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Affiliation(s)
- R Khan
- Department of Obstetrics and Gynaecology, Whipp's Cross University Hospital NHS Trust, Leytonstone, London, UK.
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2
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Affiliation(s)
- S Baruah
- Worcester Royal Hospital, Worcester, UK.
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3
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Weiniger CF, Elram T, Ginosar Y, Mankuta D, Weissman C, Ezra Y. Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification. Anaesthesia 2005; 60:1079-84. [PMID: 16229692 DOI: 10.1111/j.1365-2044.2005.04369.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
Placenta accreta may be suspected prior to surgery, but the actual diagnosis is only confirmed at surgery. This prospective and observational study was performed to assess whether preparations should be made for potential massive blood loss prior to Caesarean surgery in all patients with suspected placenta accreta. Patients were classified as high or low suspicion for placenta accreta based on ultrasonography and clinical factors. Among 28 suspected cases of placenta accreta, diagnosis was confirmed at surgery in 50% (12/17 high and 2/11 low suspicion) cases. Hysterectomy was only performed in the 12 high suspicion patients with placenta accreta (p < 0.001). High suspicion patients required more blood transfusions: mean(SD) 6.5 (7.0) units vs 1.09 (1.1) units, p = 0.017. Anaesthetists should be prepared for major haemorrhage in all cases of suspected placenta accreta, although use of a system to grade level of suspicion may identify those at greater risk.
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Affiliation(s)
- C F Weiniger
- Department of Anaesthesia and Critical Care Medicine, Hadassah Hebrew University Medical Centre, Jerusalem, Israel, POB 12000.
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4
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Usta IM, Hobeika EM, Musa AAA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 2005; 193:1045-9. [PMID: 16157109 DOI: 10.1016/j.ajog.2005.06.037] [Citation(s) in RCA: 229] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/18/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors and complications of placenta previa-accreta (PA). STUDY DESIGN Patients with placenta previa (n = 347) delivered over 20 years were reviewed, divided into PA (cases, n = 22) and no accreta (controls, n = 325), and compared. RESULTS Cases were older with a higher incidence of smoking and previous cesarean delivery (CS). Grandmultiparity, recurrent abortions, anterior/central placentae, and low socioeconomic status were similar. PA incidence increased with the number of previous CS: 1.9%, 15.6%, 23.5%, 29.4%, 33.3%, and 50.0% after 0, 1, 2, 3, 4, and 5 previous CS, respectively. Hypertensive disorders (odds ratio [OR] 13.9, 95%CI 2.1-91.2], P = .006), smoking (OR 3.4, 95%CI 1.1-10.2, P = .031) and previous CS (OR 7.9, 95%CI 1.7-37.4, P = .009) were selected by the stepwise logistic regression analysis as predictors of PA. Cases had a longer hospital stay, a higher estimated blood loss, and need for transfusion. Cesarean hysterectomy and hypogastric artery ligation were only performed in PA cases. The 2 groups had a similar delivery gestational age and neonatal outcome. CONCLUSION Hypertensive disorders, smoking, and previous cesarean are risk factors for accreta in placenta previa patients. Placenta previa-accreta is associated with higher maternal morbidity, but similar neonatal outcome compared with patients with an isolated placenta previa.
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Affiliation(s)
- Ihab M Usta
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
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Goffinet F, Mercier F, Teyssier V, Pierre F, Dreyfus M, Mignon A, Carbonne B, Lévy G. Hémorragies du post-partum : recommandations du CNGOF pour la pratique clinique (décembre 2004). ACTA ACUST UNITED AC 2005; 33:268-74. [PMID: 15894217 DOI: 10.1016/j.gyobfe.2005.03.016] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F Goffinet
- Service de gynécologie-obstétrique de Port-Royal, hôpital Cochin Saint-Vincent-de-Paul, université Paris-V, 123, boulevard de Port-Royal, 75014 Paris, France.
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6
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Affiliation(s)
- Muge Harma
- Department of Gynecology and Obstetrics, Radiology University of Harran, Sanliurfa, Turkey.
