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Jafarzade A. Placenta Invasion Anomaly without Placenta Previa in the First Trimester of Pregnancy and its Conservative Management: A Case Presentation. Z Geburtshilfe Neonatol 2024; 228:290-293. [PMID: 38325401 DOI: 10.1055/a-2247-5792] [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: 02/09/2024]
Abstract
Diagnosing placenta accreta spectrum (PAS) is rather difficult in the first trimester of pregnancy. Especially if the localization of the placenta is not in and around the cervical canal, this may not attract the attention of obstetricians. Early diagnosis can decrease bleeding during curettage or miscarriage, but there are no guidelines regarding its diagnosis in the first trimester. In addition, there is insufficient evidence-based knowledge in the literature on the management and treatment of PAS without placenta previa. In this article, conservative treatment without hysterectomy of a patient diagnosed with PAS in first trimester was presented.
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Affiliation(s)
- Aytaj Jafarzade
- Koru Health Group, Gynecology and Obstetrics Department, Ankara, Turkey
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2
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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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3
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Gregoir C, De Becker B, Hauspy J, Vanderheyden T, Loquet P. The use of methotrexate in conservative treatment of placenta accreta spectrum disorders. J Matern Fetal Neonatal Med 2021; 35:7514-7517. [PMID: 34278931 DOI: 10.1080/14767058.2021.1951211] [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: 10/20/2022]
Abstract
Aim of the study: This article reports on a series of patients with placenta accreta spectrum (PAS) disorder who were treated conservatively with Methotrexate (MTX) administration with or without embolization. We investigate whether there is a place for MTX in conservative treatment of PAS.Methods: We present a single-center retrospective case series of five patients. In all patients, diagnosis was unexpected and not made prenatally.Conclusion: The benefits should be weighed against the possible drug toxicity. Today high-quality evidence is lacking. PAS covers a broad spectrum of pathology, standardization in prenatal and postnatal diagnosis can help to compare evidence on treatment.
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Affiliation(s)
- Caroline Gregoir
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Wilrijk, Belgium
| | - Ben De Becker
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Wilrijk, Belgium
| | - Jan Hauspy
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Wilrijk, Belgium
| | - Tina Vanderheyden
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Wilrijk, Belgium
| | - Philip Loquet
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Wilrijk, Belgium.,Department of Obstetrics and Gynecology, Antwerp university Hospital UZA, Edegem, Belgium
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4
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Huang H, Wang J, Li K, Ma H. Successful conservative treatment of placenta accreta with traditional Chinese medicine: A case report. Medicine (Baltimore) 2021; 100:e24820. [PMID: 33607847 PMCID: PMC7899819 DOI: 10.1097/md.0000000000024820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Currently, placenta accreta treatment mainly includes nonconservative surgical and conservative treatments such as Traditional Chinese medicine (TCM). This report describes the case of a 37-year-old woman who suffered incomplete placenta accreta after vaginal delivery and was cured by TCM. TCM treatment of placenta accreta has its own unique advantages, including low toxicity and few side effects, unaffected breastfeeding, and retention of the uterus, which can ensure the expulsion of residual placenta and be beneficial to patients' physical and mental health. PATIENT CONCERNS Symptoms included a small amount of vaginal bleeding and occasional lesser abdominal pain. The patient showed lesser abdominal tenderness, a red tongue moss with petechial hemorrhage, and a hesitant pulse. The reproductive history was G3P2L2A1. In addition, the patient was afraid of having her uterus removed due to incomplete placental separation. DIAGNOSES The case was diagnosed as placental accreta. Ultrasound is the preferred method of diagnosis, and biomarkers, such as beta hCG, assist in screening for placental accreta. Doppler ultrasonography showed that in the bottom of the right uterine cavity, there was an uneven echo group of 7.6 × 4.6 cm, which was not clearly demarcated from the posterior wall; the muscle layer became thinner, with a thinnest part of 0.19 cm, and abundant blood flow signals were observed (Fig. 1JOURNAL/medi/04.03/00005792-202102190-00086/figure1/v/2021-02-16T234818Z/r/image-tiff). The beta hCG was 580.92 mIu/ml. INTERVENTIONS The patient initially underwent curettage therapy 9 days after delivery, but it failed due to excessive intraoperative bleeding. The patient then turned to TCM treatment. The doctor prescribed a multi-herbal formula. OUTCOMES After 4 months, the residual placenta was expelled, and the patient's symptoms disappeared completely. No adverse and unexpected events occurred during treatment. During 3 months of follow-up, the patient had no abdominal pain, abnormal vaginal bleeding, or other complications. LESSONS This study shows that TCM is safe and effective for treating placenta accreta, and it is worth recommending TCM as a conservative treatment along with other treatments. In practice, however, we find that the earlier TCM treatment is applied, the better the effect; therefore, early intervention with TCM is particularly important.
