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Tanaka ME, Keefe N, Caridi T, Kohi M, Salazar G. Interventional Radiology in Obstetrics and Gynecology: Updates in Women's Health. Radiographics 2023; 43:e220039. [PMID: 36729949 DOI: 10.1148/rg.220039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Interventional radiology has had an expanding role in women's health over the past few decades, with recent accelerated growth and development. Interventional radiology is fundamental in the treatment of multiple conditions that affect women, including pelvic venous disease, uterine fibroids, and adenomyosis, and in postpartum management. Patient workup, classification, and treatment techniques have continued to evolve as interventional radiology has become more prevalent in the treatment of patients affected by these conditions. The authors provide a review of the pathophysiology of, patient workup for, and treatment of pelvic venous disease and uterine artery embolization for various disease processes. The authors also highlight updates from the past 5-10 years in diagnosis, classification, and treatment strategies. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mari E Tanaka
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Nicole Keefe
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Theresa Caridi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Maureen Kohi
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
| | - Gloria Salazar
- From the Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.E.T.); Departments of Interventional Radiology (N.K., G.S.) and Radiology (M.K.), University of North Carolina School of Medicine, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599; and Division of Vascular and Interventional Radiology, University of Alabama at Birmingham, Birmingham, Ala (T.C.)
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Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:49-58. [PMID: 36701609 DOI: 10.1097/aog.0000000000004976] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/18/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate red blood cell use during delivery in patients with placenta accreta spectrum. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies. METHODS OF STUDY SELECTION Abstracts (n=4,275) and full-text studies (n=599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. TABULATION, INTEGRATION, AND RESULTS Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I2=91%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n=220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes. CONCLUSION Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021240993.
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Trends in Unplanned Peripartum Hysterectomy in the United States, 2009-2020. Obstet Gynecol 2022; 139:449-451. [PMID: 35115435 PMCID: PMC8857040 DOI: 10.1097/aog.0000000000004673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
The incidence of unplanned peripartum hysterectomy is increasing nationwide, which may reflect an increase in placenta accreta spectrum disorders.
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Akhade SP, Ghormade PS, Bhengra A, Chavali K, Hussain N. Uterine scar rupture at the site of the placenta accreta presenting as a case of sudden death. AUTOPSY AND CASE REPORTS 2020; 11:e2020226. [PMID: 34277490 PMCID: PMC8101679 DOI: 10.4322/acr.2020.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022] Open
Abstract
Uterine rupture during pregnancy is a known complication of placenta accreta. This paper presents a case of sudden maternal death in the 27th week of gestation due to a ruptured uterine scar at the site of placenta accreta with a short inter-pregnancy period of 6 months with previous two C-sections. Autopsy findings revealed a massive hemoperitoneum and a thinned out anterolateral uterine wall. Internal examination revealed clotted and fluid blood in the peritoneal cavity with rupture of the anterior uterine wall at the site of the placenta accreta in a healed cesarean section scar. Placenta accreta is a rare complication of pregnancy. However, it is becoming more frequent and a significant risk factor with the increasing rate of C-section.
