92 Mode of cesarean hysterectomy for abnormally invasive placenta; comparing maternal and surgical complications

An abnormally invasive placenta (AIP) is a placenta that cannot be removed spontaneously or manually without causing severe bleeding. It is a dangerous condition associated with a high rate of maternal and perinatal morbidity and mortality due to the high rate of massive bleeding and visceral injuries. The standardized ultrasound diagnostic criteria have helped improve its early diagnosis, which is essential to plan coordinated actions to reduce associated morbimortality. We present a case report in which ultrasound diagnosis played a decisive role, enabling the coordination of a multidisciplinary team and improving the immediate care of both mother and newborn. Cesarean hysterectomy was performed with minimal blood loss and a good postsurgical recovery.

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Cesarean hysterectomy for abnormally invasive placenta: is urologists’ participation in the surgery always necessary?

Scandinavian Journal of Urology ◽

10.1080/21681805.2017.1373147 ◽

2017 ◽

Vol 51 (6) ◽

pp. 496-497 ◽

Cited By ~ 1

Author(s):

Shigeki Matsubara ◽

Hironori Takahashi

Keyword(s):

Cesarean Hysterectomy ◽

Invasive Placenta ◽

Abnormally Invasive Placenta

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The Role of Bilateral Internal Iliac Artery Ligation in Minimizing Blood Loss Prior to Cesarean Hysterectomy Patients with Abnormally Invasive Placenta

QJM ◽

10.1093/qjmed/hcab115.002 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Magdy Mohamed kamal Yousef ◽

Ahmed Mohamed Rateb ◽

Ahmed Mohsen Hassan Mohamed

Keyword(s):

Blood Loss ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Ligation ◽

Cesarean Hysterectomy ◽

Internal Iliac Artery Ligation ◽

Internal Iliac ◽

Invasive Placenta ◽

Abnormally Invasive Placenta

Abstract Background Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus. Objective to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy in cases with confirmed preoperative or intraoperative diagnosis of Abnormally invasive placenta. Patients and Methods The study was carried out at Ain shams university maternity hospital in 2019. Women were recruited from the labor ward who underwent CS Hysterectomy. The total number of pregnant women enrolled in the study was 95 women. Approval from the Medical Ethics Committee were obtained. Results Our study showed that internal iliac artery ligation in CS hysterectomy cases for AIP has non significant lower blood loss than cases who did not underwent internal iliac artery ligation. In stead, it had increased the operative time. In comparison of 45 patients underwent internal iliac artery ligation and 45 without ligation blood loss was non significantly lower in the group who underwent ligation with mean 1933 ml blood loss in comparison with 2117 ml in the group who did not. Conclusion Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

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The Jellyfish Sign: A New Sonographic Cervical Marker to Predict Maternal Morbidity in Abnormally Invasive Placenta Previa

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0043-119872 ◽

2017 ◽

Vol 40 (01) ◽

pp. 40-46 ◽

Cited By ~ 4

Author(s):

Emma Bertucci ◽

Filomena Sileo ◽

Giovanni Grandi ◽

Valentina Fenu ◽

Carlotta Cani ◽

...

Keyword(s):

Blood Loss ◽

Maternal Morbidity ◽

Placenta Previa ◽

Intraoperative Bleeding ◽

Cesarean Hysterectomy ◽

Postoperative Intensive Care ◽

Invasive Placenta ◽

Postoperative Intensive Care Unit ◽

Caesarean Hysterectomy ◽

Abnormally Invasive Placenta

Abstract Purpose To investigate the value of a new cervical sonographic sign, called the jellyfish sign (JS), for predicting the risk of maternal morbidity in cases of abnormally invasive placenta (AIP) previa totalis. Materials and Methods Retrospective evaluation of transvaginal (TV) and transabdominal (TA) scans performed in all singleton pregnancies with placenta previa totalis. JS, i. e. the absence of the normal linear demarcation between the placenta previa and the cervix, was evaluated by TV scans. The presence/severity of AIP and outcomes of maternal morbidity were related to this sign. Results JS was noted in 8/39 (20.5 %) patients. The two analyzed groups, i. e. with and without JS, were similar. The specificity of JS in AIP diagnosis, histological findings of accreta/increta/percreta, need for caesarean hysterectomy or blood loss > 2000 ml ranges between 92 % and 96.2 %, with the PPV and NPV ranging between 71.4 % and 85.7 % and 61.3 % and 80.6 %, respectively. The JS group had a significant increase in blood loss (ml) (p = 0.003), transfusions (%) (p = 0.016), red blood cells (p = 0.002) and plasma (p = 0.002), admission to an postoperative intensive care unit (ICU) (%) (p = 0.002), hospitalization length (p < 0.001) and the need of cesarean hysterectomy (%) (p < 0.001). JS was independently correlated to cesarean hysterectomy (OR 25.6; 95 % CI 2.0:322.3, p = 0.012) and blood loss > 2000 ml (OR 16.6; 95 % CI 1.5:180.1, p = 0.021) also in a logistic regression model. Conclusion JS is useful in predicting the increase in maternal morbidity: massive transfusion, admission to the ICU and cesarean hysterectomy related to intraoperative bleeding in patients with a previa AIP.

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