MORBID ADHERENT PLACENTA: PREDICTION, DIAGNOSIS AND MANAGEMENT

2007 ◽  
Vol 18 (4) ◽  
pp. 357-381 ◽  
Author(s):  
JM PALACIOS JARAQUEMADA ◽  
CH BRUNO ◽  
WA CLAVELLI
Keyword(s):  
Caesarean Section ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Close Relation ◽  
Morbidity And Mortality ◽  
Vital Importance ◽  
Diagnosis And Management ◽  
On Demand ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality

Morbid adherent placenta (MAP), also known as placenta accreta, increta or percreta, is one of the main causes of maternal morbidity and mortality. Its incidence has noticeably increased in the last few decades, a fact directly related to the increase in caesarean sections. There is a close relation between iterative caesarean sections and MAP. This connection is of vital importance, since caesarean rates have risen worldwide, especially in the countries where there is the possibility of caesarean section on demand.

HYPOTENSION DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION: IMPLICATIONS, DETECTION PREVENTION AND TREATMENT

2006 ◽  
Vol 17 (2) ◽  
pp. 157-183 ◽  
Author(s):  
KIM S KHAW ◽  
WARWICK D NGAN KEE ◽  
SHARA WY LEE
Keyword(s):  
Caesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Regional Anaesthesia ◽  
Maternal Morbidity ◽  
Morbidity And Mortality ◽  
Maternal Deaths ◽  
Maternal Morbidity And Mortality ◽  
Prevention And Treatment

Regional anaesthesia is preferred by most anaesthetists for the majority of caesarean sections. The major advantage of regional anaesthesia is the avoidance of maternal morbidity and mortality associated with general anaesthesia. The importance of this can be seen in the most recent Report of Confidential Enquires into Maternal Deaths in which it was reported that of the direct maternal deaths attributed to anaesthesia, all six were associated with difficulties during general anaesthesia. Although a number of regional anaesthesia techniques are available, spinal anaesthesia is particularly popular because it is fast, easy to perform and provides excellent intraoperative analgesia.

scholarly journals An analytical study of intraoperative, immediate post-operative and perinatal complications in previous two caesarean section

2018 ◽  
Vol 7 (10) ◽  
pp. 4239
Author(s):  
Prachi Singh ◽  
Ritika Agarwal ◽  
Shweta Yadav
Keyword(s):  
Caesarean Section ◽  
Analytical Study ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity ◽  
Perinatal Complications ◽  
Lower Segment ◽  
Lower Segment Caesarean Section ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality

Background: Lower segment caesarean section is one of the commonest operations performed now a day.It has been seen that in cases with previous caesarean section there is increased maternal morbidity and mortality due to placenta previa, adherent placenta and caesarean hysterectomy.The present study was conducted to know the fetomaternal outcome and intra and immediate post-operative complications in cases with previous two lower segment caesarean section.Methods: The present study was conducted in TMMC Moradabad between January 2017-January 2018.Total 68 cases were previous two lower segment caesarean section were included in the study. Neonatal outcome and intraoperative and immediate postoperative complications were seen in these cases.Results: In the present study majority of the cases were in 30-34 years age group (39.7%), the maximum number of caesarean sections were done between gestational age of 37-39.6 weeks (47.1%). Intraoperatively adhesions between uterus, anterior abdominal wall and bladder was seen in less than half of the cases i.e. in 42.6% cases. Out of 68 cases with previous two lower segment caesarean operated 13 cases had placenta previa and 4 cases had adherent placenta.Conclusions: The present study shows that the maternal and perinatal morbidity and mortality is increased with increasing number of caesarean sections. So, there should be reduction in rate of primary caesarean section which can reduce the rate of placenta previa and adherent placenta in subsequent pregnancies.

scholarly journals Use of a Fibrin Sealant Patch at Cesarean for Conservative Management of Morbidly Adherent Placenta

2018 ◽  
Vol 08 (04) ◽  
pp. e325-e327 ◽  
Author(s):  
James Greenberg ◽  
Julian Robinson ◽  
Jean Carabuena ◽  
Michaela Farber ◽  
Daniela Carusi
Keyword(s):  
Cesarean Delivery ◽  
Fibrin Sealant ◽  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Artery Embolization ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Repeat Cesarean Delivery

