1
|
Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol 2016; 215:712-721. [PMID: 27473003 DOI: 10.1016/j.ajog.2016.07.044] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Determining the depth of villous invasiveness before delivery is pivotal in planning individual management of placenta accreta. We have evaluated the value of various ultrasound signs proposed in the international literature for the prenatal diagnosis of accreta placentation and assessment of the depth of villous invasiveness. OBJECTIVE We undertook a PubMed and MEDLINE search of the relevant studies published from the first prenatal ultrasound description of placenta accreta in 1982 through March 30, 2016, using key words "placenta accreta," "placenta increta," "placenta percreta," "abnormally invasive placenta," "morbidly adherent placenta," and "placenta adhesive disorder" as related to "sonography," "ultrasound diagnosis," "prenatal diagnosis," "gray-scale imaging," "3-dimensional ultrasound", and "color Doppler imaging." STUDY DESIGN The primary eligibility criteria were articles that correlated prenatal ultrasound imaging with pregnancy outcome. A total of 84 studies, including 31 case reports describing 38 cases of placenta accreta and 53 series describing 1078 cases were analyzed. Placenta accreta was subdivided into placenta creta to describe superficially adherent placentation and placenta increta and placenta percreta to describe invasive placentation. RESULTS Of the 53 study series, 23 did not provide data on the depth of villous myometrial invasion on ultrasound imaging or at delivery. Detailed correlations between ultrasound findings and placenta accreta grading were found in 72 cases. A loss of clear zone (62.1%) and the presence of bridging vessels (71.4%) were the most common ultrasound signs in cases of placenta creta. In placenta increta, a loss of clear zone (84.6%) and subplacental hypervascularity (60%) were the most common ultrasound signs, whereas placental lacunae (82.4%) and subplacental hypervascularity (54.5%) were the most common ultrasound signs in placenta percreta. No ultrasound sign or a combination of ultrasound signs were specific of the depth of accreta placentation. CONCLUSION The wide heterogeneity in terminology used to describe the grades of accreta placentation and differences in study design limits the evaluation of the accuracy of ultrasound imaging in the screening and diagnosis of placenta accreta. This review emphasizes the need for further prospective studies using a standardized evidence-based approach including a systematic correlation between ultrasound signs of placenta accreta and detailed clinical and pathologic examinations at delivery.
Collapse
Affiliation(s)
- Eric Jauniaux
- Department of Obstetrics and Gynecology, University College London Hospitals and University College London Institute for Women's Health, University College London, London, United Kingdom.
| | - Sally L Collins
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, and the Fetal Medicine Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Davor Jurkovic
- Department of Obstetrics and Gynecology, University College London Hospitals and University College London Institute for Women's Health, University College London, London, United Kingdom
| | - Graham J Burton
- Center for Trophoblast Research, Department of Physiology, Development, and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
2
|
Kondoh E, Kawasaki K, Chigusa Y, Mogami H, Ueda A, Kawamura Y, Konishi I. Optimal strategies for conservative management of placenta accreta: a review of the literature. HYPERTENSION RESEARCH IN PREGNANCY 2015. [DOI: 10.14390/jsshp.3.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eiji Kondoh
- Department of Gynecology and Obstetrics, Kyoto University
| | - Kaoru Kawasaki
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Haruta Mogami
- Department of Gynecology and Obstetrics, Kyoto University
| | - Akihiko Ueda
- Department of Gynecology and Obstetrics, Kyoto University
| | | | - Ikuo Konishi
- Department of Gynecology and Obstetrics, Kyoto University
| |
Collapse
|
3
|
Tam Tam KB, Dozier J, Martin JN. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review. J Matern Fetal Neonatal Med 2013; 25:329-34. [PMID: 23003574 DOI: 10.3109/14767058.2011.576720] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A systematic review of the literature was conducted to answer the following question: are there enhancements to standard peripartum hysterectomy technique that minimize unintentional urinary tract (UT) injury in pregnancies complicated by invasive placental attachment (INPLAT)? METHODS A PubMed search of English language articles on INPLAT published by June 2010 was conducted. Data regarding the following parameters was required for inclusion in the quantitative analysis of the review's objective: (1) type of INPLAT, (2) details pertaining to medical and surgical management of INPLAT, and (3) complications, if any, associated with management. An attempt was made to identify approaches that may lower the risk of unintentional UT injury. RESULTS Most cases (285 of 292) were managed by hysterectomy. There were 83 (29%) cases of unintentional UT injury. Antenatal diagnosis of INPLAT lowered the rate of UT injury (39% vs. 63%; P = 0.04). Information regarding surgical technique or medical management was available for 90 cases; 14 of these underwent a standard hysterectomy technique. Methotrexate treatment and 11 modifications of the surgical technique were associated with 16% unintentional UT injury rate as opposed to 57% for standard hysterectomy (P = 0.002). The use of ureteral stents reduced risk of urologic injury (P = 0.01). Multiple logistic regression analysis identified antenatal diagnosis as the significant predictor of an intact UT. CONCLUSIONS Antenatal diagnosis of INPLAT is paramount to minimize UT injury. Utilization of management modifications identified in this review may reduce urologic injury due to INPLAT.
