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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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Sharami SH, Milani F, Fallah Arzpeyma S, Fakour F, Jafarzadeh Z, Haghparast Z, Sedighinejad A, Attari SM. Placenta accreta outcomes and risk factors in a referral hospital in north of Iran: A case control study. Health Sci Rep 2024; 7:e2006. [PMID: 38605724 PMCID: PMC11006998 DOI: 10.1002/hsr2.2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Background Placenta accreta syndrome (PAS) may led to heavy blood loss and maternal death. Here we analyzed the main risk factors of PAS+ pregnancies and its complications in a referral hospital in the north of Iran. Methods In a case control study, all pregnant women with PAS referred to our department during 2016 till 2021 were enrolled and divided in two groups case (PAS+) and control (PAS-) based on preoperative imaging, intraoperative findings, and pathological reports. The sociodemographic features and neonatal-maternal outcomes also were recorded. Results The most frequent reason for cesarean (C/S) was repeated C/S (62.9%, 56/89). A significant difference showed up in the time lag between previous C/S and the present delivery (p < 0.001) which shows that when the time distance is longer, the risk of PAS rises (OR: 1.01 [95% CI: 1.003-1.017]). Also, a positive history of prior abortion and elective type of previous C/S were related to PAS+ pregnancies. Our other finding showed that PAS+ pregnancies will end in lower gestational age and have a longer duration of operation and hospitalization, heavy blood transfusion, and hysterectomy. Also, PAS+ pregnancies were not related to poor neonatal outcomes. Conclusions It seems that, in addition to repeated C/S as a strong risk factor, previous abortion is a forgotten key which leads to incomplete evacuation or damage the endometrial-myometrial layers.
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Affiliation(s)
- Seyedeh Hajar Sharami
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al‐Zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Forozan Milani
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al‐Zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Sima Fallah Arzpeyma
- Department of Radiology, School of Medicine, Poursina HospitalGuilan University of Medical SciencesRashtIran
| | - Fereshteh Fakour
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al‐Zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Zahra Jafarzadeh
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al‐Zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Zahra Haghparast
- Department of Obstetrics & Gynecology, Reproductive Health Research Center, Al‐Zahra Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Abbas Sedighinejad
- Department of Anesthesiology, Anesthesiology Research Center, Alzahra HospitalGuilan University of Medical SciencesRashtIran
| | - Seyedeh Maryam Attari
- Department of Midwifery and Reproductive Health, Reproductive Health Research Center, Al‐Zahra HospitalGuilan University of Medical SciencesRashtIran
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Lin F, Chen Z, Tao H, Ren X, Ma P, Lash GE, Shuai H, Li P. Sonographic Findings of Vascular Signals for Retained Products of Conception in Women Following First-Trimester Termination of Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102266. [PMID: 37940040 DOI: 10.1016/j.jogc.2023.102266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To evaluate the occurrence of retained products of conception (RPOC) after termination of pregnancy in the first trimester and to assess the vascular signals with transvaginal ultrasonography (TVUS) examination in the detection of retained products. METHODS A retrospective cohort study was performed using TVUS examination in patients following termination of pregnancy. In cases of RPOC, 3 scales of vascular signal were identified: type 1, no or small amount, spot flow signals; type 2, medium amount, strip-like flow signals; type 3, rich amount, circumferential-like flow signals. The correlation between vascular signals and placenta accreta spectrum (PAS) staging was proposed by sonography and histopathology findings. RESULTS The 3 vascular patterns were differently distributed within non-RPOC as well as RPOC patients with and without PAS: type 1 vascular signal detection rates of non-RPOC and RPOC were 97.8% (262/268) and 28.1% (18/64), respectively. Of 64 cases of RPOC, 48.4% (31/64) of the patients had type 2 vascular signals. Vascular signals were enhanced in RPOC with PAS patients whose diagnosis was confirmed by histopathology. CONCLUSIONS The vascularity (amount of flow), vascular pattern (spot, strip- or circumferential-like flow), and the flow penetrating myometrium were significant findings for distinguishing concomitant RPOC with and without PAS. Additionally, RPOC may contribute to PAS progression, or PAS and RPOC in coordination strengthen the observed vascular signals.