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Tanchev S, Georgieva V, Ivanov I, Sampat D, Gincheva D. [A rare case of placenta percreta with sprouting in the coecum]. Akush Ginekol (Sofiia) 2005; 44:54-5. [PMID: 16028382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Cieminski A, Długołiecki F. [Placenta previa accreta]. Ginekol Pol 2004; 75:919-25. [PMID: 15751211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVES The purpose of our study was to assess the relationship between previous cesarean section and placenta previa accreta and to estimate the incidence of placenta accreta et previa accreta as the indication for peripartum hysterectomy. MATERIALS AND METHODS The records of all patients delivered with the diagnosis of placenta previa accreta during the period from 1992-2002 at Hospital in Chojnice were reviewed. Statistical analyses were carried out to determine the relationship between previous cesarean section and subsequent development of placenta previa accreta. We conducted a retrospective analysis of indications for peripartum hysterectomy. RESULTS From a total 28,177 women, who delivered at the Chojnice Hospital, 15(0.05%) patients had placenta accreta, 63(0.2%) placenta previa. Among placenta previa deliveries 22(34.9%) patients had previous cesarean section. Out of 15 patients with placenta accreta 10(66.7%) had placenta previa. Incidence of placenta accreta per case of placenta previa was 158.7 per 1000. The incidence of placenta previa accreta significantly increased in those with previous post cesarean scars. This incidence increased as the number of previous cesarean sections increased. The most common indication for peripartum hysterectomy was placenta accreta--48.4%, incidence of placenta previa accreta was accounts for 32.3% of all indications. CONCLUSIONS The association between placenta previa accreta and prior cesarean section was confirmed. The incidence of placenta accreta increased as the number of previous cesarean sections increased. Patients with an antepartum diagnosis of placenta previa, who have had a previous cesarean section should be considered at high risk for developing placenta accreta. The most common indication for peripartum hysterectomy in this study was placenta previa accreta.
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Affiliation(s)
- Adam Cieminski
- Oddział Ginekologiczno-Połozniczego Szpitala Rejonowego, Chojnicach
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Abstract
BACKGROUND Concomitant with the increase in Caesarean birth over the past three decades there has been an apparent rise in the incidence of placenta accreta and its variants. The sequelae of an increase in the occurrence of abnormal placentation is the enhanced potential for severe maternal morbidity. AIM To determine the contempory demographics of placenta accreta over a 5-year period in a tertiary level teaching hospital. METHODS A retrospective review of all cases of placenta accreta and variants during the period of 1998-2002. Individual charts review followed case ascertainment via the hospital obstetric database. RESULTS Thirty-two women with placenta accreta (or variant) were identified. Median maternal age was 34 years, with a median parity of 2.5. Seventy-eight percent of cases had had at least one prior Caesarean birth, and 88% of cases were associated with placenta praevia. Pre-delivery ultrasonography was performed in all cases, providing diagnostic sensitivity of 63% and specificity of 43% with a predictive value of 76%. Hysterectomy was performed in 91% of cases with median intraoperative blood loss of 3000 mL. There were no maternal deaths in the current series. CONCLUSION A strong association between placenta accreta, placenta praevia and prior Caesarean birth has been demonstrated. As there is the potential for significant maternal morbidity the risk of placenta accreta needs to be recognised and women at risk should be considered for delivery at an institution with appropriate expertise and resources in managing this condition.
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Affiliation(s)
- Charles A Armstrong
- King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
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Esmans A, Gerris J, Corthout E, Verdonk P, Declercq S. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: Case report. Hum Reprod 2004; 19:2401-3. [PMID: 15298972 DOI: 10.1093/humrep/deh421] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [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: 11/12/2022] Open
Abstract
Reports on placenta percreta in early pregnancy leading to a spontaneous rupture of the uterus are rare. We report a case of this potentially life-threatening complication in the 14th week of pregnancy in an otherwise healthy woman who underwent a manual extraction of the placenta during a previous delivery but who had no history of severe pathology that could have potentially resulted in uterine damage. The occurrence of severe abdominal pain and the presence of a large quantity of free fluid in the abdomen necessitated an emergency laparotomy, revealing a haemoperitoneum due to rupture of the uterus, which was followed by a hysterectomy. This case demonstrates that in patients with a history of placenta accreta and subsequent manual extraction of the placenta, a close investigation of the uterine wall and placentation should be performed in the first trimester in order to anticipate a placenta percreta.
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Affiliation(s)
- A Esmans
- Department of Obstetrics and Gynecology, Lindendreef 1, 2020 Antwerp, Belgium
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Hlibczuk V. Spontaneous uterine rupture as an unusual cause of abdominal pain in the early second trimester of pregnancy. J Emerg Med 2004; 27:143-5. [PMID: 15261356 DOI: 10.1016/j.jemermed.2004.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Revised: 01/12/2004] [Accepted: 03/02/2004] [Indexed: 11/22/2022]
Abstract
A case of placenta percreta causing spontaneous uterine rupture is presented. This is a rare condition, which may present in the antepartum period as abdominal pain, with or without signs of hemorrhagic shock. This entity can lead to significant morbidity and mortality if not aggressively managed. A discussion follows on the pathophysiology, incidence, risk factors, presentation and management of this condition.
