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Nieto-Calvache AJ, Hidalgo A, Maya J, Sánchez B, Blanco LF, Sinisterra-Díaz SE, Benavides-Calvache JP, Padilla I, Aldana I, Jaramillo M, Gómez AM, Castillo AMO, Bryon AM. Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment? Rev Bras Ginecol Obstet 2022; 44:925-929. [PMID: 36067798 DOI: 10.1055/s-0042-1751060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. METHODS This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. RESULTS Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. CONCLUSION Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.
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Affiliation(s)
| | | | - Juliana Maya
- Universidad Icesi, Programa de Medicina, Cali, Colombia
| | - Beatriz Sánchez
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Departamento de Anestesiología, Fundación Valle del Lili, Cali, Colombia
| | - Luisa Fernanda Blanco
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Departamento de Anestesiología, Fundación Valle del Lili, Cali, Colombia
| | | | | | - Iván Padilla
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Ivonne Aldana
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Martha Jaramillo
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | - Ana Maria Gómez
- Unidad de Cuidad Intensivo Neonatal, Fundación Valle del Lili, Cali, Colombia
| | | | - Adriana Messa Bryon
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
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Nieto-Calvache AJ, Rodríguez F, Ordoñez CA, Cardona Astaiza A, Carbonell JP, Vergara-Galliadi LM, Sinisterra-Díaz SE, Messa Bryon A. Technical Considerations for the Use of REBOA in the Management of Placenta Accreta Spectrum. JEVTM 2022. [DOI: 10.26676/jevtm.v6i2.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: In recent years, the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has become popular to prevent or treat massive bleeding due to placenta accreta spectrum (PAS).
Objective: There are multiple variations in REBOA use in this context and although the experience of vascular surgeons is extensive with aortic balloons, there are particularities in the management of these devices in the obstetric population that deserve to be discussed.
Methods: We discuss some technical considerations or “lessons learned” in our center that may be useful for other groups starting to use REBOA in PAS
Conclusion: Although REBOA is a useful strategy to prevent or treat massive bleeding due to PAS, its incorporation into management protocols must be carried out in a programmed and supervised manner.
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Aryananda RA, Nieto-Calvache AJ, Cininta NI, Bachtiar CA, Wardhana MP, Vergara Galliadi LM, Messa Bryon A, Burgos Luna JM. Management of placenta accreta spectrum disorders in COVID 19 patients. J Matern Fetal Neonatal Med 2021; 35:8844-8847. [PMID: 34814799 DOI: 10.1080/14767058.2021.2005567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has made it difficult to respond to demands in maternal health around the world. Placenta accreta spectrum (PAS) is one of the most severe obstetric conditions and usually requires the use of multiple health resources We describe the clinical results of the management of PAS patients during the COVID-19 pandemic and analyze how the pandemic may affect the functioning of a PAS team. METHODOLOGY This was a descriptive, retrospective study including all patients treated for PAS in two low- to middle-income country reference hospitals between January 2020 and March 2021. The clinical results of patients with SARS-CoV-2 infection during PAS surgery (Group 1) were compared with those of PAS patients without SARS-CoV-2 infection (Group 2). RESULTS One hundred forty-five patients undergoing surgery for PAS were included. Group 1 patients (11 cases) showed a longer operative time (250 min, IQR 200-300) and a higher frequency of intra- or postoperative complications (54.5%) than group 2 patients (180 min [IQR 125-240], and 17.9%). CONCLUSION Placenta accreta spectrum patients undergoing surgery during acute SARS-CoV-2 infection have a higher frequency of postoperative complications. PAS teams must prepare to modify their management protocols to minimize risks for patients and healthcare personnel.