Background Morbidly adherent placenta represents a surgical challenge and source of maternal morbidity and mortality. We report the use of a fibrin sealant patch to address hemorrhage associated with a morbidly adherent placenta during cesarean delivery. Case A patient underwent repeat cesarean delivery with complete anterior placenta previa and anticipated morbidly adherent placenta. Bleeding persisted following delivery and removal of the placenta, despite uterine artery embolization. A fibrin sealant patch was applied as an adjuvant intervention to the placental bed and hemostasis was achieved without resorting to a hysterectomy. Conclusion Postpartum hemorrhage is an ongoing leading source of maternal morbidity and mortality. A case is presented in which a fibrin sealant patch provided control of focal placental bed bleeding, allowing removal of a focal morbidly adherent placenta and avoidance of hysterectomy.

scholarly journals Morbidly Adherent Placenta: Management options

2021 ◽  
Vol 31 (01) ◽  
pp. 3-7
Author(s):  
Abida Sajid ◽  
Aqsam Sajid Aqsam Sajid ◽  
Arham Sajid Arham Sajid ◽  
Maham Abid Maham Abid
Keyword(s):  
Maternal Morbidity ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Management Options ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Vaginal Deliveries ◽  
Maternal Morbidity And Mortality

Background Placenta previa with placenta accreta spectrum is one of the most feared complications responsible for increased maternal morbidity and mortality. This study aims to reduce maternal morbidity and mortality by detecting risk factors, performing relevant investigations, and deciding appropriate management options. Methods: The study design is a descriptive case series, carried out on 72 patients of MAP of a tertiary care hospital, in a 6-years duration from January 2014 to December 2019. Patients of OPD and the emergency department were diagnosed for MAP by using grayscale ultrasounds, color Doppler USG's (in most cases), and MRI's (in only a few cases). Different management options were studied and maternal morbidities were observed.  In the majority of cases, patients had operative deliveries with planned/ emergency hysterectomies, except for some having conservative surgery. Results: In the period of 6 years, the total number of deliveries was 35940. Out of these, 22140 were spontaneous vaginal deliveries and 13800 were C-sections.  The incidence of MAP was 1 per 499 normal deliveries and 1 per 192 in C-sections. The criteria for MAP was fulfilled by 72 patients. MAP diagnosed in the antenatal period was 43% while 57% were diagnosed in an emergency. The majority of patients had a history of C-sections and many underwent emergency obstetric hysterectomies. Blood transfusions were given to all patients in our study. Only 4(5.5%) patients died in our study. Conclusion:      Antenatal diagnosis of morbidly adherent placenta, followed by a well-planned surgical management, avoidance of placental separation and early caesarean hysterectomy ultimately result in a better maternal outcome. Keywords: Morbidly Adherent Placenta, Maternal Morbidity, Massive Obstetric Hemorrhage, Obstetric Hysterectomy.  

scholarly journals PLACENTA ACCRETA SPECTRUM - A CASE SERIES

2020 ◽  
pp. 1-4
Author(s):  
Medha Dadaji Davile ◽  
Anil Charandas Humane ◽  
Ashwini Kuchnur
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Obstetric Hemorrhage ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
Placenta Accreta Spectrum

Morbidly adherent placenta is a major cause for massive obstetric hemorrhage, which leads to maternal morbidity and mortality. Most accepted hypothesis for etiology of placenta accreta spectrum is defect in the endometrial–myometrial interface which leads to failure of normal decidualization in the uterine scar, which allows abnormal deep infiltration of placental anchoring villi and trophoblast. Maternal morbidity and mortality can occur as a result of massive and sometimes life-threatening obstetric hemorrhage which often requires blood transfusion. It becomes exponential and life threatening when placenta previa is associated with placenta accreta spectrum. There are several risk factors for placenta accreta spectrum, most common being previous caesarian section. Antenatal diagnosis of placenta accreta is highly desirable as outcomes are optimized when timely delivery occurs at a tertiary care facility accustomed to handle such cases. Here we are reporting six cases of placenta accreta spectrum managed by conventional and expectant way at our tertiary care hospital. Methods: Study was carried out in Government Medical College & Hospital, Nagpur. Case records of patients with placenta accreta syndrome between December 2019 and March 2020 were reviewed and analysed. Results: Six cases of placenta accreta syndrome were studied.100% patients had history of previous caesarean section, 5 patients had associated placenta previa. One out of six patients one had history of dilatation and evacuation for missed abortion.4 out of six underwent caesarean hysterectomy and 2 underwent conservative management with uterine preservation. Average blood loss was 2500 ml. Conservative management was successful in two patients. There was no maternal mortality in series. Conclusion : Among many risk factors, previous caesarean section is the most common. Therefore reducing rate of caesarean deliveries can reduce the prevalence of placenta accreta syndromes. Adherent placenta should be suspected in cases of previous caesarean with placenta previa, high parity, uterine curettage, and uterine surgeries.Conservative management should be reserved for selected patients. MRI is not mandatory for diagnosis of the condition.

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