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Affiliation(s)
- Veronica Hlibczuk
- Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, New York, USA
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Chou YJ, Cheng YF, Shen CC, Hsu TY, Chang SY, Kung FT. Failure of uterine arterial embolization: placenta accreta with profuse postpartum hemorrhage. Acta Obstet Gynecol Scand 2004; 83:688-90. [PMID: 15225198 DOI: 10.1046/j.0001-6349.2002.00002.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yin-Jou Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Hoffman MK, Sciscione AC. Placenta accreta and intrauterine fetal death in a woman with prior endometrial ablation: a case report. J Reprod Med 2004; 49:384-6. [PMID: 15214713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Few cases of pregnancy following endometrial ablation have been reported. Placenta accreta and poor perinatal outcome are potential risks due to underlying endometrial destruction and uterine scarring. CASE A 41-year-old, white woman presented for initial prenatal care at 12 weeks, 3 years after endometrial ablation with resection of a leiomyoma. The patient's prenatal care was unremarkable until 20 weeks, when she presented with intrauterine fetal death. Labor was induced with misoprostol, and a stillborn fetus resulted. The placenta failed to deliver spontaneously after 6 hours and continuing doses of misoprostol. An attempt at manual extraction failed to demonstrate a clear cleavage plane between the placenta and endometrium. The patient underwent a hysterectomy for placenta accreta, which was confirmed on pathology. CONCLUSION Endometrial ablation may predispose the patient to abnormal placentation and intrauterine fetal death. Physicians should counsel their patients appropriately about the likelihood of this outcome.
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Affiliation(s)
- Matthew K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware 19801, USA.
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Buhimschi CS, Buhimschi IA, Weiner CP. Ultrasonographic observation of Bandl's contraction ring. Int J Gynaecol Obstet 2004; 86:35-6. [PMID: 15207670 DOI: 10.1016/j.ijgo.2003.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Revised: 12/22/2003] [Accepted: 12/23/2003] [Indexed: 11/19/2022]
Affiliation(s)
- C S Buhimschi
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.
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Al-Ojaimi EH, Subramaniam BV. Placenta percreta with urinary bladder involvement. Saudi Med J 2004; 25:518-21. [PMID: 15083229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
A 37-year-old Pakistani lady, who had previously undergone one cesarean delivery and one uterine curettage, was admitted to the labor ward at 29 weeks of gestation with history of a sudden severe painless vaginal bleeding from a sonographically diagnosed placenta previa. An immediate cesarean section was performed and a live male infant was delivered. The placenta was morbidly adherent to the lower uterine segment and attempts at removal caused torrential bleeding, necessitating cesarean hysterectomy. In addition, attempts to dissect the bladder from the lower uterine segment were unsuccessful and, hence, the diagnosis of placenta percreta with involvement of the urinary bladder was made. A modified posterior approach to the hysterectomy was carried out, with subsequent good recovery.
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Affiliation(s)
- Eftekhar H Al-Ojaimi
- Department of Obstetrics and Gynecology, Salmaniya Medical Complex, Ministry of Health, manama, Bahrain.
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Gherman RB, Lockrow EG, Flemming DJ, Satin AJ. Conservative management of spontaneous uterine perforation associated with placenta accreta: a case report. J Reprod Med 2004; 49:210-3. [PMID: 15098892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Placenta accreta occurring in an unscarred uterus is exceedingly rare. Previous cases of spontaneous uterine perforation associated with placenta accreta were treated with hysterectomy. CASE A nulliparous woman was clinically diagnosed with placenta accreta when spontaneous vaginal delivery was complicated by postpartum hemorrhage and a retained placenta. Magnetic resonance imaging subsequently revealed focal areas of placenta accreta. Acute-onset abdominal pain and cul-de-sac fluid prompted diagnostic laparoscopy, which revealed a spontaneous uterine perforation in the right posterior-lateral aspect of the uterus. This area was oversewn, and the patient received 2 weeks of postoperative antibiotics because of Enterococcus faecalis bacteremia. CONCLUSION Spontaneous uterine perforation associated with placenta accreta can be managed conservatively.
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Affiliation(s)
- Robert B Gherman
- Division of Maternal/Fetal Medicine, Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, Maryland 20889, USA
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Abstract
AIM To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage. MATERIALS AND METHODS From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization. RESULTS Angiography revealed engorged and tortuous uterine arteries in all patients; and contrast medium extravasation in three patients. Eight patients (three with and five without detectable active bleeding) then underwent bilateral UAE. Medium-sized (250-355 microm) polyvinyl alcohol particles were injected via a coaxial catheter into the uterine arteries, followed by gelatin sponge pieces via a 4F Cobra catheter. Microcoil devascularization was also performed in the two patients with visible, active bleeding. The vaginal bleeding resolved in all patients, without any ischaemic complications. At follow-up, all patients who underwent UAE had normal menstruation; three of them subsequently gave birth to full-term healthy babies. CONCLUSION Selective UAE by the coaxial method is safe and effective to control obstetric haemorrhage, with the potential to preserve fertility.