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Affiliation(s)
| | | | | | - Citra Aulia Bachtiar
- Dr. Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Adriana Messa Bryon
- Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
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Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aguilera LR, Arriaga W, Colonia A, Aryananda RA, Nieto-Calvache AS, Maya J, Vergara-Galliadi LM, Messa Bryon A. Telemedicine facilitates surgical training in placenta accreta spectrum. Int J Gynaecol Obstet 2021; 158:137-144. [PMID: 34714947 DOI: 10.1002/ijgo.14000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The training of groups responsible for managing patients with placenta accreta spectrum (PAS) is complex because of the lack of hospitals with a high flow of patients and absence of formal educational programs. We report here the results of a virtual training program (VTP) that implemented one-step conservative surgery (OSCS). METHODS A prospective observation study of OSCS VTP between three expert groups and PAS reference hospitals without experience in OSCS was performed. Accessible or cost-efficient web meeting platforms were used to implement the VTP components: baseline observation of the participant's prior knowledge; instructions about essential PAS surgery topics; case selection and joint planning of surgery; expert group "telepresence" during surgery and postoperative debriefing. RESULTS One-step conservative surgery was performed successfully at six hospitals. All patients had increta/percreta with a median intraoperative bleeding of 1300 ml (IQR 825-2325) and surgical time of 184 min (IQR 113-240). All groups considered the VTP very useful (n = 33, 97%) or useful (n = 1, 3%), they would use it again (definitely: n = 27, 81.8%; or probably: n = 6, 18.2%), and they would recommend it to other colleagues. CONCLUSION Tele education and telepresence during PAS surgery facilitates the implementation of OSCS in selected cases.
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Affiliation(s)
- Albaro Jose Nieto-Calvache
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Latin American Group for the Study of Placenta Accreta Spectrum, Cali, Colombia
| | | | - Lorgio Rudy Aguilera
- Latin American Group for the Study of Placenta Accreta Spectrum, Cali, Colombia.,Hospital de la Mujer Dr Percy Boland, Santacruz, Bolivia
| | - William Arriaga
- Latin American Group for the Study of Placenta Accreta Spectrum, Cali, Colombia.,Hospital Regional de Occidente, Quetzaltenango, Guatemala
| | - Alejandro Colonia
- Latin American Group for the Study of Placenta Accreta Spectrum, Cali, Colombia.,Hospital General de Medellín, Medellín, Colombia
| | | | | | - Juliana Maya
- Facultad de Ciencias de la Salud, Programa de Medicina, Universidad Icesi, Cali, Colombia
| | | | - Adriana Messa Bryon
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia.,Latin American Group for the Study of Placenta Accreta Spectrum, Cali, Colombia
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Nieto-Calvache AJ, Palacios-Jaraquemada JM, Aryananda RA, Rodriguez F, Ordoñez CA, Messa Bryon A, Calvache JPB, Lopez J, Campos CI, Mejia M, Rengifo M, Galliadi LMV, Maya J, Zambrano MA, Aguayo IP, Carabalí IG, Burgos JM. How to identify patients who require aortic vascular control in placenta accreta spectrum disorders? Am J Obstet Gynecol MFM 2021; 4:100498. [PMID: 34610485 DOI: 10.1016/j.ajogmf.2021.100498] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The placenta accreta spectrum disorder may lead to severe complications. Helpful interventions to prevent placenta accreta spectrum bleeding include vascular control procedures in the aorta or pelvic vessels. Although these procedures are related to lower intraoperative bleeding, they are associated with complications, so the possibility of selecting patients at highest risk of bleeding while avoiding vascular procedures for all cases is attractive. OBJECTIVE We describe an intraoperative staging protocol whose objective is to identify the need to use vascular control procedures in patients with placenta accreta spectrum. We also describe the results of its application in a placenta accreta spectrum referral hospital. STUDY DESIGN This descriptive, retrospective study included patients with suspected prenatal placenta accreta spectrum treated at a referral center for placenta accreta spectrum between April 2016 and June 2020. The use of the resuscitative endovascular balloon occlusion of the aorta allowed the prevention and treatment of excessive bleeding; its application was performed according to 3 approaches: (1) presurgical