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Affiliation(s)
- Fangfang Lin
- Department of Ultrasound, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Zongbing Chen
- Department of Pathology, Jinan University School of Medicine, Guangzhou, China; Department of Gynecology and Obstetrics, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Huan Tao
- Department of Gynecology and Obstetrics, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Xinyi Ren
- Department of Pathology, Jinan University School of Medicine, Guangzhou, China
| | - Peiyan Ma
- Department of Ultrasound, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Gendie E Lash
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hanlin Shuai
- Department of Gynecology and Obstetrics, Jinan University First Affiliated Hospital, Guangzhou, China.
| | - Ping Li
- Department of Pathology, Jinan University School of Medicine, Guangzhou, China.
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4
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Cohen A, Gutman-Ido E, Karavani G, Albeck A, Rosenbloom JI, Shushan A, Chill HH. The association between history of retained placenta and success rate of misoprostol treatment for early pregnancy failure. BMC Womens Health 2023; 23:523. [PMID: 37794425 PMCID: PMC10552386 DOI: 10.1186/s12905-023-02666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND To date, the association between retained placenta and treatment success rate of misoprostol for early pregnancy failure has yet to be evaluated. The aim of this study was to evaluate this association and further investigated the connection between medical, clinical and sonographic parameters and treatment success. METHODS We conducted a retrospective cohort study of women with early pregnancy failure treated with misoprostol from 2006 to 2021. The success rate of misoprostol treatment was compared between patients with history of retained placenta including women who underwent manual lysis of the placenta following delivery or patients who were found to have retained products of conception during their post-partum period (study group) and patients without such history (controls). Demographic, clinical, and sonographic characteristics as well as treatment outcomes were compared between the groups. RESULTS A total of 271 women were included in the study (34 women in the study group compared to 237 women in the control group). Two-hundred and thirty-three women (86.0%) presented with missed abortion, and 38 (14.0%) with blighted ovum. Success rates of misoprostol treatment were 61.8% and 78.5% for the study and control groups, respectively (p = 0.032). Univariate analysis performed comparing successful vs. failed misoprostol treatment showed advanced age, gravidity, parity and gestational sac size (mm) on TVUS were associated with higher misoprostol treatment failure rate. Following a multivariate logistic regression model these variables did not reach statistical significance. CONCLUSION Women who have an event of retained placenta following childbirth appear to have decreased success rate of treatment with misoprostol for early pregnancy failure. Larger studies are needed to confirm this finding.
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Affiliation(s)
- Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel.
| | - Einat Gutman-Ido
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Alon Albeck
- Department of Internal Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Asher Shushan
- Department of Obstetrics and Gynecology, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Ein Kerem, Jerusalem, P.O.B. 12000, 91120, Israel
| | - Henry H Chill
- Division of Urogynecology, University of Chicago Pritzker School of Medicine, NorthShore University HealthSystem, Skokie, IL, USA
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Maurer J, Ramani S, Xu B, Gallousis S, Clark M, Andikyan V. Delayed presentation of placenta accreta following a first-trimester medical abortion. Clin Case Rep 2023; 11:e7849. [PMID: 37636882 PMCID: PMC10457480 DOI: 10.1002/ccr3.7849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Placenta accreta can rarely present as a uterine mass on imaging months after a first trimester medical abortion, even in patients at low-risk for abnormal placentation. Early and accurate diagnosis can be crucial to reduce morbidity and mortality associated with this disease, particularly for those desiring fertility preservation.
