07/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate anxiety and psychological impact of abnormally invasive placenta (AIP) diagnosis during pregnancy. METHODS A cross-sectional survey study was performed to assess the psychological response of pregnant women with an antenatally AIP diagnosis. The psychological impact was measured through a visual analogue scale (VAS) for anxiety, which ranged from 0 (not at all anxious) to 100 (extremely anxious) and was referred to three questions: (1) How anxious were you the first time they counselled you about AIP?; (2) How anxious were you the day of the planned cesarean delivery in terms of morbidity/mortality?; (3) How anxious were you in terms of future sexual activities? RESULTS 48 singleton pregnancies that underwent planned cesarean hysterectomy for AIP, met the inclusion criteria and were surveyed for the study. Mean VAS was 41.6 ± 25.6, with 47.9% of women with VAS >50 for question 1 (p=0.015). Mean VAS was 52.9 ± 19.1, with 75.0% of women with VAS >50 for question 2 (p=0.02). Mean VAS was 49.6 ± 20.4, with 83.3% of women with VAS >50 for question 3 (p=0.006). CONCLUSIONS More than half of pregnant women with an antenatally AIP diagnosis reported a high VAS score regarding anxiety, in particular when morbidity/mortality and long-term consequences on sexual activities were analyzed. Our findings could be used to formulate timely psychological interventions to improve mental health and psychological resilience in women with AIP.
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Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Elvira Bonito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Vincenzo F Caputo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | | | - Francesco Trama
- Department of Andrology and Urogynecological clinic, University of Perugia, Santa Maria Terni Hospital, Terni, Italy
| | - Attilio di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Brunella Zizolfi
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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10
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Retained Placenta Percreta with Acquired Uterine Arteriovenous Malformation—Case Report and Short Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12040904. [PMID: 35453952 PMCID: PMC9029973 DOI: 10.3390/diagnostics12040904] [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: 03/03/2022] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022] Open
Abstract
Placenta accreta spectrum disorder (PAS) has an increased frequency due to the high number of cesarean sections. The abnormal placentation associated with a retained placenta can cause persistent uterine bleeding, with ultrasound Doppler examination being the main choice to assess the uterine hemorrhage. An acquired uterine arteriovenous malformation (AVM) may occur because of uterine trauma, spontaneous abortion, dilation and curettage, endometrial carcinoma or gestational trophoblastic disease. The treatment for abnormal placentation associated with AVM can be conservative, represented by methotrexate therapy, arterial embolization, uterine curettage, hysteroscopic loop resection or radical, which takes into consideration total hysterectomy. Therapeutic management always considers the degree of placental invasion, the patient hemodynamic state and fertility preservation. Considering the aspects described, we present a case of retained placenta percreta associated with acquired uterine AVM, with imagistic and clinical features suggestive of a gestational trophoblastic disease, successfully treated by hysterectomy, along with a small review of the literature, as only a few publications have reported a similar association of diagnostics and therapy.
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Reppuccia S, Crocetto F, Gragnano E, D'Alessandro P, Vetrella M, Saccone G, Arduino B. Oil-based vitamin E oral spray for oral health in pregnancy. Future Sci OA 2022; 8:FSO790. [PMID: 35369278 PMCID: PMC8965794 DOI: 10.2144/fsoa-2021-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Aim: To assess the efficacy of vitamin E oral spray in pregnancy. Materials & methods: This was a retrospective study aimed to evaluate efficacy of vitamin E oral spray (vitamin E acetate in a medium chain tryglicerides vehicle – patented formulation) starting from the first trimester of pregnancy, with a control group. Results: A total of 100 women were included in the study and were compared with a matched control group. Only 25/200 women reported to have at least one teeth cleaning during pregnancy. Women who received the oral spray had a significantly lower risk of preterm birth compared with the control group, and lower risk of periodontal diseases Conclusion: Use of oil-based vitamin E oral spray in pregnancy is associated with a decreased risk of periodontal diseases and therefore preterm birth.