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Affiliation(s)
- Swapnil Prabhakar Akhade
- All India Institute of Medical Sciences, Department of Forensic Medicine and Toxicology, Raipur, Chhattisgarh, India
| | - Pankaj Suresh Ghormade
- All India Institute of Medical Sciences, Department of Forensic Medicine and Toxicology, Raipur, Chhattisgarh, India
| | - Ajay Bhengra
- Hazaribagh Medical College, Department of Forensic Medicine and Toxicology, Hazaribagh, Jharkhand, India
| | - Krishnadutt Chavali
- All India Institute of Medical Sciences, Department of Forensic Medicine and Toxicology, Raipur, Chhattisgarh, India
| | - Nighat Hussain
- All India Institute of Medical Sciences, Department of Forensic Medicine and Toxicology, Raipur, Chhattisgarh, India.,All India Institute of Medical Sciences, Department of Pathology, Raipur, Chhattisgarh, India
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Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221:208-218. [PMID: 30716286 DOI: 10.1016/j.ajog.2019.01.233] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/22/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE DATA The objective of this study was to evaluate the prevalence of placenta accreta spectrum in general population studies and the main maternal outcomes at delivery. STUDY We searched PubMed, Google Scholar, clinicalTrials.gov, and MEDLINE between 1982 and 2018. Articles that provided data on the number of cases of placenta accreta spectrum per pregnancies, births, or deliveries in a defined population were used. STUDY APPRAISAL AND SYNTHESIS METHODS Study characteristics were evaluated by 2 independent reviewers who used a predesigned protocol. Primary outcomes were the prevalence of placenta accreta spectrum and clinical diagnostic data at birth; the pathologic criteria were used to confirm the diagnosis. Secondary outcomes included cases that required transfusion, incidence of peripartum hysterectomy, and maternal mortality rates. Heterogeneity between studies was analyzed with the Cochran's Q-test and the I2 statistics. RESULTS Of the 98 full-text studies that were identified, 29 articles met the defined criteria and included 22 retrospective and 7 prospective studies comprising 7001 cases of placenta accreta spectrum of 5,719,992 births. Prevalence rates ranged from 0.01-1.1% with an overall pooled prevalence of 0.17% (95% confidence interval, 0.14-0.19). Only 10 studies provided detailed histopathologic data. The pool prevalence for the adherent vs the invasive grades was 0.5 (95% confidence interval, 0.3-0.36) and 0.3 (95% confidence interval, 0.2-0.4) per 1000 births, respectively. The pooled incidence for peripartum hysterectomy was 52.2% (95% confidence interval, 38.3-66.4; I2=99.8%) and 46.9% (95 % confidence interval, 34-59.9; I2=98.8%) for hemorrhage that required transfusion. The pooled estimate of maternal death was 0.05% (95% confidence interval, 0.06-0.69; I2=73%). We found large amounts of heterogeneity between studies for all parameters and further quantification was limited because of methodologic inconsistencies between studies with regards to clinical criteria that were used for the diagnosis of the condition at birth and the histopathologic confirmation of the diagnosis and differential diagnosis between adherent and invasive accreta placentation. CONCLUSION This meta-analysis indicated wide variation between studies for the prevalence rate of placenta accreta spectrum and for the different grades of accreta placentation that highlighted the need for consistency in definitions that are used to describe placenta accreta spectrum at birth and in the reporting of this increasing common obstetric complication.
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Abnormally adherent placenta: Current concepts and anesthetic management. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abbas AM, Michael A, Ali SS, Abdalmageed OS. Placenta percreta presenting with marked hemoperitoneum in the first trimester of pregnancy: A case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abbas AM, Ali SEEA, Michael A, Ali SS. Successful fertility-preserving management of a case of placenta percreta invading the urinary bladder and anterior abdominal wall: A case report. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Kilicci C, Sanverdi I, Ozkaya E, Eser A, Bostanci E, Yayla Abide C, Yenidede I. Segmental resection of anterior uterine wall in cases with placenta percreta: a modified technique for fertility preserving approach. J Matern Fetal Neonatal Med 2017; 31:1198-1203. [DOI: 10.1080/14767058.2017.1311862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cetin Kilicci
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Ilhan Sanverdi
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Enis Ozkaya
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Eser
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Evrim Bostanci
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Yayla Abide
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
| | - Ilter Yenidede
- Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children’s Health Training and Research Hospital, Istanbul, Turkey
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Direct puncture embolization of the internal iliac artery during cesarean delivery for pernicious placenta previa coexisting with placenta accreta. Int J Gynaecol Obstet 2016; 135:264-267. [DOI: 10.1016/j.ijgo.2016.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/26/2016] [Accepted: 08/15/2016] [Indexed: 11/15/2022]
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Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome. J Obstet Gynaecol India 2016; 67:42-47. [PMID: 28242967 DOI: 10.1007/s13224-016-0923-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. METHODS This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. RESULTS The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26-28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fifty-three per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000-2000 mL. CONCLUSION Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.
