Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI – useful features for differentiating placenta percreta from placenta accreta

2017 ◽  
Vol 28 (2) ◽  
pp. 708-717 ◽  
Author(s):  
Xin Chen ◽  
Ruiqin Shan ◽  
Lianxin Zhao ◽  
Qingxu Song ◽  
Changting Zuo ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
Invasive Placenta

Prior Cesarean Delivery Healthcare Facilities Variations in Pregnancy Outcomes of Placenta Accreta Spectrum with Placenta Previa: A retrospective study from a tertiary transferal center (Preprint)

2021 ◽  
Author(s):  
Xuan Gao ◽  
Shaoshuai Wang ◽  
Lijie Wei ◽  
Peng Gao ◽  
Jiaqi Li ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
County Level ◽  
Healthcare Facilities ◽  
Placenta Accreta Spectrum ◽  
Province Level ◽  
Rural Township ◽  
Previous Cesarean

BACKGROUND The prevalence of Placenta Accreta Spectrum(PAS) is increasing rapidly linked with the cesarean rate increase worldwide, creating a threatening condition from severe postpartum hemorrhage to various maternal morbidities. The socio-economic imbalance, geographical, qualification, and specialty variations of the previous cesarean delivery healthcare facilities resulted in assessment and management difficulties. OBJECTIVE To assess variations of prior cesarean delivery healthcare facilities on pregnancy outcomes on current PAS with Placenta Previa. METHODS This retrospective study was conducted in a tertiary referral center from Nov.2015 to Nov.2020 in central China. Healthcare facilities were classified by geographical, hospital grading, ownership, and specialty variations. The primary outcome was postpartum hemorrhage(PPH), secondary outcomes included Placenta Percreta and maternal-fetal morbidities. RESULTS In total, 252 patients were enrolled, 58(23%) patients had Placenta Accreta, 131(52%) had Placenta Increta and 63(25%) had Placenta Percreta. The overall incidence of PPH was 47.2%(119 out of 252). As the administrative geographical level becoming smaller and more distant, PPH incidence climbed up: province-level(10, 32.3%), prefecture-level(65, 48.5%), county-level(30, 42.3%), and rural township(14, 82.5%), P for trend= 0.019. The odds of PPH in rural township clinics was 5.84(P=0.03, 95%CI 1.18~28.77) compared to the province-level hospitals. Similarly, when hospital grades declined, PPH incidence raised: tertiary(26, 39.4%), secondary(28, 43.8%), primary(14, 38.9%) and unclassified(51, 59.3%), P for trend= 0.047. Unclassified hospitals had 2.16(P= 0.046, 95%CI 1.02~4.61) times odds of PPH compared to tertiary medical centers. PPH showed no statistical significance based on ownership or specialty variations. Also, Placenta Percreta increased when geographical location shifted from urban to rural: three (9.7%) from province-level, 34(25.6%) from prefecture-level, 18(25.4%) from county-level and eight(47.1%) from rural township clinics, P= 0.04, P for trend =0.018. Patients with previous rural township clinics cesarean delivery had a 7.49 times risk((P=0.011, 95%CI 1.59~35.19) of developing Placenta Percreta compared with province-level hospitals. CONCLUSIONS Healthcare facilities variations of the previous cesarean delivery have upcoming impacts on subsequent pregnancy. The tendency of experiencing adverse maternal outcomes is more significant with prior cesarean in the rural township clinics and unclassified hospitals. The findings call for physicians’ alertness, persistent efforts in urban-rural disparity reduction, and measures to achieve equitable management.

scholarly journals Management of placenta percreta. A case report

2020 ◽  
pp. 01-04
Author(s):  
DIOUF A ◽  
Thiam O ◽  
Ndour K ◽  
Gueye M ◽  
Ndiaye MD ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Organ ◽  
Placenta Percreta ◽  
High Parity ◽  
Surgical Wounds ◽  
History Of ◽  
Uterine Curettage ◽  
High Risk Situation ◽  
Previous Cesarean