use in all placenta accreta spectrum patients (Group 1), (2) according to the prenatal placenta accreta spectrum topography (Group 2), and (3) according to the "intraoperative staging" (Group 3). In addition, the frequency of use of resuscitative endovascular balloon occlusion of the aorta and the clinical results in the management of placenta accreta spectrum were described in the 3 groups. RESULTS Seventy patients underwent surgery for a prenatal suspicion of placenta accreta spectrum. Of these, 16 underwent intraoperative staging (Group 3); in 20 cases, resuscitative endovascular balloon occlusion of the aorta was used based on the prenatal imaging topographic classification (Group 2), and in the remaining 34 patients (Group 1), it was always used before the laparotomy. The frequency of use of resuscitative endovascular balloon occlusion of the aorta was progressively lower in Groups 1 (32 patients, 94.1% of cases), 2 (11 patients, 75% of cases), and 3 (4 patients, 25% of cases). Similarly, resuscitative endovascular balloon occlusion of the aorta went from being applied predominantly before the laparotomy (all cases in Group 1) to being applied after intraoperative staging (all cases in Group 3). The percentage of endovascular devices applied but not used, decreased from 23.5% in Group 1 to 0% in Group 3. Complications related to the resuscitative endovascular balloon occlusion of the aorta were seen in 4 patients (2 women in Group 1, and 1 woman each in Groups 2 and 3). CONCLUSION The "intraoperative staging" of placenta accreta spectrum allows the optimization of the use of resuscitative endovascular balloon occlusion of the aorta, which decreases the frequency of its use without increasing the volume of blood loss.
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Affiliation(s)
- Albaro José Nieto-Calvache
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos).
| | | | - Rozi Aditya Aryananda
- Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia (Dr Aryananda)
| | - Fernando Rodriguez
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos); División de Trauma y Emergencias, Departamento de Cirugía General, Fundación Valle del Lili, Cali, Colombia (Drs Rodriguez and Ordoñez)
| | - Carlos A Ordoñez
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos); División de Trauma y Emergencias, Departamento de Cirugía General, Fundación Valle del Lili, Cali, Colombia (Drs Rodriguez and Ordoñez)
| | - Adriana Messa Bryon
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos)
| | - Juan Pablo Benavides Calvache
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos)
| | - Jaime Lopez
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos)
| | - Clara Ivette Campos
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos); Departamento de Patología y Laboratorio Clínico, Fundación Valle del Lili, Cali, Colombia (Dr Campos)
| | - Mauricio Mejia
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos); Departamento de Radiología e Imágenes Diagnósticas, Fundación Valle del Lili, Cali, Colombia (Drs Mejia and Rengifo)
| | - Martin Rengifo
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos); Departamento de Radiología e Imágenes Diagnósticas, Fundación Valle del Lili, Cali, Colombia (Drs Mejia and Rengifo)
| | | | - Juliana Maya
- Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia (Drs Maya, Aguayo, and Carabalí)
| | - Maria Andrea Zambrano
- Programa de Ginecología y Obstetricia, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia (Dr Zambrano)
| | - Isabella Prado Aguayo
- Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia (Drs Maya, Aguayo, and Carabalí)
| | - Isabella Gutierrez Carabalí
- Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia (Drs Maya, Aguayo, and Carabalí)
| | - Juan Manuel Burgos
- Clinica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia (Drs Nieto-Calvache, Rodriguez, Ordoñez, Bryon, Calvache, Lopez, Campos, Mejia, Rengifo, and Burgos)
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Nieto-Calvache AJ, Vergara-Galliadi LM, Rodríguez F, Ordoñez CA, García AF, López MC, Manzano R, Velásquez J, Carbonell JP, Bryon AM, Echavarría MP, Escobar MF, Carvajal J, Benavides-Calvache JP, Burgos JM. A multidisciplinary approach and implementation of a specialized hemorrhage control team improves outcomes for placenta accreta spectrum. J Trauma Acute Care Surg 2021; 90:807-816. [PMID: 33496549 DOI: 10.1097/ta.0000000000003090] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The main complication of placenta accreta spectrum (PAS) is massive bleeding. Endoarterial occlusion techniques have been incorporated into the management of this pathology. Our