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Affiliation(s)
- Sabrina Reppuccia
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elisabetta Gragnano
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pietro D'Alessandro
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Martin Vetrella
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Bruno Arduino
- Department of Neuroscience, Reproductive Sciences & Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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Saccone G, De Angelis MC, Zizolfi B, Gragnano E, Musone M, Zullo F, Bifulco G, Sardo ADS. Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol MFM 2022; 4:100592. [DOI: 10.1016/j.ajogmf.2022.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
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Carbone L, Saccone G, Conforti A, Maruotti GM, Berghella V. Cesarean delivery: an evidence-based review of the technique. Minerva Obstet Gynecol 2021; 73:57-66. [PMID: 33314903 DOI: 10.23736/s2724-606x.20.04681-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The cesarean section is utilized to deliver babies since the late 19th century. Nowadays, the frequency of cesarean section is increased, mainly because of the low rate of complications and for the increasing demand from future mothers, scared by the idea of painful labor. Although the technique to perform cesarean section has been refined over time, infections, hemorrhage, pain and other consequences still represent matter of debate. To try to reduce the incidence of these complications many trials, randomized or not, have been performed, with the aim to analyze different technical aspects of this surgery. The aim of our review was to resume all the evidence-based instructions on how to best approach to cesarean section practice, in a step-to-step fashion, considering pre-operative actions, opening and closing steps, and postoperative prophylaxis.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy -
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Giuseppe M Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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Saccone G, Migliorini S, Crocetto F, Della Corte L, Cancellieri E, Improda L, Improda FP, Maruotti GM, Cancelmo G, Imbimbo C, Bifulco G, Zullo F, Berghella V. Risk of unscheduled delivery in women with placenta accreta according to planned gestational age at delivery. J Matern Fetal Neonatal Med 2021; 35:5308-5311. [PMID: 33504230 DOI: 10.1080/14767058.2021.1878493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The optimal gestational age at delivery for stable women with suspected placenta accreta is still subject of debate. OBJECTIVE To estimate the likelihood of vaginal bleeding necessitating expedited delivery in women with placenta accreta according to gestational age at planned cesarean hysterectomy. STUDY DESIGN This was a multicenter cohort study. Singleton pregnancies at risk of placenta accreta because of placenta previa in the setting of prior cesarean delivery were included. Outcomes were compared in cohort of women who had planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks versus at 35 0/7 - 35 6/7 weeks. The primary outcome was incidence of vaginal bleeding severe enough to necessitate delivery. RESULTS 118 singleton pregnancies with placenta previa in the setting of prior cesarean delivery, and confirmed placenta accreta at the time of delivery were included in the study. Women who had planned cesarean hysterectomy at 34 weeks had lower episodes of vaginal bleeding severe enough to necessitate immediate or emergency delivery (20.6% vs 38.0%; odds ratio (OR) 0.42, 95% confidence interval (CI) 0.19 to 0.96). Eight women (11.8%) in the 34 weeks group and 6 women (12.0%) in the 35 weeks group delivered before the planned date due to onset of spontaneous labor (OR 0.98, 95% CI 0.32 to 3.02). CONCLUSION In singleton gestations with suspected placenta accreta, planned cesarean hysterectomy at 34 0/7 - 34 6/7 weeks was associated with a decreased chance of unscheduled delivery due to severe vaginal bleeding. CONDENSATION In case of placenta accreta, planned cesarean hysterectomy at 34 weeks was associated with decreased chance of unscheduled delivery due to severe vaginal bleeding.