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Affiliation(s)
- T-M Hong
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Khan AM, Dawlatly B, Khan D, Deol N. An unusual presentation of placenta accreta. J OBSTET GYNAECOL 2004; 24:180-1. [PMID: 14766464 DOI: 10.1080/01443610410001648359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A M Khan
- Whipps Cross University Hospital, London, UK.
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Topuz S. Spontaneous uterine rupture at an unusual site due to placenta percreta in a 21-week twin pregnancy with previous cesarean section. CLIN EXP OBSTET GYN 2004; 31:239-41. [PMID: 15491074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Spontaneous uterine rupture is a rare, but serious complication of placenta percreta. This case report is about a spontaneous uterine rupture at an unusual site due to placenta percreta in a 21-week twin pregnancy with previous cesarean section. A 30-year-old, G3, P2 woman was referred to our unit in the 21st week of a twin pregnancy with acute abdomen. An emergency laparotomy was performed with the diagnosis of uterine rupture and intra-abdominal hemorrhage. A significant hemoperitoneum was found, with both fetuses freely floating in the peritoneal cavity. A large transverse rupture at the posterior isthmus wall was detected. Subtotal hysterectomy with preservation of both ovaries was performed. Pathological investigation of the uterus revealed placenta percreta.
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Affiliation(s)
- S Topuz
- Department Obstetrics and Gynecology, School of Medicine, Istanbul University, Istanbul (Turkey)
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Abstract
UNLABELLED In this case report, we report a patient with a placenta accreta and thalassemia intermedia undergoing cesarean delivery. There are no data regarding the use of cell salvage in patients with thalassemia. During the course of her surgery, she lost approximately 9000 mL of blood. Of this blood, 2250 mL of concentrated red cells were collected, washed, and returned to the patient. During processing, increased hemolysis was noted in the effluent line of the cell salvage machine, which resolved by increasing the wash volume. The patient's postoperative course was uneventful. This case would suggest that cell salvage in patients with thalassemia can be performed safely; however, further study is warranted. IMPLICATIONS This case report details the safe administration of cell salvage in a patient with beta thalassemia undergoing cesarean delivery. Cell salvage is the collection, washing, and re-administration of blood lost during surgery. This process has not been previously reported in a patient with this type of blood disease.
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Affiliation(s)
- Jonathan H Waters
- Departments of *General Anesthesiology and †Obstetrics & Gynecology, Cleveland Clinic Foundation, Ohio
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Lapresta Moros M, Conte Martín P, Pérez Pérez P, Azúa Romeo J, Oro Fraile J, Lapresta Ferrández C. Postabortal haemorrhage and disseminated intravascular coagulation due to placenta accreta. Arch Gynecol Obstet 2003; 268:329-30. [PMID: 14504880 DOI: 10.1007/s00404-002-0403-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2002] [Accepted: 08/02/2002] [Indexed: 11/24/2022]
Abstract
We describe the case of a second trimester placenta accreta presenting as postabortal haemorrhage complicated by disseminated intravascular coagulation, requiring hysterectomy.
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Akhter S, Begum MR, Kabir Z, Rashid M, Laila TR, Zabeen F. Use of a condom to control massive postpartum hemorrhage. MedGenMed 2003; 5:38. [PMID: 14600674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES To evaluate the efficacy of a condom as a tamponade for intrauterine pressure to stop massive postpartum hemorrhage (PPH). DESIGN AND SETTING This prospective study was done in the Obstetrics and Gynecology Department of Dhaka Medical College and Hospital, Bangladesh, between July 2001 and December 2002. PATIENTS During the study period, 152 cases of PPH were identified; 109 were managed medically; 20 were managed using the B-Lynch procedure, and 23 were managed using the condom catheter. Patients were selected for intervention with the condom catheter when PPH that occurred as a result of atonicity or morbid adhesion (accreta) could not be controlled by uterotonics or a surgical procedure. In patients who were in shock due to massive hemorrhage, a condom catheter was introduced immediately without prior medical management. INTERVENTION With aseptic precautions, a sterile rubber catheter fitted with a condom was introduced into the uterus. The condom was inflated with 250-500 mL normal saline, according to need. The condom catheter was kept for 24-48 hours, depending upon the initial intensity of blood loss, and gradually deflated when bleeding ceased. MAIN OUTCOME MEASURES (1) Ability of condom catheter to stop bleeding; (2) time required to stop bleeding after the tamponade was applied; (3) subsequent morbidity in terms of severe infection, despite use of prophylactic antibiotics. RESULTS In all 23 cases in which the condom catheter was used, bleeding stopped within 15 minutes. No patient needed further intervention. No patient went into irreversible shock. There was no intrauterine infection as documented by clinical signs and symptoms and culture and sensitivity of high vaginal swab. CONCLUSION The hydrostatic condom catheter can control PPH quickly and effectively. It is simple to use, inexpensive, and safe. In developing countries where PPH remains a primary cause of maternal mortality, any healthcare provider involved in delivery may use this procedure for controlling massive PPH to save the lives of patients.
