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Ayub TH, Strizek B, Poetzsch B, Kosian P, Gembruch U, Merz WM. Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid. J Clin Med 2023; 13:135. [PMID: 38202142 PMCID: PMC10780074 DOI: 10.3390/jcm13010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS). METHODS This is a monocentric retrospective study of women with PAS presenting at our hospital between 2005 and 2021. All data were retrospectively collected through the departmental database. RESULTS 35 patients with PAS were included. EM was planned in 25 patients prior to delivery. Complete absorption of the retained placenta was seen in two patients (8%). Curettage was performed in 14 patients (56%). A hysterectomy (HE) was needed in seven (28%) patients; 18 patients (72%) underwent uterus-preserving treatment without severe complications. The mean duration of EM was 107 days. The mean day of onset of hyperfibrinolysis and beginning of TXA treatment was day 45. The mean nadir of fibrinogen level before TXA was 242.4 mg/dL, with a mean drop of 29.7% in fibrinogen level. CONCLUSIONS Our data support EM as a safe treatment option in PAS. Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. To our knowledge, this is the first cohort of patients with EM of PAS in whom coagulation monitoring and use of TXA have been shown to successfully treat hyperfibrinolysis.
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Affiliation(s)
- Tiyasha Hosne Ayub
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Bernd Poetzsch
- Institute for Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Sugai S, Yamawaki K, Sekizuka T, Haino K, Yoshihara K, Nishijima K. Comparison of maternal outcomes and clinical characteristics of prenatally vs nonprenatally diagnosed placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101197. [PMID: 37865220 DOI: 10.1016/j.ajogmf.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. DATA SOURCES A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022. STUDY ELIGIBILITY CRITERIA Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa. METHODS Study screening was performed after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21-0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% confidence interval, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% confidence interval, -3.25 to -0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10-0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12-11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06-0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24-7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12-11.25) showed statistical significance. No significant difference was found for the other outcomes. CONCLUSION Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kaoru Yamawaki
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tomoyuki Sekizuka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
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Sugai S, Yamawaki K, Sekizuka T, Haino K, Yoshihara K, Nishijima K. Pathologically diagnosed placenta accreta spectrum without placenta previa: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101027. [PMID: 37211089 DOI: 10.1016/j.ajogmf.2023.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa. DATA SOURCES A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022. STUDY ELIGIBILITY CRITERIA The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. In addition, maternal age, assisted reproductive technology, previous cesarean delivery, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa. METHODS Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS Among 2598 studies that were initially retrieved, 5 were included in the review. With the exception of 1 study, 4 studies were included in the meta-analysis. This meta-analysis showed that placenta accreta spectrum without placenta previa was associated with less risk of invasive placenta (odds ratio, 0.24; 95% confidence interval, 0.16-0.37), blood loss (mean difference, -1.19; 95% confidence interval, -2.09 to -0.28) and hysterectomy (odds ratio, 0.11; 95% confidence interval, 0.02-0.53), and more difficult to diagnose prenatally (odds ratio, 0.13; 95% confidence interval, 0.04-0.45) than placenta accreta spectrum with placenta previa. In addition, assisted reproductive technology and a previous uterine procedure were strong risk factors for placenta accreta spectrum without placenta previa, whhereas previous cesarean delivery was a strong risk factor for placenta accreta spectrum with placenta previa. CONCLUSION The differences in clinical aspects of placenta accreta spectrum with and without placenta previa need to be understood.
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Affiliation(s)
- Shunya Sugai
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kaoru Yamawaki
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tomoyuki Sekizuka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koji Nishijima
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
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Ryo E, Namai S, Seto M, Shiba M, Kido K, Ayabe T. Intraoperative monitoring of placental blood flow after cesarean birth to diagnose placenta accreta spectrum disorder: A preliminary study. Int J Gynaecol Obstet 2019; 148:267-269. [PMID: 31743432 DOI: 10.1002/ijgo.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/27/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Eiji Ryo
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Shigenari Namai
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Michiharu Seto
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Masahiro Shiba
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Koichiro Kido
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
| | - Takuya Ayabe
- Department of Obstetrics and Gynecology, School of Medicine, Teikyo University, Tokyo, Japan
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Welz J, Keyver-paik M, Gembruch U, Merz WM. Self-reported physical, mental, and reproductive sequelae after treatment of abnormally invasive placenta: a single-center observational study. Arch Gynecol Obstet 2019; 300:95-101. [DOI: 10.1007/s00404-019-05175-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/24/2019] [Indexed: 12/15/2022]
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Kellie FJ. Interventions for improving pregnancy outcomes in antenatally diagnosed or suspected morbidly adherent placenta. Hippokratia 2017. [DOI: 10.1002/14651858.cd012159.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Frances J Kellie
- The University of Liverpool; Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
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Schröder L, Pötzsch B, Rühl H, Gembruch U, Merz WM. Tranexamic Acid for Hyperfibrinolytic Hemorrhage During Conservative Management of Placenta Percreta. Obstet Gynecol 2015; 126:1012-5. [PMID: 26132457 DOI: 10.1097/AOG.0000000000000915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complications of conservative management of abnormal placentation in which the placenta is left in situ for resorption include secondary hemorrhage, infection, and disseminated intravascular coagulation. CASE A 41-year old woman received conservative treatment for placenta percreta. Nine weeks after delivery, she developed gingival bleeding, easy bruising, and moderate-to-severe vaginal bleeding. Hemostasis testing established the diagnosis of isolated hyperfibrinolysis; acute disseminated intravascular coagulation was excluded. Bleeding was successfully treated using the antifibrinolytic agent tranexamic acid. Eight weeks later uncomplicated curettage was performed. CONCLUSION Isolated hyperfibrinolysis is a potential cause of bleeding during conservative management of placenta increta and percreta. Management of this treatment approach should include hemostasis monitoring, because hyperfibrinolysis can be successfully controlled using fibrinolysis inhibitors.