aim was to examine the endovascular practice patterns among PAS patients treated during a 9-year period in a low-middle income country in which an interdisciplinary group's technical skills were improved with the creation of a PAS team. METHODOLOGY A retrospective cohort study including all PAS patients treated from December 2011 to November 2020 was performed. We compared the clinical results obtained according to the type of endovascular device used (group 1, internal iliac artery occlusion balloons; group 2, resuscitative endovascular balloons of the aorta; group 3, no arterial balloons due to low risk of bleeding) and according to the year in which they were attended (reflects the PAS team level of experience). A fourth group of comparisons included the woman diagnosed during a cesarean delivery and treated in a nonprotocolized way. RESULTS A total of 113 patients were included. The amount of blood loss decreased annually, with a median of 2,500 mL in 2014 (when endovascular occlusion balloons were used in all patients) and 1,394 mL in 2020 (when only 38.5% of the patients required arterial balloons). Group 3 patients (n = 16) had the lowest bleeding volume (1,245 mL) and operative time (173 minutes) of the entire population studied. Group 2 patients (n = 46) had a bleeding volume (mean, 1,700 mL) and transfusions frequency (34.8%) slightly lower than group 1 patients (n = 30) (mean of 2,000 mL and 50%, respectively). They also had lower hysterectomy frequency (63% vs. 76.7% in group 1) and surgical time (205 minutes vs. 275 in group 1) despite a similar frequency of confirmed PAS and S2 compromise. CONCLUSION Endovascular techniques used for bleeding control in PAS patients are less necessary as interdisciplinary groups improve their surgical and teamwork skills. LEVEL OF EVIDENCE Therapeutic care management, level III.
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Affiliation(s)
- Albaro José Nieto-Calvache
- From the Placenta Accreta Spectrum Clinic (A.J.N.-C., F.R., C.A.O., A.F.G., J.V., J.P.C., A.M.B., M.P.E., M.F.E., J.C., J.P.B.-C., J.M.B.), Clinical Research Center (L.M.V.-G., M.C.L., R.M.); Division of Trauma and Acute Care Surgery, Department of Surgery (F.R., C.A.O., A.F.G.); and Interventional Radiology Department (J.V., J.P.C.), Fundación Valle del Lili, Cali, Colombia
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Nieto-Calvache AJ, López-Girón MC, Quintero-Santacruz M, Bryon AM, Burgos-Luna JM, Echavarría-David MP, López L, Macia-Mejia C, Benavides-Calvache JP. A systematic multidisciplinary initiative may reduce the need for blood products in patients with abnormally invasive placenta. J Matern Fetal Neonatal Med 2020; 35:738-744. [PMID: 32089029 DOI: 10.1080/14767058.2020.1731460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The main complication of the abnormally invasive placenta is massive bleeding, with transfusions required frequently. We aim to evaluate the impact of interdisciplinary management on transfusion practices in women with abnormally invasive placenta.Methodology: Clinical outcomes of women with abnormally invasive placenta treated between 2011 and 2019 were reviewed, including transfusion frequency. Patients divided into three groups: group A (women treated before the introduction of interdisciplinary management), group B (women attended to by a fixed interdisciplinary group), and group C (women with no accreta prenatal diagnosis).Results: Patients with prenatal diagnosis and attended by a fixed interdisciplinary group (group B) required fewer units of red blood cells to be prepared and transfused (median number of units, 0 versus 2 in group A and 3 in group C).Conclusion: The participation of an interdisciplinary group, with strict standards for transfusion, reduces the frequency of use of blood substitutes during the care of women with abnormally invasive placenta.
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Affiliation(s)
- Albaro José Nieto-Calvache
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | | | | | - Adriana Messa Bryon
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - Juan Manuel Burgos-Luna
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - María Paula Echavarría-David
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Clinical Postgraduate Department, Universidad ICESI, Cali, Colombia
| | - Leidy López
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia
| | - Carmenza Macia-Mejia
- Abnormally Invasive Placenta Clinic, Fundación Valle del Lili, Cali, Colombia.,Blood Bank and Transfusion Service, Fundación Valle del Lili, Cali, Colombia
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