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Affiliation(s)
- Jenna Maurer
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Sangeeta Ramani
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Bo Xu
- Department of PathologyStamford HospitalStamfordConnecticutUSA
| | - Stephen Gallousis
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
| | - Mitchell Clark
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenConnecticutUSA
| | - Vaagn Andikyan
- Department of Obstetrics and GynecologyStamford HospitalStamfordConnecticutUSA
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenConnecticutUSA
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6
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Berriozabal C, De La Rosa JH, Lobo I, Beiro E, Dehesa T. A rare case of placenta accreta after a first-trimester abortion. Int J Gynaecol Obstet 2023; 161:322-323. [PMID: 36399398 DOI: 10.1002/ijgo.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Cristina Berriozabal
- Department of Gynecologic Oncology, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Ignacio Lobo
- Department of Gynecologic Oncology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Eva Beiro
- Department of Gynecologic Oncology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Tamara Dehesa
- Department of Gynecologic Oncology, Hospital Universitario de Basurto, Bilbao, Spain
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7
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Suhaimi N, Ishak A, Mohammad N. A near miss case of placenta percreta at primary care: A case report. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present a case of severe placenta percreta in a 33-year-old woman, gravida 9 para5+3, who presented to the health clinic with gross hematuria for three days at 16 weeks gestation. She had a history of multiple cesarean deliveries and uterine curettage. The diagnosis was suspected, and an urgent referral was made. Ultrasonography findings done by an obstetrician in a tertiary hospital confirmed the diagnosis. Unfortunately, the pregnancy had to be terminated as her condition deteriorated. Primary care practitioners should have high clinical suspicion to recognize this rare and life-threatening condition.
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Affiliation(s)
- Nornadia Suhaimi
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA
| | - Azlina Ishak
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA
| | - Noraini Mohammad
- School of Dental Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA
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8
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Noblett D, Sekhon S, Corwin MT, Lamba R, McGahan JP. Retained Morbidly Adherent Placenta Presenting as a Myometrial Mass in Patients With Vaginal Bleeding: A Case Series and Review of Current Literature. Ultrasound Q 2022; 38:263-266. [PMID: 35426380 DOI: 10.1097/ruq.0000000000000612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The differential diagnosis for a uterine mass and vaginal bleeding after abortion or delivery is broad and includes both benign and malignant causes. A rare etiology for this condition is retained morbidly adherent placenta. Few cases of retained morbidly adherent placenta presenting as a myometrial mass in the setting of vaginal bleeding have been described in the medical literature. In this case series and review of the current literature, we describe the ultrasound features of 3 retained morbidly adherent placentae, along with correlative magnetic resonance imaging findings.
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Affiliation(s)
- Dylan Noblett
- Department of Radiology, University of California, Davis Medical Center, Sacramento, CA
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9
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Pellegrino A, Campanelli FD, Villa M, Damiani GR, Riva C, Dainese E. Exaggerated Placental Site as a Cause of Hysterectomy for Massive Bleeding After First Trimester Voluntary Abortion. J Obstet Gynaecol India 2022; 72:463-465. [PMID: 36458070 PMCID: PMC9568625 DOI: 10.1007/s13224-021-01469-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/17/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Placental implantation anomalies in first-trimester abortions may determine severe bleeding leading to hysterectomy. There are very few cases of urgent hysterectomy post-abortion reported in the literature, related to placenta accreta spectrum, but in any of them is considered association with benign trophoblastic lesions. Methods We report the case of a woman, who underwent surgical voluntary abortion by vacuum aspiration during first trimester, without any apparent surgical complications. Immediately, after this procedure, the patient had massive vaginal bleeding; an emergency hysterectomy was performed. Histological examination showed an exaggerated placental site (EPS). Results Morphological findings describe a trophoblastic tumor-like lesion, which differs from placenta accreta and often considered an asymptomatic occasional feature. Proliferative index, evaluated by double immunostain for CK8-18 and Ki-67, was unremarkable (<1%). Conclusions Only a single report in the literature describes a case of symptomatic EPS 65 after first-trimester abortion. Major attention should be paid to trophoblastic pathology in order to understand a possible relationship with uterine bleeding and to find a clinical, ultrasound or chemical indicator.