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Ahmed SR, Aitallah A, Abdelghafar HM, Alsammani MA. Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study. J Clin Diagn Res 2015; 9:QC17-9. [PMID: 26674539 DOI: 10.7860/jcdr/2014/14930.6831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. AIM To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). MATERIALS AND METHODS A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. RESULTS The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. CONCLUSION The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services.
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Affiliation(s)
- Salah Roshdy Ahmed
- Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Abdusaeed Aitallah
- Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Hazem M Abdelghafar
- Assistant Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Mohamed Alkhatim Alsammani
- Associate Professor, Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Saudi Arabia & University of Bahri , Sudan
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D'Souza DL, Kingdom JC, Amsalem H, Beecroft JR, Windrim RC, Kachura JR. Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization. Can Assoc Radiol J 2015; 66:179-84. [DOI: 10.1016/j.carj.2014.08.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 08/01/2014] [Accepted: 08/08/2014] [Indexed: 10/23/2022] Open
Abstract
Purpose The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery. Methods Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity. Results All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%. Conclusion Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.
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Affiliation(s)
- Donna L. D'Souza
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
- University of Minnesota, Minneapolis, Minnesota, USA
| | - John C. Kingdom
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John R. Beecroft
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Rory C. Windrim
- Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John R. Kachura
- Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Shabana A, Fawzy M, Refaie W. Conservative management of placenta percreta: a stepwise approach. Arch Gynecol Obstet 2014; 291:993-8. [PMID: 25288269 DOI: 10.1007/s00404-014-3496-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To describe a modified surgical approach in the form of stepwise cesarean section in placenta percreta. METHODS We conducted a prospective observational study. A total of 71 patients with placenta percreta were subjected to the new stepwise surgical approach and uterine repair at the time of cesarean delivery. RESULTS The procedure was successful in controlling the bleeding and preserving the patient's uterus in 65 (91.5%) women. Ten patients (14.1%) had urinary tract complications, nine (90%) were managed during cesarean section and one presented late in the form of vesicouterine fistula. CONCLUSIONS A stepwise cesarean section is safe and effective procedure that can be applied in placenta percreta.
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Affiliation(s)
- Ahmed Shabana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Dickinson JE. Caesarean delivery: truths and consequences. Aust N Z J Obstet Gynaecol 2014; 54:295-7. [PMID: 25117186 DOI: 10.1111/ajo.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, WA, Australia.
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Pather S, Strockyj S, Richards A, Campbell N, de Vries B, Ogle R. Maternal outcome after conservative management of placenta percreta at caesarean section: a report of three cases and a review of the literature. Aust N Z J Obstet Gynaecol 2013; 54:84-7. [PMID: 24471850 DOI: 10.1111/ajo.12149] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/28/2013] [Indexed: 10/26/2022]
Abstract
Retaining the placenta in situ at caesarean section for placenta percreta and awaiting placental reabsorption is widely practiced; however, there is limited evidence on the efficacy and complications of this strategy. We present three cases of placenta percreta managed conservatively and note that all three women experienced significant complications. A review of the literature showed that despite initial conservative management, 40% of women subsequently require emergency hysterectomy and 42% will experience major morbidity.