Collapse
Affiliation(s)
- Kiran Babu Tam Tam
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA
| | | | | |
Collapse
|
4
|
Shukunami K, Hattori K, Nishijima K, Kotsuji F. Transverse fundal uterine incision in a patient with placenta increta. J Matern Fetal Neonatal Med 2009. [DOI: 10.1080/jmf.16.6.355.356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- K Shukunami
- Department of Obstetrics and Gynecology University of Fukui Matsuoka-Cho Yoshida-Gun, Fukui 910-1193 Japan
| | - K Hattori
- Department of Obstetrics and Gynecology University of Fukui Matsuoka-Cho Yoshida-Gun, Fukui 910-1193 Japan
| | - K Nishijima
- Department of Obstetrics and Gynecology University of Fukui Matsuoka-Cho Yoshida-Gun, Fukui 910-1193 Japan
| | - F Kotsuji
- Department of Obstetrics and Gynecology University of Fukui Matsuoka-Cho Yoshida-Gun, Fukui 910-1193 Japan
| |
Collapse
|
5
|
Abstract
Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta. The diagnosis is typically made by gray-scale ultrasound and confirmed with magnetic resonance imaging, which may better delineate the extent of placental invasion. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta. Aggressive management of hemorrhage through the use of uterotonics, fluid resuscitation, blood products, planned hysterectomy, and surgical hemostatic agents can be life-saving for these patients. Conservative management, including the use of uterine and placental preservation and subsequent methotrexate therapy or pelvic artery embolization, may be considered when a focal accreta is suspected; however, surgical management remains the current standard of care.
Collapse
Affiliation(s)
- Samuel T Bauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
| | | |
Collapse
|
6
|
Thia EWH, Tan LK, Devendra K, Yong TT, Tan HK, Ho TH. Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n4p298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta).
Clinical Picture: We report on 2 cases, one treated “conservatively”, the other with a caesarean hysterectomy, both of which led to a safe outcome for both mother and baby.
Conclusions: Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.
Key words: Management, Obstetric haemorrhage, Placenta accreta, Placenta percreta, Placenta increta
Collapse
|
7
|
Affiliation(s)
- G Burke
- Mid-Western Regional Maternity Hospital, Limerick, Ireland.
| |
Collapse
|
8
|
Abstract
A total of 54 166 mothers delivered at the Riyadh Armed Forces Hospital between 1990 and 1997, including 6119 (11.3%) caesarean sections. Emergency peripartum hysterectomy for obstetric haemorrhage was carried out in 16 cases (0.3/1000 deliveries). The operation followed major degrees of placenta praevia in 12 (75%) cases and atonic postpartum haemorrhage in four (25%). All patients required blood transfusion. There was one neonatal death and no maternal deaths. Although the operation was straightforward, bladder injury occurred in five (31%) cases which was repaired with no residual damage. Placenta accreta was confirmed histologically in 12 (75%) patients. In conclusion, all obstetricians should be aware of the strong association between a scarred uterus, placenta praevia and placenta accreta which can be very adherent and difficult to remove causing bleeding and necessitating hysterectomy. The operation should be performed by an experienced obstetrician before the patient's condition is extreme.
Collapse
Affiliation(s)
- R Mesleh
- Department of Obstetrics and Gynaecology, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | |
Collapse
|
9
|
Campbell PT. Placenta accreta: a case study. Crit Care Nurs Clin North Am 2004; 16:231-2. [PMID: 15145367 DOI: 10.1016/j.ccell.2004.03.001] [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: 11/17/2022]
Abstract
Placenta accreta is a placenta implantation that results in an abnormal firm adherence to the uterine wall. The placenta is attached directly to the myometrium. Placenta increta extends in the myometrium into the uterine musculature. The most severe form of accreta is percreta. In placenta percreta, penetration of the trophoblast through the myometrium possibly occurs into the peritoneum and invades adjunct organs.