The placenta accreta designates an abnormality of the placental insertion characterized, on the anatomopathological level, by an absence of deciduous deciduous between the placenta and the myometrium. This insertion anomaly may interest all or only part of the placenta. We distinguish within this terminology the terms of - placenta accreta when the placenta is simply attached to the Myometrium. - placenta increta when the placenta invades the myometrium. - placenta percreta when the placenta enters the serosa uterine, or even the neighboring organs (bladder, peritoneum, etc.) [1]. Placentas accretas are a high-risk situation for severe postpartum hemorrhage and its inherent complications such as disseminated intravascular coagulation, hemostasis hysterectomy, surgical wounds to the ureters, bladder, multiple organ failure, or even maternal death, particularly in the case of placenta percreta [2,3]. Risk factors for placenta percreta include a history of cesarean, uterine curettage or manual removal of placenta, presence of placenta previa, endometriosis, high parity and advanced maternal age [4]. We report the case of a 30-year-old woman, IIGIIP, who had a previous cesarean section during her first pregnancy and who had a placenta percreta and who underwent hysterectomy without cystectomy and without ligation of the hypogastric arteries.

scholarly journals Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review :

2019 ◽  
Vol 5 (1) ◽  
pp. 52
Author(s):  
Rajuddin Rajuddin ◽  
Roziana Roziana ◽  
Munawar Munawar ◽  
Muhammad Iqbal
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Placenta Percreta ◽  
Risk Of Bleeding ◽  
Placenta Accreta Spectrum

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. The management of placenta accrete spectrum will be discussed here and is essentially the same. The following discussion of management of placenta accreta spectrum applies to all depths of placental invasion. Incidence: In 1950 placentaaccreta was rare, occurring 1 in 30.000 deliveries in the United States. Duringbetween 2008 and 2011 in a cohort of over 115.000 deliveries in 25 hospitals in the United States reaching 1 in 731 deliveries. The marked increase has been attributed to the increasing prevalence of cesarean delivery in recent decades.The incidence of placenta accreta spectrum will also increase due to increasing of caesarean section rate. Case: Mrs.44 yo, G3P2 36-37weekslive, previous cesarean section 2 time,placenta previa totalis, placenta percreta. She’s comes with a chief complaint of lower abdominal cramps, patients regularly antenatal care at obstetrician. Ultrasound finding, a single fetus lives at transvers lie, dorso superior, corresponding to 36-37 weeks, placenta previa, placenta percreta (PAI:83%). This patient planned for elective conservative surgery management, due to cesarean section and or cesarean hysterectomy. Discussion:Surgical conservative management giving birth a baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion. The discovery of placenta accreta spectrum earlier when antenatal care, better birth planning than multidisciplinary science includedfetomaternal, gyneco-oncologist, anesthesiologist, thorac& cardiovascular surgeon, radiology intervention, intensivist - obstetric intensive care, urologist and neonatology can determine the success of handling cases of placenta accreta spectrum so as to reduce maternal, fetal morbidity and mortality. Conclusions:  The discovery of placenta accreta spectrum earlier when antenatal care, planning delivery is better than multidisciplinary science. Management with corporal incisions away from placental implantation, giving birth baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion.

scholarly journals A Case Report of Placenta Percreta

2021 ◽  
Vol 5 (4) ◽  
pp. 139-145
Author(s):  
Widiana Ferriastuti ◽  
Dwi P. R. Tampubolon ◽  
Qonita Qonita
Keyword(s):  
Case Report ◽  
Cesarean Delivery ◽  
Physiological Condition ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Abdominal Ultrasound ◽  
Placenta Percreta ◽  
Total Weight ◽  
Clot Retention ◽  
Placental Invasion

There has been an increased incidence of placenta accreta in recent decades, which is associated with an increase in cesarean delivery. A woman aged 39 years GIVP1111 at 8 months of gestation was a breech location with antepartum bleeding et. causa placenta previa totalis suspected percreta bladder infiltration and hematuria. The last abdominal ultrasound showed no visible clot retention and mild right-sided hydronephrosis (possibly a physiological condition). Due to doubts regarding the suspicion of placental invasion of the bladder, an MRI examination of the abdomen was performed. A network was irregular in shape and can not be oriented either right or left, some of which have been split. Attached to the placenta. It was not clear that the cervix and bladder were visible, the total weight was 500 grams, the size was 15x13x5 cm. Based on both macroscopic and microscopic histopathological examinations, it could be concluded that the uterus, adnexa, surgery: placenta percreta, adenomyosis uteri. Keywords: placenta percreta; uterus; antepartum bleeding

scholarly journals Case Report: Anaesthetic Management of Placenta Percreta

2022 ◽  
Vol 9 (1) ◽  
pp. 39-44
Author(s):  
Subir Kumar Ghosh ◽  
Babita Ramdev ◽  
Noorjit Sidhu
Keyword(s):  
Case Report ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Bladder Wall ◽  
Hemodynamic Instability ◽  
Placenta Percreta ◽  
Elective Cesarean Section ◽  
Mortality And Morbidity ◽  
Risk Pregnancy ◽  
Perioperative Bleeding