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Affiliation(s)
- Selvan Pather
- The Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
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Hequet D, Morel O, Soyer P, Gayat E, Malartic C, Barranger E. Delayed hysteroscopic resection of retained tissues and uterine conservation after conservative treatment for placentaaccreta. Aust N Z J Obstet Gynaecol 2013; 53:580-3. [DOI: 10.1111/ajo.12138] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/26/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Delphine Hequet
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
| | - Olivier Morel
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
- Obstetrics and Gynecology unit; Maternité Universitaire de Nancy; Université Nancy I Henri Poincaré; Nancy France
| | - Philippe Soyer
- Department of Body & Interventional Radiology; Lariboisière Hospital - APHP; Université Diderot Paris 7; Paris France
| | - Etienne Gayat
- Anesthesiology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
| | - Cécile Malartic
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
- Obstetrics and Gynecology unit; Maternité Universitaire de Nancy; Université Nancy I Henri Poincaré; Nancy France
| | - Emmanuel Barranger
- Obstetrics and Gynecology unit; Lariboisière Hospital - APHP; Paris 7 Diderot University; Paris France
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Upson K, Silver RM, Greene R, Lutomski J, Holt VL. Placenta accreta and maternal morbidity in the Republic of Ireland, 2005-2010. J Matern Fetal Neonatal Med 2013; 27:24-9. [PMID: 23638753 DOI: 10.3109/14767058.2013.799654] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the nationwide prevalence of placenta accreta and to quantify its impact on maternal morbidity. METHODS Using discharge data for public hospitals in Ireland, years 2005-2010, deliveries with placenta accreta were identified using ICD-10-AM code for morbidly adherent placenta and compared with deliveries without the condition. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using logistic regression. RESULTS Placenta accreta prevalence increased 34% from 2005 to 2010 (7.9/10 000 deliveries versus 10.6/10 000 deliveries). This condition was associated with a substantial increased risk of hemorrhage (aOR: 16.6, 95% CI: 13.4-20.5), hysterectomy (aOR: 950.6, 95% CI: 632.9-1427.9), procedures to reduce uterine blood flow (aOR: 72.4, 95% CI: 35.1-149.4), transfusion (aOR: 41.8, 95% CI: 33.4-52.2), anemia (aOR 15.1, 95% CI: 10.8-21.0), abdominal organ injury (aOR: 8.2, 95% CI: 5.2-13.1), bladder surgery (aOR: 38.5, 95% CI: 21.8-68.1), mechanical ventilation (aOR: 63.2, 95% CI: 28.4-140.6), intensive care unit admission (aOR: 41.3, 95% CI: 30.0-56.9), and co-existing placenta previa (aOR: 23.2, 95% CI: 16.8-31.8) as well as increased risk of cesarean section, longer hospitalization and stillbirth. CONCLUSIONS To our knowledge, this is the first study to use a comparison group of deliveries without placenta accreta and quantitatively illustrate with odds ratios the profound adverse health effects of this condition on the mother.
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Affiliation(s)
- Kristen Upson
- Department of Epidemiology, School of Public Health, University of Washington , Seattle, WA , USA
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Kamara M, Henderson JJ, Doherty DA, Dickinson JE, Pennell CE. The risk of placenta accreta following primary elective caesarean delivery: a case-control study. BJOG 2013; 120:879-86. [DOI: 10.1111/1471-0528.12148] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
- M Kamara
- School of Women's and Infants' Health; The University of Western Australia; Crawley; WA; Australia
| | - JJ Henderson
- School of Women's and Infants' Health; The University of Western Australia; Crawley; WA; Australia
| | - DA Doherty
- School of Women's and Infants' Health; The University of Western Australia; Crawley; WA; Australia
| | - JE Dickinson
- School of Women's and Infants' Health; The University of Western Australia; Crawley; WA; Australia
| | - CE Pennell
- School of Women's and Infants' Health; The University of Western Australia; Crawley; WA; Australia
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Shazly SAE, Badee AY, Ali MK. The use of multiple 8 compression suturing as a novel procedure to preserve fertility in patients with placenta accreta: case series. Aust N Z J Obstet Gynaecol 2012; 52:395-9. [DOI: 10.1111/j.1479-828x.2012.01449.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Accepted: 04/09/2012] [Indexed: 11/26/2022]
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Epidemiology, etiology, diagnosis, and management of placenta accreta. Obstet Gynecol Int 2012; 2012:873929. [PMID: 22645616 PMCID: PMC3356715 DOI: 10.1155/2012/873929] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/29/2012] [Accepted: 02/19/2012] [Indexed: 11/18/2022] Open
Abstract
Placenta accreta is a severe pregnancy complication and is currently the most common indication for peripartum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Main risk factor for placenta accreta is a previous cesarean delivery particularly when accompanied with a coexisting placenta previa. Antenatal diagnosis seems to be a key factor in optimizing maternal outcome. Diagnosis can be achieved by ultrasound in the majority of cases. Women with placenta accreta are usually delivered by a cesarean section. In order to avoid an emergency cesarean and to minimize complications of prematurity it is acceptable to schedule cesarean at 34 to 35 weeks. A multidisciplinary team approach and delivery at a center with adequate resources, including those for massive transfusion are both essential to reduce neonatal and maternal morbidity and mortality. The optimal management after delivery of the neonate is vague since randomized controlled trials and large cohort studies are lacking. Cesarean hysterectomy is probably the preferable treatment. In carefully selected cases, when fertility is desired, conservative management may be considered with caution. The current review discusses the epidemiology, predisposing factors, pathogenesis, diagnostic methods, clinical implications and management options of this condition.