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Affiliation(s)
- Antonio Pellegrino
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Francesco Davide Campanelli
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Mario Villa
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Cristina Riva
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
| | - Emanuele Dainese
- Department of Biomedical Sciences and Human Oncology, Division of Gynecology and Obstetrics, University of Bari,, ‘Aldo Moro’, P.Za Giulio Cesare, 11, 70124 Bari, Italy
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Guzmán López JA, Gutiérrez Sánchez LÁ, Pinilla-Monsalve GD, Timor-Tritsch IE. Placenta accreta spectrum disorders in the first trimester: a systematic review. J OBSTET GYNAECOL 2022; 42:1703-1710. [PMID: 35724241 DOI: 10.1080/01443615.2022.2071151] [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: 10/18/2022]
Abstract
Placenta accreta spectrum (PAS) disorders involve an abnormality in the implantation of the placenta, being rarely diagnosed in the first trimester. To conduct a systematic review of the risk factors, clinical and imaging features, and outcomes of histopathologically confirmed cases of PAS disorders in the first trimester of pregnancy. Different databases including PubMed, MEDLINE Complete, Scopus, Web of Science, EMBASE, SciELO, LILACS, and Ovid were reviewed up to November 2018. 55 patients with a definitive histopathological diagnosis were reported. About 18 had a history of prior curettage and 47 of previous caesarean deliveries (CD). About 74.54% presented with miscarriage and ultrasound signs of caesarean scar pregnancy (CSP) were reported in 22.49%. Temporal sequence of diagnostic studies could be determined in 52 women, and, among these, PAS disorders were defined through imaging techniques in 11 (21.15%) while surgical findings unveiled them in 15 (28.84%). Nonetheless, in half of the cases, the diagnosis was concluded only on histopathological samples. PAS disorders in the first trimester of pregnancy are rarely diagnosed through imaging techniques and lead to hysterectomy in most cases. Ultrasound training to detect PAS disorders in women with risk factors is crucial for early diagnosis and prevention of adverse outcomes.
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Affiliation(s)
| | - Luz Ángela Gutiérrez Sánchez
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Unit, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | - Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, Division of Obstetrics and Gynecological Ultrasound, New York University School of Medicine, New York City, NY, USA
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Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology. Diagnostics (Basel) 2022; 12:diagnostics12061436. [PMID: 35741246 PMCID: PMC9222048 DOI: 10.3390/diagnostics12061436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.
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12
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Bhatia A, Palacio M, Wright AM, Yeo GSH. Lower uterine segment scar assessment at 11-14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:40-48. [PMID: 34254386 DOI: 10.1002/uog.23734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To validate prospectively transvaginal ultrasound assessment of the lower uterine segment (LUS) scar at the time of first-trimester screening in women with previous Cesarean section (CS) and to determine its feasibility and accuracy in stratifying women according to the risk for placenta accreta spectrum (PAS) disorder. METHODS Women with a history of CS were recruited between 11 + 0 and 13 + 6 weeks' gestation and underwent LUS scar assessment using transvaginal ultrasound. A standardized midsagittal plane, which included the cervicoisthmic canal (CIC), the uterine scar and the placental site, was obtained. The scar was described in terms of its size (narrow or dehiscent) and its location in relation to the CIC (within or above), with each LUS scar classified into one of four groups based on these features. Placental location was assessed and classified as high- or low-lying. Women were stratified according to the risk of PAS, based on the relationship between the scar location and placental site. Women were considered high risk when the scar was above the CIC and the placenta was low-lying (i.e. when the placenta was overlying an exposed scar) and low risk when the scar was within the CIC and/or the placenta was high. High-risk patients were followed up at 20 weeks and 28-30 weeks for the development of PAS. Maternal demographics, detailed obstetric history and obstetric outcome were collected. RESULTS First-trimester transvaginal ultrasound was offered to 535 women with prior CS during the study period. A LUS scar was visualized in 79.9% (401/502) of those who agreed to undergo the examination. At this scan, the LUS scar was above the CIC in 9.0% (36/401) of women, but only 5.7% (23/401) additionally had a low-lying placenta overlying the scar. Of these 23 high-risk women, two were found to have PAS on the mid-trimester screening scan and one was noted to have placental adherence during evacuation following mid-trimester termination of pregnancy. On the first-trimester scan, 94.3% (378/401) of women were at low risk of PAS. This screening protocol yielded a positive likelihood ratio of 21.33 (95% CI, 