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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. Hypertens Res Pregnancy 2015. [DOI: 10.14390/jsshp.3.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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
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Abstract
Diagnosing placenta percreta can be difficult. We describe a 41-year-old woman presenting at 21 weeks' gestation with intraabdominal bleeding and no signs of placental abnormality on ultrasound. The disagreement between results of the ultrasound and magnetic resonance imaging made definitive diagnosis difficult. The bleeding resolved spontaneously after a blood transfusion, and the patient was hospitalized for the remainder of the pregnancy. Delivery was by scheduled repeat cesarean at 34 weeks' gestation. Spontaneous rupture of the entire fundus occurred at the time of delivery. Placenta percreta was confirmed by histologic examination of the operatively excised uterus.
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Affiliation(s)
- Lauren Dew
- Department of Obstetrics and Gynecology (Dew, Harris), Division of Maternal and Fetal Medicine (Yost, Magee), and Department of Radiology (dePrisco), Baylor University Medical Center at Dallas
| | - Steven Harris
- Department of Obstetrics and Gynecology (Dew, Harris), Division of Maternal and Fetal Medicine (Yost, Magee), and Department of Radiology (dePrisco), Baylor University Medical Center at Dallas
| | - Nicole Yost
- Department of Obstetrics and Gynecology (Dew, Harris), Division of Maternal and Fetal Medicine (Yost, Magee), and Department of Radiology (dePrisco), Baylor University Medical Center at Dallas
| | - Kevin Magee
- Department of Obstetrics and Gynecology (Dew, Harris), Division of Maternal and Fetal Medicine (Yost, Magee), and Department of Radiology (dePrisco), Baylor University Medical Center at Dallas
| | - Gregory dePrisco
- Department of Obstetrics and Gynecology (Dew, Harris), Division of Maternal and Fetal Medicine (Yost, Magee), and Department of Radiology (dePrisco), Baylor University Medical Center at Dallas
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Abstract
The objective of this study was to illustrate a false-positive diagnosis of adherent placenta due to underlying adenomyosis. A 34-year-old woman was diagnosed for placenta previa totalis with adherent placenta at 33 weeks, based on the findings of loss of clear space or distinguishing outline separating the placenta and uterine wall, presence of intraplacental lacunae and densely atypical vessels in the lesion. Caesarean hysterectomy was performed at 35 weeks. Pathological findings revealed placenta previa totalis with adenomyosis beneath the placenta at the lower segment, with no adherent placenta. In conclusion, this report underlines the importance of possible false-positive test of prenatal ultrasound and MRI findings of adherent placenta caused by underlying adenomyosis which could obliterate the outline distinguishing the placenta and myometrium and atypical vessels secondary to decidualisation and hypervascularity from pregnancy. This case may probably encourage physician to beware of false-positive test of adherent placenta due to adenomyosis.
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Affiliation(s)
- Theera Tongsong
- Department of Obstetrics and Gynecology, Chiang Mai University, Chiang Mai, Thailand
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Current world literature. Curr Opin Obstet Gynecol 2011; 23:135-41. [PMID: 21386682 DOI: 10.1097/GCO.0b013e32834506b7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esakoff TF, Sparks TN, Kaimal AJ, Kim LH, Feldstein VA, Goldstein RB, Cheng YW, Caughey AB. Diagnosis and morbidity of placenta accreta. Ultrasound Obstet Gynecol 2011; 37:324-327. [PMID: 20812377 DOI: 10.1002/uog.8827] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the diagnostic precision of ultrasound examination for placenta accreta in women with placenta previa and to compare the morbidity associated with accreta to that of previa alone. METHODS This was a retrospective cohort study of all women with previa with/without accreta examined at the University of California, San Francisco (UCSF) between 2002 and 2008. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of ultrasound examination for the diagnosis of accreta were calculated and compared with results from similar studies in the literature. Univariable analysis was used to compare clinical outcomes. RESULTS The PPV of an ultrasound diagnosis of accreta was 68% and NPV was 98%. Ultrasound had a sensitivity of 89.5%. Compared with previa alone, accreta had an odds ratio (OR) of 89.6 (95% CI, 19.44-412.95) for estimated blood loss > 2 L, an OR of 29.6 (95% CI, 8.20-107.00) for transfusion and an OR of 8.52 (95% CI, 2.58-28.11) for length of hospital stay > 4 days. CONCLUSION Placenta accreta is associated with greater morbidity than is placenta previa alone. Ultrasound examination is a good diagnostic test for accreta in women with placenta previa. This is consistent with most other studies in the literature.
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Affiliation(s)
- T F Esakoff
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Zou L, Zhong S, Zhao Y, Zhu J, Chen L. Evaluation of “J”-shaped uterine incision during caesarean section in patients with placenta previa: A retrospective study. ACTA ACUST UNITED AC 2010; 30:212-6. [DOI: 10.1007/s11596-010-0216-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 11/28/2022]
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