Background: The placenta is a complicated organ and is partially understood. It is the essential part for physiological changes leading to a successful pregnancy. Placenta percreta is the most severe and least common form of placenta accreta in which villi penetrate the entire myometrial thickness and reach or traverse the serosa to encroach adjacent organs. Patients with placenta percreta are at a greater risk of life-threatening perioperative bleeding as well as massive and deadly thromboembolic events. Case report: Our patient was a 34-year-old gravida 5female who underwent elective cesarean section at 37 weeks of gestation with a diagnosis of placenta accreta or percreta. Intraoperative findings showed placenta percreta with bladder wall involvement. Hence, hysterectomy was done. Anticipated intraoperative haemorrhage and hemodynamic instability were managed properly. Discussion: Placenta percreta is the most serious among abnormal placentation, sometimes leading to catastrophic blood loss and very high maternal mortality and morbidity up to 10%. The most important risk factor in placenta percreta is placenta previa (low lying placenta) after cesarean delivery. Our patient met all these risk factors. Prenatal diagnosis of an invasive placenta is paramount for reducing maternal morbidity and mortality by implementing a multidisciplinary approach. Keywords: haemorrhage, placenta percreta, hysterectomy, high-risk pregnancy.

scholarly journals Management Strategies and Maternal Outcome of Placenta Accreta

2016 ◽  
Vol 28 (2) ◽  
pp. 71-75
Author(s):  
Ferdousi Chowdhury ◽  
Mahbuba Akhter ◽  
Rokeya Khatoon ◽  
Morzina Begum ◽  
Mahbuba Siddiqua ◽  
...  
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Management Strategies ◽  
Maternal Outcome ◽  
Placenta Percreta ◽  
Team Approach ◽  
College Hospital ◽  
Medical College ◽  
Postpartum Hysterectomy

Objectives: To find out the proportion and maternal outcome of placenta accreta.Materials and Methods: Total 10579 deliveries were served during January 2013 to 31st December 2013 in the Department of Obstetrics and Gynecology of Addin Women Medical College Hospital, Dhaka. All patients who needed postpartum or cesarean hysterectomy for postpartum hemorrhage and diagnosed as placenta accreta after postpartum hysterectomy were included for the study. Among them who were antentally diagnosed as placenta previa with having other risk factors of placenta accreta, were evaluated by Doppler Sonography. All these cases such as diagnosed, suspected or only had multiple risk factors of placenta accreta were managed by a team approach and proper counseling of the patient’s guardian about need of massive transfusion, hysterectomy, Intensive Care Unit (ICU) admission .Results: Among the total 10579 deliveries 22 cases were diagnosed as placenta accreta after postpartum hysterectomy. On histopathology 8 of these cases were placenta percreta, 7 cases were placenta increta and 7 cases were placenta accreta vera. Almost ninety one (90.90%) patient had placenta previa and 90.90% patient had past H/O one or two cesarean section. Placenta percreta cases were more common in patients with H/O two previous C/S or one C /S and dilatation & curettage (D&C). In all preoperatively diagnosed cases, Right lower paramedian incision was given and hysterectomy was done leaving the placenta in situ.Conclusion: Placenta accreta is associated with previous two or more cesarean deliveries, or multigravidae with past H/O repeated D&C or M/R or combined. History of of these operations are diagnosed as having anterior or central placenta previa.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(2) : 71-75

Sonographic Detection of Placenta Percreta With Associated Placenta Previa and Succenturiate Lobe

2021 ◽  
Vol 37 (2) ◽  
pp. 194-199
Author(s):  
Melissa Detweiler ◽  
Emily Downs
Keyword(s):  
Placenta Accreta ◽  
Imaging Modality ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
Clinical Factors ◽  
Placenta Accreta Spectrum ◽  
Placental Invasion