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Affiliation(s)
- Huamin Huang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong
| | - Jialin Wang
- The Affiliated Hospital of Shandong Academy of Chinese Medicine
| | - Keqin Li
- Shandong Provincial Hospital Affiliated to Shandong University, Jingwuweiqi Road, Jinan, Shandong, China
| | - Hongbo Ma
- Shandong Provincial Hospital Affiliated to Shandong University, Jingwuweiqi Road, Jinan, Shandong, China
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5
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Savage P. Chemotherapy Curability in Leukemia, Lymphoma, Germ Cell Tumors and Gestational Malignancies: A Reflection of the Unique Physiology of Their Cells of Origin. Front Genet 2020; 11:426. [PMID: 32582272 PMCID: PMC7295948 DOI: 10.3389/fgene.2020.00426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
Cytotoxic DNA damaging chemotherapy brings clinical benefits in the treatment of many metastatic malignancies. However routine curative treatment remains restricted to a small number of malignancies including acute leukemia, high grade lymphoma, germ cell tumors, gestational malignancies and some of the rare childhood cancers. The detailed explanation for this dramatic divergence in outcomes remains to be elucidated. However, we have previously argued that there is a strong correlation between presence of the unique genetic events of immunoglobulin gene variable/diversity/joining (VDJ) recombination, somatic hypermutation (SHM), meiosis, nuclear fusion and gastrulation occurring in cells of origin of these malignancies and their high sensitivity to DNA damaging chemotherapy. In this study we have reviewed some of the basic physiological information relating to the specialized activity and sensitivity to DNA damage mediated apoptosis of normal cells undergoing these processes. In each of unique genetic events there are dramatic changes in apoptotic sensitivity. In VDJ recombination and somatic hypermutation over 95% of the cells involved undergo apoptosis, whilst in meiosis and nuclear fusion there are dramatic short term increases in the apoptotic sensitivity to DNA damage. It is apparent that each of the malignancies arising during these processes retains some of the unique phenotype associated with it. The impact of the physiological differences is most clearly seen in the two non-mutational malignancies. Gestational choriocarcinoma which arises shortly after nuclear fusion is routinely curable with chemotherapy whilst CIMP-positive ependymomas which is not linked to any of the unique genetic events is highly resistant. A similar pattern is found in a pair of malignancies driven by a single driver mutation. Infantile acute lymphoblastic leukemia (ALL) arises in a cell undergoing the early stages of VDJ recombination and has a 40% cure rate in contrast pediatric rhabdoid malignancy which is not linked to a unique genetic event responds very poorly to chemotherapy treatment. The physiological changes occurring in cancer cells at the time of the malignant transformation appear to have a major impact on the subsequent sensitivity to chemotherapy and curability. New therapies that impact on these pathways may be of therapeutic value.
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Affiliation(s)
- Philip Savage
- Department of Oncology, Brighton and Sussex University Hospitals, Brighton, United Kingdom
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6
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Reply to letter to the editor entitled ‘Re: 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 2020; 246:191. [DOI: 10.1016/j.ejogrb.2020.01.006] [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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7
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Palacios-Jaraquemada JM. Conservative vs. Radical Management of Placenta Accreta Spectrum (PAS). CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-019-00274-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Tan Z, Liu W, Guo H, Hu K, Zhao R. Severe toxic effects of low-dose methotrexate treatment for placenta accreta in a patient with methylenetetrahydrofolate reductase mutations. J Clin Pharm Ther 2019; 45:214-217. [PMID: 31545520 DOI: 10.1111/jcpt.13050] [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] [Received: 10/12/2018] [Revised: 02/04/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Low-dose methotrexate (LDMTX) has been widely used for many decades in clinical settings, with good safety profiles compared with those of high-dose methotrexate. LDMTX is also used as one of the off-label conservative therapies in treating placenta accreta (PA). Until now, only a few mild adverse drug reactions (ADRs) have been published after short-term use of LDMTX, and no severe cases have been reported. CASE SUMMARY We present a case of a 30-year-old female who developed acute severe oral ulcerative mucositis with degree IV myelosuppression and degree III hepatic injury, after three doses of LDMTX to treat placenta accrete. The symptoms gradually improved after leucovorin rescue and supportive treatments. WHAT IS NEW AND CONCLUSION The present case provides the first severe ADR report for the short-term use of LDMTX for treating PA, indicating that potentially life-threatening complications can also occur when using LDMTX. Early recognition and immediate leucovorin rescue could result in a favourable outcome.