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Affiliation(s)
- Sayeba Akhter
- Department of Obstetrics and Gynecology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
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Abstract
BACKGROUND Placenta percreta with bladder invasion is a rare but potentially lethal complication of pregnancy. CASE A multigravida, with a history of two prior cesarean deliveries, presented with complaints of heavy vaginal bleeding near term. She had been previously diagnosed with an anterior placenta previa. A placenta percreta with bladder invasion was confirmed on cystoscopy. The patient underwent a successful cesarean hysterectomy using the argon beam coagulator. CONCLUSION Argon beam coagulation may successfully help manage placenta percreta with bladder invasion while minimizing blood loss.
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Affiliation(s)
- Amer K Karam
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital and Medical Institutions, Baltimore, Maryland 21287, USA.
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Kapoor DS, Tincello DG, Kingston RE. Life-threatening obstetric haemorrhage in second trimester from a placenta percreta with raised alpha-fetoprotein levels. J OBSTET GYNAECOL 2003; 23:570-1. [PMID: 12963529 DOI: 10.1080/0144361031000156609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D S Kapoor
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool, UK.
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Kazandi M. Placenta percreta: report of two cases and review of the literature. CLIN EXP OBSTET GYN 2003; 30:70-2. [PMID: 12731751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Placenta percreta is a serious complication of pregnancy. Two cases of placenta percreta confirmed histologically were treated by supravaginal hysterectomy. Case 1: A case of uterine rupture secondary to placenta percreta was diagnosed in a 29-year-old term primigravida during an elective abdominal delivery of a healthy fetus. Spontaneous rupture of the primigravid uterus due to placenta percreta without a history of trauma or infection is a very rare occurrence. Case 2: A 33-year-old previously healthy G4P2 woman was admitted at 29 weeks of gestation with acute abdominal pain and hemorrhagic shock. There was a history of one induced abortion and two cesarean section deliveries. A review of risk factors, diagnostic tools and treatment possibilities are given.
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Affiliation(s)
- M Kazandi
- Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
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Liang HS, Jeng CJ, Sheen TC, Lee FK, Yang YC, Tzeng CR. First-trimester uterine rupture from a placenta percreta. A case report. J Reprod Med 2003; 48:474-8. [PMID: 12856524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Cesarean scar pregnancy complicated by placenta percreta and uterine rupture is an uncommon gynecologic emergency. CASE A woman presenting with abdominal pain and shock was found to have a cesarean scar pregnancy complicated by placenta percreta and uterine rupture. CONCLUSION Implantation within a cesarean scar may cause placenta percreta, leading to uterine rupture in the first trimester and mimicking other gynecologic emergencies.
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Affiliation(s)
- Hung-Shuo Liang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei Medical University Hospital, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
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Maria NE, Mishra N, Mubarek M, Reginald PW. Silent dehiscence of a caesarean section scar with placenta praevia accreta. J OBSTET GYNAECOL 2003; 23:77. [PMID: 12647706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Segal S, Shemesh IY, Blumenthal R, Yoffe B, Laufer N, Ezra Y, Levy I, Mazor M, Martinowitz U. Treatment of obstetric hemorrhage with recombinant activated factor VII (rFVIIa). Arch Gynecol Obstet 2002; 268:266-7. [PMID: 14504866 DOI: 10.1007/s00404-002-0409-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2002] [Accepted: 01/26/2002] [Indexed: 11/25/2022]
Abstract
Recombinant activated factor VII (rFVIIa, NovoSeven) was used in three patients with massive obstetric hemorrhage due to placenta previa accreta, rupture of the uterus and pre-eclampsia with HELLP. Administration of the drug markedly decreased the bleeding and enabled control of the hemorrhage. rFVIIa seems to be an adjunctive hemostatic measure for the treatment of severe obstetric hemorrhage.
