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Abouda HS, Marzouk SB, Boussarsar Y, Aloui H, Frikha H, Hammami R, Chennoufi B, Maghrebi H. Tourniquet on the low segment of the uterus reduces blood loss in postpartum hemorrhage during hysterectomy for placenta accreta: Old but gold. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100285. [PMID: 38351966 PMCID: PMC10862398 DOI: 10.1016/j.eurox.2024.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives To investigate the feasibility, safety, and efficiency after application of a cervical tourniquet during caesarian hysterectomy owing to placenta accreta. Study design It was a monocentric prospective observational study for 3 years. Patients were allocated into two group: Group Tourniquet: (TG) in which a cervical tourniquet was systematically applied during hysterectomy, control group (CG) when the caesarian hysterectomy was performed without. Results 20 patients in the TG and 23 patients in the CG. Tourniquet application significantly reduced per operative estimated blood loss volume (TG: 530 ± 135 vs 940 ± 120 ml in the CG, p = 0.0074), ΔHB (0.6 [0.3-1.9] vs 2.5[2.5-3.6] g/dl in the CG, p = 0.006) RBC transfusion requirements' (TG: 2 ± 1.7 vs 4.3 ± 2.1 units in the CG, p = 0.046) procedure duration (TG: 98 ± 21 vs 137 ± 33 min in the CG, p = 0.015), clotting disorders (TG: 1 (5%) vs 6 (26,1%) in the CG, p = 0.013) and the incidence of bladder wounds (TG: 1 (5%) vs 5 (21,7%) in the CG, p = 0.048). There was no significant difference regarding ICU transfer rate (TG: 16 (80%) vs 20 (86.9%) in the CG, p = 0.53) or length of stay (TG: 1.4 [2,3] vs 2.3 [1-4] days in the CG, p = 0.615) and digestive wound (TG: 0 vs 2 (8,7%) in the CG, p = 0.641). Conclusion In case of a radical management of placenta accreta. A strategy that involves the application of a cervical Tourniquet should be considered as a feasible, safe and above all efficient alternative to prevent blood spoliation.
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Affiliation(s)
- Hassine S. Abouda
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Sofiene B. Marzouk
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Yecer Boussarsar
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Haithem Aloui
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hatem Frikha
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Rami Hammami
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Badis Chennoufi
- Department ‘C’ of Gynecology and Obstetrics, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunisia
| | - Hayen Maghrebi
- Department of Anesthesiology and Intensive Care, University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis Maternity and Neonatology Center, Tunis, Tunisia
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2
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Poder L, Weinstein S, Maturen KE, Feldstein VA, Mackenzie DC, Oliver ER, Shipp TD, Strachowski LM, Sussman BL, Wang EY, Weber TM, Whitcomb BP, Glanc P. ACR Appropriateness Criteria® Placenta Accreta Spectrum Disorder. J Am Coll Radiol 2020; 17:S207-S214. [PMID: 32370965 DOI: 10.1016/j.jacr.2020.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
Placenta accreta spectrum disorder (PASD) is the current terminology recommended by the International Federation of Obstetrics and Gynecology (FIGO) and should replace terms such as abnormally adherent/invasive placenta or morbidly adherent placenta. PASD refers to a variety of potential clinical complications, which may result from abnormal placental implantation. More specifically, placenta accreta refers to a defect in the decidua basalis where the chorionic villi adhere directly to the myometrium with trophoblastic invasion. Accurate antenatal diagnosis is needed to plan for an appropriate delivery strategy at an experienced center in order to reduce maternal and potential fetal morbidity and mortality. Obtaining radiologic and clinical data when PASD is first suspected can play a significant role in formulating an appropriate delivery strategy. Depending on the clinical risk factors and initial imaging findings, transabdominal ultrasound of the pregnant uterus with duplex Doppler and transvaginal ultrasound as needed are the most appropriate imaging procedures. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Liina Poder
- University of California San Francisco, San Francisco, California.