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Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Sonia Migliorini
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elena Cancellieri
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Improda
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Paolo Improda
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gennaro Cancelmo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Crocetto F, Migliorini S, Cancelliere E, Mastantuoni E, Saccone G, Cancelmo G, Trama F, Verrazzo P, Giudicepietro A, Zullo F. Risk factors associated with bladder injury at the time of cesarean hysterectomy for placenta accreta. MINERVA GINECOLOGICA 2020; 72:425-426. [PMID: 32744449 DOI: 10.23736/s0026-4784.20.04611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Sonia Migliorini
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Elena Cancelliere
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Enrica Mastantuoni
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy -
| | - Gennaro Cancelmo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Francesco Trama
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Paolo Verrazzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Antonia Giudicepietro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
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Szlachta-McGinn A, Mei J, Tabsh K, Afshar Y. Transverse versus vertical skin incision for planned cesarean hysterectomy: does it matter? BMC Pregnancy Childbirth 2020; 20:65. [PMID: 32005190 PMCID: PMC6995109 DOI: 10.1186/s12884-020-2768-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/24/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS). METHODS A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student's t-test was used for continuous variables and Fisher's exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test. RESULTS Forty-two planned cesarean hysterectomies were identified. A transverse skin incision was made in 43% (n = 18); a vertical skin incision was made in 57% (n = 24). Skin incision was independent of BMI (30.3 vs 30.8 kg/m2, p = 0.37), placental location (p = 0.82), and PAS-subtype (p = 0.26). Mean estimated blood loss (EBL) was 2.73 l (L) (range 0.5-20) and was not significantly different between transverse and vertical skin incision (2.6 L vs 2.8 L, p = 0.8). There was significantly shorter operative time with transverse skin incision (180 vs 238 min, p = 0.03), with no difference in intraoperative complications, including cystotomy (p = 0.22) and ureteral injury (p = 0.73). Postoperatively, there was no difference in maternal length of stay (4.8 vs 4.4 days, p = 0.74) or post-operative opioid use (117 vs 180 morphine equivalents, p = 0.31). CONCLUSION Transverse skin incision is associated with shorter operative time for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we should consider variables that optimize maternal outcomes and resource utilization.
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Affiliation(s)
- Alec Szlachta-McGinn
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA USA
| | - Jenny Mei
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA USA
| | - Khalil Tabsh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740 USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740 USA
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Palacios-Jaraquemada JM, Fiorillo A, Hamer J, Martínez M, Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J Matern Fetal Neonatal Med 2020; 35:275-282. [DOI: 10.1080/14767058.2020.1716715] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- José Miguel Palacios-Jaraquemada
- Department of Obstetrics and Gynaecology, Cemic University Hospital, Buenos Aires, Argentina
- MRI Department, Fundación Científica del Sur, Buenos Aires, Argentina
| | - Angel Fiorillo
- Department of Obstetrics and Gynaecology, Cemic University Hospital, Buenos Aires, Argentina
| | - Jorge Hamer
- Ultrasound Department, CEGYR Reproductive Medicine, Buenos Aires, Argentina
| | - Marcelo Martínez
- CYMSA Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Claudio Bruno
- CYMSA Clínica y Maternidad Suizo Argentina, Buenos Aires, Argentina
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Fratto VM, Conturie CL, Ballas J, Pettit KE, Stephenson ML, Truong YN, Henry D, Afshar Y, Murphy A, Kim L, Field N, Wing DA, Norton ME, Ramos GA. Assessing the multidisciplinary team approaches to placenta accreta spectrum across five institutions within the University of California fetal Consortium (UCfC). J Matern Fetal Neonatal Med 2019; 34:2971-2976. [PMID: 31645153 DOI: 10.1080/14767058.2019.1676411] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe the multidisciplinary approaches to placenta accreta spectrum (PAS) across five tertiary care centers that comprise the University of California fetal Consortium (UCfC) and to identify potential best practices. MATERIALS AND METHODS Retrospective review of all cases of pathologically confirmed invasive placenta delivered from 2009 to 2014 at UCfC. Differences in intraoperative management and outcomes based on prenatal suspicion were compared. Interventions assessed included ureteral stent use, intravascular balloon use, anesthetic