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Affiliation(s)
- S Segal
- Department of Obstetrics and Gynecology, Ben-Gurion University of The Negev, Barzilai Medical Center, Ashkelon, Israel 78306.
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Affiliation(s)
- S Vyjayanthi
- Department of Obstetrics and Gynaecology,West Wales General Hospital, Carmarthen, UK
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31
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Miras T, Collet F, Seffert P. [Acute puerperal uterine inversion: two cases]. J Gynecol Obstet Biol Reprod (Paris) 2002; 31:668-71. [PMID: 12457139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.
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Affiliation(s)
- T Miras
- Service de Gynécologie-Obstétrique, CHRU de Saint-Etienne, Hôpital Nord, 42055 Saint-Etienne Cedex 2, France
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32
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Affiliation(s)
- T S Jaswal
- Department of Pathology, Pt. B.D. Sharma PGIMS, Rohtak (Haryana), India
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33
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Pirard C, Squifflet J, Gilles A, Donnez J. Uterine necrosis and sepsis after vascular embolization and surgical ligation in a patient with postpartum hemorrhage. Fertil Steril 2002; 78:412-3. [PMID: 12137882 DOI: 10.1016/s0015-0282(02)03229-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Céline Pirard
- Department of Gynecology, Université Catholique de Louvain, Cliniques Universitaires St. Luc, Brussels, Belgium
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34
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Baloul SM, Al-Sayali AR, Basha AM, Gangoo NJ. Placenta percreta with painless uterine rupture at the 2nd trimester. Saudi Med J 2002; 23:857-9. [PMID: 12174241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
A pregnant lady at 27 weeks and 2 days gestation with a known placenta previa major and a history of previous lower segment cesarean section had a sudden severe painless vaginal bleeding. At laparotomy a uterine rupture was noted, no hemoperitoneum found and placenta percreta was diagnosed. This is the first case reported in the Kingdom of Saudi Arabia, it is rare, only 3 cases of silent or asymptomatic uterine rupture secondary to placenta percreta were reported in the literature in the last 30-years. Non-invasive methods could help in the diagnosis or increase suspicion of placenta percreta, therefore, proper management could be arranged through a multi-disciplinary team.
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Affiliation(s)
- Salah M Baloul
- Department of Obstetrics, Taif Maternity Hospital, PO Box 5084, Taif, Kingdom of Saudi Arabia.
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35
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Washecka R, Behling A. Urologic complications of placenta percreta invading the urinary bladder: a case report and review of the literature. Hawaii Med J 2002; 61:66-9. [PMID: 12050959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Placenta percreta invading the urinary bladder may cause hemorrhagic shock, hematuria and urologic complications at parturition. This retrospective survey of 54 patients reviews maternal characteristics, presentations, urologic complications, and management. METHODS The first reported case of placenta percreta with urinary bladder invasion in Hawaii is presented. Medline search and literature review identified an additional 53 patients. A meta-analysis of all 54 cases was performed. RESULTS Hematuria was present initially in 31% (17/54) patients. Of these, 9 of 17 required transfusion support. A preoperative diagnosis was established by ultrasound or MRI in 33% of patients. Cystoscopy was performed in 12 patients and did not make a preoperative diagnosis in any patient. 39 urologic complications included bladder laceration 26%, urinary fistula 13%, gross hematuria 9%, ureteral transection 6%, and small capacity bladder 4%. Partial cystectomy was performed in 44% (24/54). Three maternal deaths and 14 fetal deaths occurred. Only 1 patient subsequently had a delivery. CONCLUSION Readily identifiable risk factors by history are important to suggest placenta percreta in pregnant patients with gross hematuria. Ultrasound and/or MRI can establish a preoperative diagnosis. Cystoscopy did not identify any patient preoperatively. Partial cystectomy is commonly required for extensive or deep bladder invasion.
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Affiliation(s)
- Robert Washecka
- Kaiser Permanente Department of Urology, 3288 Moanalua Road, Honolulu, HI 96819, USA
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36
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Affiliation(s)
- Manish Singh
- Department of Obstetrics and Gynaecology, Townsville Hospital, Queensland, Australia
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37
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Affiliation(s)
- Peter Jurcevic
- The Royal Women's Hospital, Melbourne, Victoria, Australia
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38
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Abstract
Arterial embolization is a safe and effective treatment for persistent post-partum haemorrhage that is unresponsive to conservative management. Embolization should be the treatment of choice in these patients provided that suitable radiological skills and equipment are available. Embolization is potentially useful in patients with antepartum haemorrhage in the last trimester or in patients at high risk for antepartum haemorrhage.