13.02-34.96), sensitivity of 100% (95% CI, 29.24-100%), specificity of 95.31% (95% CI, 92.39-97.35%), positive predictive value of 16.7% (95% CI, 5.8-39.2%) and negative predictive value of 100% (95% CI, 98.4-100%). On multivariable regression analysis performed to identify confounding variables associated with a LUS scar above the CIC, only maternal body mass index ≥ 30 kg/m2 was significant (odds ratio (OR), 2.42 (95% CI, 1.04-5.39); P = 0.03). Although there was a trend towards an increased risk of a LUS scar above the CIC in women with prior elective prelabor CS (OR, 1.72 (95% CI, 0.80-3.68)), this association did not reach statistical significance. CONCLUSIONS Routine transvaginal ultrasound assessment of the location of the LUS scar and placenta at the time of first-trimester screening between 11 + 0 and 13 + 6 weeks' gestation in women with prior CS is a feasible and effective tool to identify those at risk of subsequent development of PAS disorder. A finding of placental implantation over an exposed LUS scar seems to be cardinal in predicting the risk of PAS disorder in women with prior CS, with an excellent negative predictive value. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Bhatia
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - M Palacio
- Hospital Clinic of Barcelona (BCNatal), IDIBAPS, University of Barcelona, CIBER-ER, Barcelona, Spain
| | - A M Wright
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - G S H Yeo
- Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore
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13
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Anupama Marnal BA, Poornima M, Sapna HP. Unusual case of placenta accreta - A Case Report. APOLLO MEDICINE 2022. [DOI: 10.4103/am.am_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nik-Ahmad-Zuky NL, Seoparjoo A, Husna EIE. Placenta increta presenting with threatened miscarriage during the first trimester in rhesus-negative mother: a case report. J Med Case Rep 2021; 15:448. [PMID: 34493340 PMCID: PMC8424964 DOI: 10.1186/s13256-021-03030-x] [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: 07/31/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Placenta accreta is known to be associated with significant maternal morbidity and mortality-primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon. CASE PRESENTATION A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta. CONCLUSION A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.
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Affiliation(s)
- Nik Lah Nik-Ahmad-Zuky
- Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. .,Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - Azmel Seoparjoo
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Engku Ismail Engku Husna
- Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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De Gennaro E, Orsaria M, Driul L. Placenta accreta in the first trimester: A case report. Clin Case Rep 2021; 9:e04615. [PMID: 34512978 PMCID: PMC8423128 DOI: 10.1002/ccr3.4615] [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: 02/28/2021] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 11/11/2022] Open
Abstract
Placenta accreta is a severe complication of pregnancy normally diagnosed during the second trimester. Early detection could reduce the risk of hemorrhage during abortion or miscarriage; however, guidelines on first-trimester diagnosis are lacking. We describe a case of placenta accreta during the first trimester with its sonographic and histological features.
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Affiliation(s)
- Elena De Gennaro
- Clinic of Obstetrics and GynecologyHospital of UdineDAMEUniversity of UdineUdineItaly
| | - Maria Orsaria
- Institute of PathologyHospital of UdineDAMEUniversity of UdineUdineItaly
| | - Lorenza Driul
- Clinic of Obstetrics and GynecologyHospital of UdineDAMEUniversity of UdineUdineItaly
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Chou MM, Yuan JC, Lu YA, Chuang SW. Recurrent severe placenta increta at 8 weeks of gestation in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum disorder. Taiwan J Obstet Gynecol 2021; 59:956-959. [PMID: 33218421 DOI: 10.1016/j.tjog.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We describe herein our experience of employing a hysterectomy and prophylactic internal iliac artery balloon occlusion (IIABO) strategy for the management of recurrent severe placenta increta at 8 weeks in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum (PAS) disorder. CASE REPORT A 40-year-old woman with a history of uterus-conserving surgery for PAS disorder underwent transvaginal ultrasound evaluation at 8 weeks of pregnancy, which showed a dichorionic/diamniotic pregnancy with viable embryos of a crown-rump length of 1.65 cm and 2.03 cm, respectively. Many irregularly-shaped grade 3+ lacunae were observed, and color Doppler imaging revealed diffuse intraplacental and perihypervascularity. A total abdominal hysterectomy was performed at 10 weeks, with an estimated blood loss of 1275 mL. Placenta increta was confirmed by histopathologic examination. CONCLUSION The high rate of recurrence of PAS disorder in a subsequent pregnancy should be discussed following an antenatal diagnosis of PAS disorder with patients who may be considering uterine conservation in order to retain the option of a future pregnancy.