Placenta percreta is the most complicated degree of the placenta accreta spectrum (PAS). It involves placental invasion through the uterine myometrium and into, or beyond, the uterine serosa, which can ultimately lead to severe maternal hemorrhage. Placenta previa is often associated with PAS and can be a significant indicator, along with other clinical factors. Sonography has historically been a highly accurate and safe imaging modality to assess the PAS. This specific case examines a patient with a pathologically proven percreta with an associated previa and succenturiate placental lobe.

scholarly journals Diagnostic tests of placenta accreta index score (PAIS) as supporting prenatal diagnosis and outcomes of maternal neonatal in abnormally invasive placenta management at general hospital of Hasan Sadikin Bandung

2017 ◽  
Vol 6 (9) ◽  
pp. 3765
Author(s):  
Sefty Mariany Samosir ◽  
Setyorini Irianti ◽  
Dian Tjahyadi
Keyword(s):  
Prenatal Diagnosis ◽  
General Hospital ◽  
Maternal Death ◽  
Predictive Value ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Diagnostic Value ◽  
Caesarian Section ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Background: The incidence of abnormally invasive placenta increases tenfold as the number of caesarian section increases in the past 50 years. Placenta previa accreta is strongly associated with massive bleeding and leads to maternal death. Prenatal diagnosis helps in planning the delivery to reduce the risk of bleeding and possible complications. This study aims to find out diagnostic value of Placenta Accreta Index Score (PAIS) as supporting tool in prenatal diagnostic of abnormally invasive placenta.Methods: The diagnostic test was undertaken in May 2017 at General Hospital of Hasan Sadikin, identifying patients with placenta previa with history of caesarian section between May 2016-May 2017. PAIS were obtained and compared with histopathological findings.Results: Among 21 placenta previa patients with post caesarian section, 10 (47.6%) of them histopathologically proven as abnormally invasive placenta. With statistical analysis accuracy values obtained PAIS and histopathological findings in patient with placenta previa is 0.762 (good). Diagnostic value of PAIS with histopathological findings in placenta previa patient had a sensitivity 70%, a specificity 81,8%, positive predictive value (PPV) 77.8%, and negative predictive value (NPV) 75% by PAIS cut off point is 3.125. No maternal death. Mean duration of postoperative care was 5 days. Average total bleeding during surgery is 2622 ml with lowest postoperative hemoglobin 8.36g/dl. All babies born with appropriate to gestational birth weight with average first minute APGAR was 7 and without fetal anemia.Conclusions: PAIS can be used to help to predict the risk of abnormally.

scholarly journals Anesthesia Management in Patient with Placenta Percreta Performed Intra-aortic Ballooning Caesarean Section

2021 ◽  
Vol 1 (1) ◽  
pp. 16
Author(s):  
RTh. Supraptomo ◽  
Alma Hepa Allan
Keyword(s):  
Caesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
Anesthetic Technique ◽  
Hemodynamic Changes ◽  
Risk Of Bleeding ◽  
History Of ◽  
Operation Duration ◽  
Placenta Accreta Spectrum

<p>Placenta accreta spectrum is one of maternal mortality’s causes which is related with severe obstetric bleeding that requires hysterectomy. The incidence rate of the spectrum placenta increases with increasing caesarean section. Placenta accreta spectrum is also close-related to placenta previa. The aim of this study is to  understand perioperative management in patient with placenta percreta performed with intra-aortic ballooning in caesarean section. We are following a case on a 36 year old female patient, multigravida at term pregnant with placenta percreta and history of caesarean section 5 and 2 years ago. The surgeries performed were caesarean section surgery as well as intra-aortic ballooning. Anesthetic technique used was general anesthesia. Operation duration approximately ± 180 minutes, bleeding 1500 cc. After the operation, the patient was admitted to the ICU. The patient going well and discharged from ICU to ward on the second day. After three days in ward, the patient discharged to home. Hemodynamic changes during balloon intra-aortic procedures are of particular concern to anesthetists. This is because the stopping of blood flow to the aorta in this case can cause an increase in blood vessel pressure, where the administration of nitroglycerin at low doses can reduce venous tone resulting in venous vasodilation which will maintain hemodynamic stability during the process of blocking blood vessels with a balloon. From the case we may conclude that anesthesia in pregnant women with placenta accreta spectrum should be carried out with caution and involve a multidisciplinary specialist given its high risk of bleeding. The intra-aortic balloon insertion technique can be an option used to reduce the risk of bleeding in patients with placenta accreta spectrum.</p>

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