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Affiliation(s)
- P Corr
- Department of Radiology, University of Natal, Durban, Private Bag 7, Congella 4013, South Africa
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39
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Abstract
Healthy pregnancy is accompanied by changes in the haemostatic system which convert it into a hypercoagulable state vulnerable to a spectrum of disorders ranging from venous thromboembolism to disseminated intravascular coagulation (DIC). This latter is always a secondary phenomenon triggered by specific disorders such as abruptio placentae and amniotic fluid embolism due to release of thromboplastin intravascularly or endothelial damage resulting from pre-eclampsia and sepsis. In modern obstetric practice the most common cause is haemorrhagic shock with delay in resuscitation leading to endothelial damage. The initial management of massive obstetric haemorrhage is the same whether associated with coagulopathy initially or not. Low-grade DIC, associated with pre-eclampsia, is monitored haematologically by serial platelet counts and serum fibrin degradation products (FDPs). Supportive measures and removal of the triggering mechanism are the key to successful management. Outcome depends primarily on our ability to deal with the trigger and not on direct attempts to correct the coagulation deficit.
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Affiliation(s)
- E A Letsky
- Imperial College School of Medicine, Queen Charlotte's Hospital, Hammersmith Hospitals Trust, Hammersmith House, 2nd Floor, Du Cane Road, London, W12 0HS, UK
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Chanrachakul B, Hamontri S, Leopairut J, Herabutya Y. Placenta increta complicating the first trimester abortion. Acta Obstet Gynecol Scand 2001; 80:467-8. [PMID: 11328225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- B Chanrachakul
- Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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42
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Oral B, Güney M, Ozsoy M, Sönal S. Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature. Arch Gynecol Obstet 2001; 265:100-2. [PMID: 11409470 DOI: 10.1007/s004040000140] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 11/25/2022]
Abstract
Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.
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Affiliation(s)
- B Oral
- Beta Patoloji Laboratuari, Hastane Caddesi, Isparta, Turkey.
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43
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Aggarwal P, Gill-Randall R, Wheatley T, Buchalter MB, Metcalfe J, Alcolado JC. Identification of mtDNA mutation in a pedigree with gestational diabetes, deafness, Wolff-Parkinson-White syndrome and placenta accreta. Hum Hered 2001; 51:114-6. [PMID: 11096278 DOI: 10.1159/000022950] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [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: 11/19/2022] Open
Abstract
Mitochondrial DNA (mtDNA) defects are associated with a number of human disorders. Although many occur sporadically, maternal transmission is the hallmark of diseases due to mtDNA point mutations. The same mutation may manifest strikingly different phenotypes; for example, the A to G substitution at np 3243 was first reported in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (the MELAS syndrome), but is also found in patients with diabetes and deafness. Here we present a case of gestational diabetes, deafness, premature greying, placenta accreta and Wolff-Parkinson-White (WPW) syndrome associated with a mtDNA mutation. Although this is the first report of such an association, study of 27 other patients with WPW syndrome failed to confirm that this mtDNA mutation is a common cause of such pre-excitation disorders.
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Affiliation(s)
- P Aggarwal
- Department of Medicine, University of Wales College of Medicine, Cardiff, UK
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44
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Bonn J. Re: temporary balloon occlusion in the internal iliac arteries for control of hemorrhage during cesarean hysterectomy in a patient with placenta previa and placenta increta. J Vasc Interv Radiol 2001; 12:121-2. [PMID: 11200346 DOI: 10.1016/s1051-0443(07)61414-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Abstract
A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.
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Affiliation(s)
- S Lurie
- Department of Obstetrics and Gynecology, Laniado Hospital, Netanya, Israel
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46
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Abstract
Placenta accreta is a complication that is rising in incidence. The reported experience of methotrexate treatment in the conservative management of placenta accreta is scant. Three cases of placenta accreta managed with methotrexate are presented. Case 1: A woman had an antenatal diagnosis of placenta percreta. A successful manual placental removal occurred on post-cesarean day 16. Case 2: A woman had retention of a placenta accreta after a term vaginal delivery. Successful dilation and curettage were performed on postpartum day 37. Case 3: A woman had an antenatal diagnosis of placenta previa-percreta with bladder invasion. A simple hysterectomy was performed on post-cesarean day 46. Conservative management and methotrexate treatment resulted in uterine preservation in two of our three patients; however, this treatment did not prevent significant delayed hemorrhage. In view of the rapid resolution of vascular invasion of the bladder, methotrexate may have an important role in the management of placenta percreta with bladder invasion. The utility of methotrexate treatment with the conservative management of placenta accreta requires further evaluation.