Collapse
|
10
|
|
11
|
Caliskan E, Tan O, Kurtaran V, Dilbaz B, Haberal A. Placenta previa percreta with urinary bladder and ureter invasion. Arch Gynecol Obstet 2002; 268:343-4. [PMID: 14504885 DOI: 10.1007/s00404-002-0402-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2002] [Accepted: 08/02/2002] [Indexed: 11/27/2022]
Abstract
A 26-year-old woman, with one previous cesarean delivery and two uterine curettage due to incomplete abortion, was admitted to the labor ward with the diagnosis of partial placenta previa at 35 weeks of gestation. Repeat cesarean section was performed due to profuse vaginal bleeding. Placenta previa percreta invading the bladder trigone was confirmed with cystotomy. As bilateral hypogastric artery ligation and supracervical hysterectomy performed were not successful in stopping the profuse bleeding, the abdomen was packed with laparotomy pads. Dilatation of the left ureter was noticed on the second postoperative day. Relaparotomy was performed to remove the pads, and placental invasion of the distal left ureter was noticed. Ureteroneocystostomy was performed. The postoperative course was uneventful, and the double-J-catheter was removed two months later.
Collapse
Affiliation(s)
- E Caliskan
- SSK Ankara Maternity and Women's Health Teaching Hospital, 06660 Kucukesat Ankara, Turkey.
| | | | | | | | | |
Collapse
|
12
|
DeFriend DE, Dubbins PA, Hughes PM. Sacculation of the uterus and placenta accreta: MRI appearances. Br J Radiol 2000; 73:1323-5. [PMID: 11205679 DOI: 10.1259/bjr.73.876.11205679] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- D E DeFriend
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | | | | |
Collapse
|
13
|
Abstract
PURPOSE To document whether hemorrhage and fluid administration during peripartum hysterectomy results in changes in the airway that may predispose to subsequent difficult intubation, in the event that intraoperative general anesthesia is required during regional anesthesia. CLINICAL FEATURES A 32-yr-old underwent peripartum hysterectomy for placenta accreta. Blood loss of 5.5 L occurred during surgery requiring 6 L crystalloid, 1 L hetastarch, five units packed RBCs and two units fresh frozen plasma. Airway changes were followed using Samsoon's modification of Mallampati airway classification. In addition, airway photographs were obtained using a Polaroid camera. The airway of the patient changed from class 2 preoperatively to class 4 in the immediate postoperative period. The airway gradually returned to normal over the ensuing 48 hr, during which a negative fluid balance of 4 L occurred due to substantial postoperative diuresis. CONCLUSION Peripartum airway changes were detected during Cesarean hysterectomy and fluid resuscitation that gradually returned to normal within 48 hr after surgery.
Collapse
Affiliation(s)
- K Bhavani-Shankar
- Department of Anaesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | | | | |
Collapse
|
14
|
Otsubo Y, Shinagawa T, Chihara H, Araki T. Conservative management of a case of placenta praevia percreta. Aust N Z J Obstet Gynaecol 1999; 39:518-9. [PMID: 10687782 DOI: 10.1111/j.1479-828x.1999.tb03151.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pregnancies complicated by placenta praevia and a history of caesarean section are associated with increased risk of placenta percreta (1). Placenta praevia percreta sometimes involves the bladder or other pelvic organ, invasion leading to genital bleeding or haematuria (2, 3). Bladder injury or uncontrollable profuse haemorrhage occasionally occurs in such patients during surgery. Examination of placental invasion is necessary as this clinical condition is severe. Treatment of placental myometrium invasion is required to prevent uncontrollable profuse haemorrhage during surgery. We present a multiparous patient who was diagnosed prenatally with placenta praevia percreta using magnetic resonance imaging (MRI) and who was treated conservatively with a good prognosis.
Collapse
Affiliation(s)
- Y Otsubo
- Department of Obstetrics and Gynaecology, Omiya Chuo Sogo Hospital, Omiya-shi, Saitama, Japan
| | | | | | | |
Collapse
|
15
|
Abstract
Recent studies using transvaginal and transperineal sonography to monitor the cervix have dramatically increased our knowledge of morphological changes of the cervix throughout pregnancy. Knowledge of the normal and abnormal appearance of the cervix gives insight into the processes of premature labor and cervical incompetence. The finding of a short cervix can be used to identify (and possibly treat) patients at risk for premature delivery. This article reviews the use of cervical sonography in obstetric care, including the diagnosis of incompetent cervix, the detection and monitoring of premature labor, and the evaluation of placenta previa.
Collapse
Affiliation(s)
- G Wong
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | |
Collapse
|