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Affiliation(s)
- Min-Min Chou
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
| | - Jia-Chun Yuan
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Yaw-An Lu
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Wei Chuang
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
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Chou MM, Yuan JC, Lu YA, Chuang SW. Successful treatment of placenta accreta spectrum disorder using management strategy of serial uterine artery embolization combined with standard weekly and a 8-day methotrexate/folinic acid regimens at 7 weeks of gestation. Taiwan J Obstet Gynecol 2021; 59:952-955. [PMID: 33218420 DOI: 10.1016/j.tjog.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We describe our experience with serial uterine artery embolization (UAE) combined with standard weekly methotrexate and a eight-day methotrexate/folinic acid (MTX/FA) treatment regimen in the management of placenta accreta spectrum (PAS) disorder at 7 weeks of gestation. CASE REPORT A 38-year-old woman, gravida 2 para 0, with a history of myomectomy, was referred for ultrasound (US) evaluation due to suspected cervico-isthmic pregnancy. Transvaginal US image showed a viable embryo with a disproportionately bigger placenta encircling the fetus and completely covering the internal os of the cervix at 7 weeks of gestation. Color Doppler imaging revealed diffuse intraplacental and periplacental vascularity. Patient chose to terminate the pregnancy but attempted to preserve the uterus for future fertility following counseling. Serial UAE procedures were performed using Gelfoam and metallic microcoils. Two courses of a standard weekly MTX and a eight-day MTX/FA treatment regimen were administered to accelerate placental regression. The beta-hCG gradually decreased to a normal level, and an ultimate resolution of the PAS disorder was observed at 110 days after treatment. CONCLUSION Early diagnosis of the PAS disorder could result in better obstetric outcome through earlier intervention using serial UAE combined with standard weekly and a eight day MTX//FA regimen in the first trimester of pregnancy.
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Affiliation(s)
- Min-Min Chou
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan.
| | - Jia-Chun Yuan
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Yaw-An Lu
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Sheng-Wei Chuang
- Center for High Risk Pregnancy and Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 40447, Taiwan
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Fonseca A, Ayres de Campos D. Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol 2020; 72:84-91. [PMID: 32778495 DOI: 10.1016/j.bpobgyn.2020.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022]
Abstract
Placenta accreta spectrum (PAS) disorders are an increasing health problem in many parts of the world. They are an important risk factor for adverse maternal outcomes related to delivery, with a reported 18-fold increase in maternal morbidity. Profuse haemorrhage after attempting to remove the placenta is the most frequent complication and can lead to major maternal morbidity and ultimately to maternal death. Morbidity can also arise from the multiple procedures required to treat PAS disorders. Intensive care unit admission, mechanical ventilation, infection, and prolonged hospitalization are common in these patients. Long-term complications related to infertility and psychological disturbances can also occur and may have a strong and long-lasting impact on women's health. Antenatal diagnosis allows for appropriate scheduling of delivery and referral to a specialized centre and has been shown to reduce maternal morbidity and mortality.
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Affiliation(s)
- Andreia Fonseca
- Department of Obstetrics, Santa Maria University Hospital, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal.
| | - Diogo Ayres de Campos
- Department of Obstetrics, Santa Maria University Hospital, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal; Medical School, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
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Orellana T, Peters A, Lee TT. Cesarean Section Scar Increta Following First Trimester Surgical Abortion: A Rare Phenomenon Requiring Hysterectomy. J Minim Invasive Gynecol 2020; 27:800-802. [DOI: 10.1016/j.jmig.2019.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 11/16/2022]
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