The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders

2020 ◽  
Vol 302 (5) ◽  
pp. 1143-1150
Author(s):  
Ahmed M. Hussein ◽  
Mohamed Momtaz ◽  
Ahmad Elsheikhah ◽  
Ahmed Abdelbar ◽  
Ahmed Kamel
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Operative Blood Loss ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

scholarly journals The Choice of Anesthesia During Organ-Saving Operations Concerning Patients With Placenta Accreta Spectrum Disorders

2020 ◽  
Vol 9 (2) ◽  
pp. 221-230
Author(s):  
E. N. Plakhotina ◽  
T. N. Belousova ◽  
I. A. Kulikov ◽  
R. V. Latyshev ◽  
K. M. Pavlyutina
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Placenta Accreta ◽  
Pain Syndrome ◽  
Tissue Perfusion ◽  
Optimal Method ◽  
Clear Trend ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss

2020 ◽  
pp. 1-10
Author(s):  
Liviu Cojocaru ◽  
Allison Lankford ◽  
Jessica Galey ◽  
Shobana Bharadwaj ◽  
Bhavani S. Kodali ◽  
...  
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Operative Blood Loss ◽  
Placenta Accreta Spectrum

scholarly journals OC08.03: The role of three‐dimensional ultrasonography in the uncertain diagnosis of placenta accreta spectrum disorders: a large study from a single centre

2020 ◽  
Vol 56 (S1) ◽  
pp. 23-23
Author(s):  
S. Pranpanus ◽  
E. Thiangphak ◽  
T. Suntharasaj ◽  
C. Suwanrath ◽  
N. Pruksanusak ◽  
...  
Keyword(s):  
Large Study ◽  
Placenta Accreta ◽  
Three Dimensional ◽  
Single Centre ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

scholarly journals MANAGING PLACENTA ACCRETA SPECTRUM IN LOW RESOURCE SETTING USING A NOVEL DISSECTION-FREE AORTA CLAMP: OPERATIVE TECHNIQUE

2021 ◽  
Author(s):  
Vakkanal Paily ◽  
Afshana Sidhik ◽  
Raji Raj ◽  
Ajithakumari Sudhamma ◽  
Joshy Joseph ◽  
...  
Keyword(s):  
Blood Loss ◽  
Abdominal Aorta ◽  
Placenta Accreta ◽  
Low Grade ◽  
Operative Blood Loss ◽  
Surgical Morbidity ◽  
Resource Setting ◽  
Increased Risk ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum

Objective: Surgical management of Placenta accreta spectrum (PAS) is associated with profuse bleeding and increased risk of operative injury to the adherent pelvic structures. We propose the use of a novel aorta clamp that can occlude the abdominal aorta, without retro-peritoneal dissection, thereby making it easy for the obstetrician to use it. limiting the incident blood loss. Methods: This is a retrospective chart review of 33 women, with varying grades of histopathology confirmed PAS, who were managed as an elective or emergency procedure in a tertiary center in India. In all cases, the novel Paily Aorta Clamp (PAC) was applied just above the bifurcation of the abdominal aorta. Results: Twenty-nine women with advanced grades of PAS, underwent sub-total hysterectomies while four women with low grade (focal) PAS underwent a conservative procedure. The procedures were associated with median estimated intra-operative blood loss of 1000 ± 1500 ml with only 51.5% (n = 17) requiring any blood transfusions. PAC was applied for a median 55 ± 20 minutes and was not associated with any peri-operative aortic wall injury or distal thromboembolic phenomenon. Conclusion: Aortic clamping is feasible without retroperitoneal dissection using the PAC, which can be used to limit operative blood loss and surgical morbidity in PAS disorders.

The Role of Interventional Radiology in the Management of Placenta Accreta Spectrum Disorders

2019 ◽  
Vol 8 (4) ◽  
pp. 139-144
Author(s):  
Daniele Di Mascio ◽  
Pierluigi Benedetti Panici ◽  
Luigi Nappi ◽  
Francesco D’Antonio
Keyword(s):  
Interventional Radiology ◽  
Placenta Accreta ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders

2019 ◽  
Vol 48 (1) ◽  
pp. 21-26
Author(s):  
Grigory A. Penzhoyan ◽  
Tatiana B. Makukhina
Keyword(s):  
High Risk ◽  
Blood Loss ◽  
Pregnant Women ◽  
Placenta Accreta ◽  
Screening Program ◽  
First Trimester ◽  
Significant Difference ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Β Hcg

AbstractObjectiveTo select a group at high risk of placenta accreta spectrum disorders (PAS) based on the data of serum screening in the first trimester.MethodsA retrospective analysis of 48 patients with abnormal placental location (AP), including placenta previa (PP) only (n = 23) and PP and PAS (n = 25), was performed. Additionally, the AP group was divided depending on the blood loss volume: not higher than 1000 mL (LBL) (n = 29) and higher than 1000 mL (HBL) (n = 19); diagnostic term of PAS by ultrasound, data pregnancy-associated plasma protein-A (РAРР-A) and free β subunit of human chorionic gonadotropin (free β-hCG) multiple of median (MоM) at 11+0–13+6 weeks of gestation were evaluated. Serological markers were compared with the data of 39 healthy pregnant women with scar after previous cesarean section and normal placental location (control).ResultsThe mean gestation at diagnostic term of PAS was 29 weeks. PAPP-Р MоM [mean (M) ± standard deviation (SD)] was: in controls, 1.07 ± 0.47; in the AP group, 1.59 ± 0.24; in PP, 1.91 ± 1.52; in PAS, 1.30 ± 0.85; in LBL, 1.37 ± 1.20; in HBL, 1.91 ± 1.24. The difference between control/AP, control/PP, control/PAS, PP/PAS, control/LBL, control/HBL and LBL/HBL was Р = 0.256, 0.145, 0.640, 0.311, 0.954, 0.025 and 0.09, respectively. Free β-hCG MoM (M ± SD) was: in controls, 1.08 ± 0.69, in AP, 1.31 ± 0.96; in PP, 1.46 ± 0.19; in PAS, 1.16 ± 0.65; in LBL, 1.30 ± 0.06; in HBL, 1.32 ± 0.78. Comparison of free β-hCG AP with controls and between subgroups did not reveal a significant difference.ConclusionUnderestimation of PAS risk factors in pregnant women with AP leads to late diagnostics of pathology only in the third trimester. The assessment of the РAРР-A level in the first trimester may be helpful for the early prognosis of pathological blood loss at delivery for pregnant women with AP and for forming the high-risk group for PAS.

scholarly journals Placenta Accreta Spectrum Disorders and Cesarean Scar Pregnancy Screening: Are we Asking the Right Questions?

2021 ◽  
Vol 43 (05) ◽  
pp. 347-350
Author(s):  
Conrado Milani Coutinho ◽  
Laure Noel ◽  
Veronica Giorgione ◽  
Lígia Conceição Assef Marçal ◽  
Amar Bhide ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
The Right
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