| | - Stefanie Weinstein
- Research Author, University of California San Francisco, San Francisco, California
| | | | | | - David C Mackenzie
- Maine Medical Center, Portland, Maine; American College of Emergency Physicians
| | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Bradford P Whitcomb
- University of Connecticut, Farmington, Connecticut; Society of Gynecologic Oncology
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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3
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Sichitiu J, El-Tani Z, Mathevet P, Desseauve D. Conservative Surgical Management of Placenta Accreta Spectrum: A Pragmatic Approach. J INVEST SURG 2019; 34:172-180. [PMID: 31429327 DOI: 10.1080/08941939.2019.1623956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the last 30 years, with increasing cesarean section rates, the incidence of the placenta accreta spectrum has also increased. It is estimated that by the year 2020 there will be nearly 9000 cases annually in the United States. Currently, no consensus exists regarding optimal management. Conventional treatment by cesarean-hysterectomy is challenging, with a high maternal morbidity due to massive hemorrhage, and surgical complications such as urinary tract, bowel and pelvic nerve injury, in addition to loss of fertility and its accompanying psychological trauma. Innovative approaches seek to preserve the uterus with the adherent placenta in situ, thus maintaining fertility and potentially reducing hemorrhage and adjacent organ injury. This review reports strategies for conservative treatment of such conditions, based on the current literature.
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Affiliation(s)
- Joanna Sichitiu
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Zeina El-Tani
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Mathevet
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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4
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Millischer A, Deloison B, Silvera S, Ville Y, Boddaert N, Balvay D, Siauve N, Cuenod C, Tsatsaris V, Sentilhes L, Salomon L. Dynamic contrast enhanced MRI of the placenta: A tool for prenatal diagnosis of placenta accreta? Placenta 2017; 53:40-47. [DOI: 10.1016/j.placenta.2017.03.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/07/2017] [Accepted: 03/08/2017] [Indexed: 11/27/2022]
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5
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Kocher MR, Sheafor DH, Bruner E, Newman C, Mateus Nino JF. Diagnosis of abnormally invasive posterior placentation: the role of MR imaging. Radiol Case Rep 2017; 12:295-299. [PMID: 28491174 PMCID: PMC5417735 DOI: 10.1016/j.radcr.2017.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/07/2017] [Accepted: 01/13/2017] [Indexed: 11/30/2022] Open
Abstract
Abnormally invasive placentation is becoming more common with a recent increase in cesarean sections and maternal age, among other risk factors. Ultrasonography is the first line-imaging, but it can be difficult to diagnose when limiting factors are present. Failure to recognize this serious placental abnormality precludes us from making the appropriate plan for the delivery and consequently can lead to fatal results. In this report, we present a case in which magnetic resonance imaging was used to diagnose posterior placenta increta missed by multiple sonographic examinations in a patient with previous myomectomies, and we also include a review of the literature on this topic. It is our conclusion that magnetic resonance imaging is superior to sonography to diagnose abnormally invasive placentation in cases of posterior placenta previa and high pretesting probability.
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Affiliation(s)
- Madison R Kocher
- Department of Radiology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Douglas H Sheafor
- Department of Radiology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Evelyn Bruner
- Department of Pathology, Medical University of South Carolina, USA
| | - Charles Newman
- Department of Pathology, Medical University of South Carolina, USA
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6
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Dhansura T, Shaikh N. The parturient in the interventional radiology suite: New frontier in obstetric anaesthesia. Indian J Anaesth 2017; 61:289-294. [PMID: 28515515 PMCID: PMC5416717 DOI: 10.4103/ija.ija_438_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The anaesthesiologist's presence during interventional radiology (IR) is increasing due to increasingly ill patients and intricate procedures. The management of a parturient in IR suite is complex in terms of logistics of an unfamiliar procedure in an unfamiliar area. The literature available is largely written by radiologists with little attention paid to anaesthetic details and considerations. In the Indian scenario, in the absence of hybrid operating rooms (ORs), logistics involve transport of a parturient back and forth between the IR suite and the OR. As members of a multidisciplinary team, anaesthesiologists should utilise their expertise in fluid management, transfusion therapy and critical care to prevent and treat catastrophic events that may accompany severe peri-partum bleeding. Ensuring familiarity with the variety of IR procedures and the peri-procedure requirements can help the anaesthesiologist provide optimum care in the IR suite.