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Makino S, Tanaka T, Yorifuji T, Koshiishi T, Sugimura M, Takeda S. Double vertical compression sutures: A novel conservative approach to managing post-partum haemorrhage due to placenta praevia and atonic bleeding. Aust N Z J Obstet Gynaecol 2012; 52:290-2. [DOI: 10.1111/j.1479-828x.2012.01422.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 01/24/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Shintaro Makino
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
| | - Toshitaka Tanaka
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
| | - Takashi Yorifuji
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
| | - Taro Koshiishi
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
| | - Motoi Sugimura
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology; Juntendo University School of Medicine; Tokyo; Japan
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Awan N, Bennett MJ, Walters WAW. Emergency peripartum hysterectomy: a 10-year review at the Royal Hospital for Women, Sydney. Aust N Z J Obstet Gynaecol 2011; 51:210-5. [PMID: 21631438 DOI: 10.1111/j.1479-828x.2010.01278.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There appears to be a rise in the rate of emergency peripartum hysterectomy (EPH) in the developed world. AIMS To determine the incidence, indications, risk factors, complications and management of EPH in our tertiary level teaching hospital, the Royal Hospital for Women (RHW) in Sydney, over the last decade. METHODS A retrospective analysis was conducted of all cases of EPH performed at the RHW between the years 1999-2008 inclusive. EPH was defined as one performed after 20 weeks gestation for uncontrollable uterine bleeding not responsive to conservative measures occurring at any time after delivery but within the first 6 weeks post-partum. Cases were ascertained via our hospital obstetric database. RESULTS There were 33 EPH among 38,998 births, a rate of 0.85 per 1000 births. Indications for EPH were morbid adherence of the placenta (54.8%), placenta praevia (19.4%), uterine atony (12.9%) and uterine rupture or cervical laceration (9.7%). A significant association between previous caesarean section (CS) and abnormal placentation was confirmed (P=0.011), especially for morbid adherence of the placenta (P=0.004). There was one maternal death. Maternal morbidity was significant, with disseminated intravascular coagulation and urinary tract injury among the most common complications. All women required blood transfusions, and over a quarter were admitted to the intensive care unit. CONCLUSIONS In our series, abnormal placentation causing severe haemorrhage was the commonest indication for EPH. Previous CS is a risk factor for abnormal placentation and particularly for morbid adherence of the placenta. The morbidity associated with EPH is considerable.
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Affiliation(s)
- Nida Awan
- The School of Women's and Children's Health, University of New South Wales Royal Hospital for Women, Sydney, New South Wales, Australia
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Armstrong CA, Harding S, Dickinson JE. Clinical aspects and conservative management of placenta accreta. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.6.3.132.26994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thon S, McLintic A, Wagner Y. Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series. Int J Obstet Anesth 2010; 20:64-70. [PMID: 21112764 DOI: 10.1016/j.ijoa.2010.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/15/2010] [Accepted: 08/31/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Endovascular occlusion balloon catheters can be placed preoperatively in internal iliac vessels of patients perceived to be at risk of major obstetric haemorrhage during caesarean section. Their safety and efficacy remains undefined, and we report our experience of 14 patients over four years. METHODS We undertook a chart review of all patients who had undergone prophylactic internal iliac balloon catheters before caesarean section in our institution. RESULTS Balloon catheters were placed in 14 and inflated in 11 (78.6%) patients. Five of the 14 patients (35.7%) underwent emergency balloon catheter placement before unscheduled caesarean section. Surgeons reported that balloon inflation provided favourable surgical conditions in six of 11 cases (54.5%), no improvement in four and was not required in one due to lack of pathology. Within the balloon-inflated group, nine patients underwent a hysterectomy: two electively, the remaining seven because of perioperative confirmation of placenta accreta or for control of bleeding. One patient suffered massive haemorrhage leading to three perioperative hypovolaemic cardiac arrests. Four patients required intervention to avoid complications related to balloon catheters: three minor and one related to catheter displacement and prolonged resuscitation. CONCLUSION Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management.