type, gynecologic oncology (Gyn Onc) involvement, and cell saver use. Intervention variation by institution was also assessed. Analyses were adjusted for final pathologic diagnosis. Chi-square, Fisher's exact, Student's t-test, and Mann-Whitney's U-test were used as appropriate. Binary logistic regression and multivariable linear regression were used to adjust for confounders. RESULTS One hundred and fifty-one cases of pathologically confirmed invasive placenta were identified, of which 82% (123) were suspected prenatally. There was no correlation between the degree of invasion on prenatal imaging and use of each intervention. Ureteral stents were placed in 33% (41) of cases and did not reduce GU injury. Intravascular balloons were placed in 29% (36) of cases and were associated with shorter OR time (161 versus 236 min, p < .01) and lower estimated blood loss (EBL) (1800 versus 2500 ml, p < .01). General endotracheal anesthesia (GETA) was used in 70% (86). EBL did not differ between GETA and regional anesthesia. Gyn Onc was involved in 58% (71) of cases and EBL adjusted for final pathology was reduced with their involvement (2200 versus 2250 ml, p = .02) while OR time and intraoperative complications did not differ. Cell saver was used in 20% (24) and was associated with longer OR time (296 versus 200 min, p < .01). Use of cell saver was not associated with a difference in EBL or number of units of packed red cells transfused. All analyses were adjusted for pathologic severity of invasion. CONCLUSIONS Intravascular interventions such as uterine artery balloons and the inclusion of Gynecologic Oncologists as part of a multidisciplinary approach to treating PAS reduce EBL. Additionally, the placement of intravascular balloons may reduce OR time. No significant differences were seen in outcomes when comparing the use of ureteral stents, general anesthesia, or institutions. A team of experienced operators with a standard approach may be more significant than specific practices.
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Affiliation(s)
- Victoria M Fratto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
| | - Charlotte L Conturie
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
| | - Jerasimos Ballas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
| | - Kate E Pettit
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
| | - Megan L Stephenson
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, CA, USA
| | - Yen N Truong
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Dana Henry
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aisling Murphy
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lena Kim
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nancy Field
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | - Deborah A Wing
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, CA, USA
| | - Mary E Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Gladys A Ramos
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA, USA
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Celik S, Celik H, Soyer Calıskan C, Tosun M, Hatirnaz S. Bladder filling before accreta surgery is a very effective method for preventing bladder injury: a retrospective cohort study. J Matern Fetal Neonatal Med 2019; 34:2206-2211. [PMID: 31570023 DOI: 10.1080/14767058.2019.1670809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study is to show whether bladder filling with saline before percreta surgery diminish the rate of bladder injuries or not. A secondary aim was to check the operative and postoperative outcomes between the cases of filled and unfilled bladder in placenta accreta surgery. METHODS This retrospective multicentric cohort study involved 88 patients who were diagnosed with placenta accreta and underwent cesarean hysterectomy between 1 January 2009 and 1 January 2019. Women who had cesarean hysterectomies due to the indication of placenta accreta and did not have bladder filling were used as the control group. RESULTS Eighty-eight women met the inclusion criteria. Forty-nine of the cases, the bladder was filled with saline solution before the operation, whereas in 39 the bladder was not filled. Intraoperative bladder injury occurred less in patients with preoperative filled bladders than in patients with unfilled bladders (p = .015; p < .05). There was a statistically significant difference between the duration of surgery according to bladder inflation (p = .001; p < .01); in the filled bladder group, the operation time was shorter than in the unfilled group. CONCLUSIONS Filling the bladder with 200 ml saline solution before starting a cesarean section is an easy and useful technique that can reduce the possibility of bladder injury in placenta accreta surgery.
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Affiliation(s)
- Samettin Celik
- Maternity Hospital, Samsun Training and Research Hospital, Samsun, Turkey
| | - Handan Celik
- Department of Obstetrics and Gynecology, Ondokuz Mayıs University, Samsun, Turkey
| | | | - Miğraci Tosun
- Department of Obstetrics and Gynecology, Ondokuz Mayıs University, Samsun, Turkey
| | - Safak Hatirnaz
- IVF Center, Medicana International Hospital, Samsun, Turkey
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