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Affiliation(s)
- Tasneem Dhansura
- Department of Anaesthesiology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Nabila Shaikh
- Department of Anaesthesiology, Saifee Hospital, Mumbai, Maharashtra, India
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7
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Özcan HÇ, Uğur MG, Balat Ö, Bayramoğlu Tepe N, Sucu S. Emergency peripartum hysterectomy: single center ten-year experience. J Matern Fetal Neonatal Med 2016; 30:2778-2783. [DOI: 10.1080/14767058.2016.1263293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hüseyin Çağlayan Özcan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mete Gurol Uğur
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Özcan Balat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Neslihan Bayramoğlu Tepe
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Seyhun Sucu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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8
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Lim WH, Pavlov T, Dennis AE. Analysis of emergency peripartum hysterectomy in Northern Tasmania. Aust J Rural Health 2014; 22:235-40. [DOI: 10.1111/ajr.12135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wei How Lim
- Women's and Children's Service; Launceston General Hospital; Launceston Tasmania Australia
| | - Toly Pavlov
- Women's and Children's Service; Launceston General Hospital; Launceston Tasmania Australia
| | - Amanda E. Dennis
- Women's and Children's Service; Launceston General Hospital; Launceston Tasmania Australia
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
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Walker MG, Allen L, Windrim RC, Kachura J, Pollard L, Pantazi S, Keating S, Carvalho JC, Kingdom JC. Multidisciplinary Management of Invasive Placenta Previa. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:417-425. [DOI: 10.1016/s1701-2163(15)30932-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Cheung CSY, Chan BCP. The sonographic appearance and obstetric management of placenta accreta. Int J Womens Health 2012; 4:587-94. [PMID: 23239929 PMCID: PMC3516467 DOI: 10.2147/ijwh.s28853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Indexed: 11/23/2022] Open
Abstract
Placenta accreta is a condition of abnormal placental implantation in which the placental tissue invades beyond the decidua basalis. It may invade into or even through the myometrium and adjacent organs, such as the urinary bladder. The incidence has been rising in recent years. It is one of the important obstetric complications nowadays, leading to significant maternal morbidity and mortality. In the past, this condition was often diagnosed at the time of delivery when massive and unexpected hemorrhage occurred. Hysterectomy, associated with significant physical and psychological consequences, was usually the only management option. As more obstetricians have become aware of this condition, early identification with antenatal imaging diagnostic technology has become possible. Ultrasound scan plays an important role in the antenatal diagnosis. Various sonographic features with different specificity and sensitivity have been described in the literature. In equivocal cases, magnetic resonance imaging may be helpful. With such information, more accurate counseling can be offered to the mothers and their families before delivery. The delivery can also be arranged at a favorable time and in an institution where multidisciplinary support is available. Input from a hematologist, interventional radiologist, intensive care physician, urology surgeon, and/or other specialist are desirable. Apart from hysterectomy, various forms of conservative management can also be considered when the diagnosis is made prior to delivery. Fertility can therefore be preserved. After delivery, with or without hysterectomy performed, psychological support to the mothers and their families is essential.
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12
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WONG HS, CHEUNG YK, WILLIAMS E. Antenatal ultrasound assessment of placental/myometrial involvement in morbidly adherent placenta. Aust N Z J Obstet Gynaecol 2012; 52:67-72. [DOI: 10.1111/j.1479-828x.2011.01400.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Utility of Ultrasound and MRI in Prenatal Diagnosis of Placenta Accreta: A Pilot Study. AJR Am J Roentgenol 2011; 197:1506-13. [DOI: 10.2214/ajr.11.6858] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Interventional radiology in the treatment of morbidly adherent placenta: are we asking the right questions? Int J Obstet Anesth 2011; 20:279-81. [DOI: 10.1016/j.ijoa.2011.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/06/2011] [Indexed: 11/24/2022]
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Jolley JA, Nageotte MP, Wing DA, Shrivastava VK. Management of placenta accreta: a survey of Maternal-Fetal Medicine practitioners. J Matern Fetal Neonatal Med 2011; 25:756-60. [DOI: 10.3109/14767058.2011.594467] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:463-5. [DOI: 10.1097/aco.0b013e3283499d5a] [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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17
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Jeffrey A, Clark V. The anaesthetic management of caesarean section in the interventional radiology suite. Curr Opin Anaesthesiol 2011; 24:439-44. [DOI: 10.1097/aco.0b013e32834811d4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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