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Affiliation(s)
- S Thon
- Department of Anaesthetics, Auckland City Hospital, Auckland, New Zealand
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Phillips LE, McLintock C, Pollock W, Gatt S, Popham P, Jankelowitz G, Ogle R, Cameron PA. Recombinant Activated Factor VII in Obstetric Hemorrhage: Experiences from the Australian and New Zealand Haemostasis Registry. Anesth Analg 2009; 109:1908-15. [DOI: 10.1213/ane.0b013e3181c039e6] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Opinion: Integration of diagnostic and management perspectives for placenta accreta. Aust N Z J Obstet Gynaecol 2009; 49:578-87. [DOI: 10.1111/j.1479-828x.2009.01088.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kildea S, Pollock WE, Barclay L. Making pregnancy safer in Australia: the importance of maternal death review. Aust N Z J Obstet Gynaecol 2008; 48:130-6. [PMID: 18366484 DOI: 10.1111/j.1479-828x.2008.00846.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Australia is one of the safest countries in the world to birth. Because maternal deaths are rare, often the focus during pregnancy is on the well-being of the fetus. The relative safety of birth has fostered a shift in the focus of maternal health, from survival, to the model of care or the birth experience. Yet women still die in Australia as a result of child bearing and many of these deaths are associated with avoidable factors. The purpose of this paper is to outline the maternal death monitoring and review process in Australia and to present to clinicians the salient features of the most recently published Australian maternal death report. The notion of preventability and the potential for practice to have an effect on reducing maternal mortality are also discussed.
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Affiliation(s)
- Sue Kildea
- Graduate School for Health Practice, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia.
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Perioperative Endovascular Internal Iliac Artery Occlusion Balloon Placement in Management of Placenta Accreta. AJR Am J Roentgenol 2007; 189:1158-63. [DOI: 10.2214/ajr.07.2417] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Briery CM, Rose CH, Hudson WT, Lutgendorf MA, Magann EF, Chauhan SP, Morrison JC. Planned vs emergent cesarean hysterectomy. Am J Obstet Gynecol 2007; 197:154.e1-5. [PMID: 17689631 DOI: 10.1016/j.ajog.2007.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 01/09/2007] [Accepted: 03/08/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare operative and postpartum outcomes between planned and emergent cesarean hysterectomy. STUDY DESIGN In this multicenter retrospective review over a 5-year period, 65 cases of cesarean hysterectomy (30 planned vs 35 emergent) were identified. Demographic, operative, and postoperative data were extracted and stratified by group (planned vs emergent). RESULTS Patients who underwent an emergent cesarean hysterectomy were more likely to have higher estimated blood loss (2597.1 +/- 1369.4 mL vs 1963.3 +/- 1180.2 mL; P = .05), have transfusion (66% vs 33%; P = .02), and require greater quantities of packed red blood cells (4.49 +/- 4.7 x10(12)/L vs 1.6 +/- 3.1 x10(12)/L; P = .006) compared with the planned cesarean hysterectomy group. Patients who underwent emergent cesarean hysterectomy had higher overall complication rates (37% vs 66%; P = .03) and more intensive care unit admissions (7% vs 29%; P = .03). CONCLUSION After planned cesarean hysterectomy, patients had a significantly lower rate of blood loss, less need for blood transfusions, and fewer complications compared with patients who underwent an emergent cesarean hysterectomy.
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Affiliation(s)
- Christian M Briery
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
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Abstract
AIM This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy. BACKGROUND Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS. METHODS Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy. FINDINGS Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient. CONCLUSION In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.
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Affiliation(s)
- Jennifer Fenwick
- Curtin University Technology & King Edward Memorial Hospital, School of Nursing and Midwifery, Curtin University of Technology, Perth, Western Australia, Australia.
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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] [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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