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Affiliation(s)
- Zhiyuan Tan
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Science, Peking University, Beijing, China
| | - Wei Liu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicity Center, Peking University, Beijing, China
| | - Hua Guo
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Kai Hu
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Rongsheng Zhao
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Therapeutic Drug Monitoring and Clinical Toxicity Center, Peking University, Beijing, China
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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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10
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Khodaverdi S, Babaei MR, Mohseni I, Farasatinasab M. In Reply to Letter to the Editor: methotrexate and uterine artery embolization for placenta accreta spectrum disorders: some clarifications. Clin Radiol 2019; 74:647-648. [PMID: 31202565 DOI: 10.1016/j.crad.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Affiliation(s)
- S Khodaverdi
- Iran University of Medical Sciences, Tehran, Iran.
| | - M R Babaei
- Iran University of Medical Sciences, Tehran, Iran
| | - I Mohseni
- Iran University of Medical Sciences, Tehran, Iran
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Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol 2019; 74:378-383. [DOI: 10.1016/j.crad.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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12
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Abstract
The term "morbidly adherent placenta" has recently been introduced to describe the spectrum of disorders including placenta accreta, increta and percreta. Due to excessive invasion of the placenta into the uterus there is associated significant maternal morbidity and mortality. Most significant risk factors for morbidly adherent placenta include history of prior cesarean delivery as well as placenta previa in the current pregnancy. Ultrasound remains the gold standard for antenatal diagnosis, however, in recent years MRI has assisted in identifying complex parametrial involvement. Optimizing maternal and neonatal outcomes involves early prenatal diagnosis, a multi-disciplinary team-based approach, and referral to an experienced center.
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Affiliation(s)
- Whitney Booker
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, United States.
| | - Leslie Moroz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, United States
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13
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Latif Khan Y, Rahim A, Gardezi J, Iqbal M, Hassan Z, Altaf S, Bhatti S. Conventional and conservative management of placenta accreta is two ends of a single continuum: A report of three cases and literature review. Clin Case Rep 2018; 6:1739-1746. [PMID: 30214754 PMCID: PMC6132159 DOI: 10.1002/ccr3.1717] [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: 03/21/2018] [Accepted: 06/23/2018] [Indexed: 11/11/2022] Open
Abstract
Placenta accreta (PA) is a critical condition that represents a significant source of morbidity and mortality observed in women with multiple prior cesarean sections. Precise prenatal identification of affected pregnancies permits optimal obstetric management. Antenatal diagnosis leads to less blood loss and a requirement for blood transfusion than women diagnose during cesarean section.
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Affiliation(s)
- Yousaf Latif Khan
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
- Department of Gynecology and ObstetricsRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
| | - Arooba Rahim
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
- Department of Gynecology and ObstetricsRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
| | - Javed Gardezi
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Mariam Iqbal
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Zahira Hassan
- Department of Cellular PathologyRoyal Free HospitalLondonUK
| | - Sumbal Altaf
- Department of Gynecology and ObstetricsHameed Latif Hospital14 – Abu Bakar Block New Garden TownLahorePakistan
| | - Shahzad Bhatti
- Department of Medical EducationRashid Latif Medical College 35‐KMFerozepur Road LahorePakistan
- Department of Human Genetics and Molecular BiologyUniversity of Health Sciences LahorePakistan
- Lahore Institute of Fertility and EndocrinologyHameed Latif Hospital Lahore14 – Abu Bakar Block New Garden TownLahorePakistan
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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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15
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Matsuzaki S, Yoshino K, Endo M, Kakigano A, Takiuchi T, Kimura T. Conservative management of placenta percreta. Int J Gynaecol Obstet 2018; 140:299-306. [PMID: 29194646 DOI: 10.1002/ijgo.12411] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/10/2017] [Accepted: 11/29/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Maternal outcomes after conservative management of placenta percreta are poorly understood. OBJECTIVE To assess the success and complication rates of conservative management of placenta percreta. SEARCH STRATEGY The PubMed, MEDLINE, and Scopus databases were searched for English-language articles published between January 1990 and December 2016, using combinations of search terms related to conservative management of placenta percreta. SELECTION CRITERIA Only studies describing conservative treatment for placenta percreta (without placental removal) were included in the systematic review. DATA COLLECTION AND ANALYSIS There were 44 studies included and maternal outcomes were reviewed and categorized among 72 patients. MAIN RESULTS The uterus was preserved among 42 (58%) patients and severe complications developed among 40 (56%). Prophylactic uterine artery embolization (UAE) did not improve success rates (P=0.807); however, the mean time for complete placental resorption was lower in the UAE group than in the non-UAE group (22.4 weeks vs 35.3 weeks; P=0.014). Hysterectomy was performed at a mean of 44.6 days after cesarean delivery. Among the 23 patients with hysterectomy-related complications, 18 (78%) experienced bladder injury, intraoperative bleeding (>2000 mL), or both. The use of chemotherapy did not improve success rates (P=0.064). CONCLUSIONS The present systematic review revealed high maternal morbidity during conservative management of placenta percreta.
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Affiliation(s)
- Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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