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Affiliation(s)
- G M Mussalli
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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47
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Lachman E, Mali A, Gino G, Burstein M, Stark M. [Placenta accreta with placenta previa after previous cesarean sections--a growing danger in modern obstetrics]. Harefuah 2000; 138:628-31, 712. [PMID: 10883200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The increased rate of cesarean sections in recent decades has brought with it an increase in the frequency of placenta accreta. There are direct correlations between previous cesarean deliveries and also maternal age, with the risk of placenta accreta. There is also a direct correlation between placenta accreta and placenta previa. The risk of placenta accreta in women who have had placenta previa is 2% for those younger than 35 years and with no history of uterine surgery. The risk increases to 39% for those over 35 who have had 2 or more cesarean sections. We present 3 cases of placenta accreta admitted in 15 months, all of whom had a history of cesarean sections. The frequency of placenta accreta in our hospital is 1:1,579 deliveries, in line with the 1:1,420 in the literature. We consider hysterectomy the treatment of choice for this serious complication. When performing a cesarean in cases of placenta previa with a history of cesarean sections, the possibility of placenta accreta should be considered.
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Affiliation(s)
- E Lachman
- Dept. of Obstetrics and Gynecology, Misgav Ladach Hospital, Jerusalem
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48
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Abstract
BACKGROUND Acute puerperal uterine inversion is a rare but potentially life-threatening complication in which the uterine fundus collapses within the endometrial cavity. Although the cause of uterine inversion is unclear, several predisposing factors have been described. Maternal mortality is extremely high unless the condition is recognized and corrected. METHODS MEDLINE was searched from 1966 to the present using the key phrase "uterine inversion." Nonpuerperal uterine inversion case reports were excluded from review except when providing information on classification and diagnostic techniques. A summarized case involving uterine inversion and a review of the classification, etiology, diagnosis, and management are reported. RESULTS AND CONCLUSIONS Although uncommon, if left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. Tocolytics, such as magnesium sulfate and terbutaline, or halogenated anesthetics may be administered to relax the uterus to aid in reversal. Intravenous nitroglycerin provides an alternative to the tocolytics and offers several pharmacodynamic advantages. Treatment with hydrostatic pressure may be attempted while waiting for medications to be administered or for general anesthesia to be induced. In the most resistant of inversions, surgical correction might be required.
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Affiliation(s)
- D R Hostetler
- Dayton Community Family Practice Residency, Ohio, USA
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49
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Megier P, Harmas A, Mesnard L, Esperandieu OL, Desroches A. Picture of the month. Antenatal diagnosis of placenta percreta using gray-scale ultrasonography, color and pulsed Doppler imaging. Ultrasound Obstet Gynecol 2000; 15:268. [PMID: 10846790 DOI: 10.1046/j.1469-0705.2000.00083.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- P Megier
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional d'Orléans, Orleans, France
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50
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Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of transabdominal color Doppler ultrasound in diagnosing placenta previa accreta. DESIGN Eighty patients with persistent placenta previa underwent transabdominal B-mode and color Doppler ultrasound evaluation in the second and third trimesters because they had a high risk of placenta accreta. Color Doppler imaging criteria used included diffuse intraparenchymal placental lacunar flow; focal intraparenchymal placental lacunar flow; bladder-uterine serosa interphase hypervascularity; prominent subplacental venous complex; and loss of subplacental Doppler vascular signals. The color Doppler images were interpreted prospectively for signs of placenta previa accreta according to the exhibited color Doppler sonographic features. RESULTS Sixteen of the 80 patients exhibited characteristic color Doppler imaging patterns highly specific for placenta accreta according to the preceding criteria, and 14 of these had histopathological proof of placenta accreta. Two patients had false-positive color Doppler imaging evidence mistaken for interphase hypervascularity caused by bladder varices. Thirteen patients underwent hysterectomy in the group suspicious for accreta. Of the 64 patients with negative color Doppler imaging results, three had placenta accreta, while two required cesarean hysterectomy; the remaining patient underwent uterine artery ligation for bleeding from the lower uterine segment. The sensitivity of color Doppler imaging in the diagnosis of placenta previa accreta was 82.4% (14/17) and the specificity was 96.8% (61/63). The positive and negative predictive values were 87.5% (14/16) and 95.3% (61/64), respectively. CONCLUSIONS Variable vascular morphological patterns of placenta previa accreta were exhibited and categorized by transabdominal color Doppler sonography in the antenatal period. The identification of these specific vascular patterns had a positive impact on the peripartum clinical management of the affected patients.
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Affiliation(s)
- M M Chou
- Department of Obstetrics and Gynecology, Taichung Veterans' General Hospital, Chung Shan Medical and Dental College, Taiwan, Republic of China
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