scholarly journals Cesarean Hysterectomy for Placenta Previa Accreta Using Retrograde Abdominal Hysterectomy Approaching from the Posterior Vaginal Wall

2021 ◽  
Author(s):  
Yuji Hiramatsu
Keyword(s):  
Iliac Artery ◽  
Placenta Previa ◽  
Intraoperative Complications ◽  
Autologous Blood ◽  
Vaginal Wall ◽  
Massive Bleeding ◽  
Placenta Percreta ◽  
Posterior Vaginal Wall ◽  
Patient Consent ◽  
Bladder Invasion

AbstractHysterectomy for placenta percreta with bladder invasion is a difficult operation because of the high possibility of massive bleeding; therefore, surgery should be performed in a facility equipped with a sufficient number of trained staff. The degree of bladder invasion should be assessed correctly before the operation, and it is necessary to carefully consider how to address intraoperative complications and massive bleeding in the preoperative conference. The following should be prepared preoperatively: autologous blood and stored blood; ureteral catheter and insertion materials; materials to separate and tape the internal iliac artery and ureter; balloon for insertion into the common iliac artery or aorta and aortic clamps; and materials for compression suturing, such as B-Lynch suture. Sufficient informed patient consent is also required. During surgery, which may cause massive and sometimes life-threatening bleeding, the general rule is to begin at a safe site without adhesions and then treat the adhesion site. According to this rule, bladder dissection should be performed last in cases of placenta percreta with bladder invasion. As a surgical technique using this principle, we introduce retrograde hysterectomy approaching from the posterior vaginal wall.

scholarly journals Placenta Previa Accreta Spectrum: Cesarean Hysterectomy

2021 ◽  
Author(s):  
Satoru Takeda ◽  
Jun Takeda ◽  
Yoshihiko Murayama
Keyword(s):  
Blood Flow ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Autologous Blood ◽  
Vaginal Wall ◽  
Balloon Occlusion ◽  
Bladder Injury ◽  
Ureteric Injury ◽  
Cardinal Ligament ◽  
Cesarean Hysterectomy

AbstractWhen cesarean hysterectomy is scheduled in cases of placenta previa accreta/increta/percreta, it is necessary that the departments of obstetrics, anesthesiology, blood transfusion, urology, and radiology hold a preoperative conference to assure full preparation for the surgery. A ureteral stent inserted just before cesarean section serves as a marker. A uterine incision should be made at a site free of placental contact. The presence/absence of bladder invasion by villi, adhesions, and the degree of vascularization greatly influence the amount of bleeding, and bleeding control is a key point. For prevention of massive hemorrhage, methods of blood flow blockage, such as balloon occlusion catheterization of the aorta or common iliac artery, should be considered. Stored autologous blood and Cell Saver should be prepared. When hysterectomy is performed with the placenta left in situ, handling of the elongated cardinal ligament, ureteric injury, and bladder injury are important issues because the lower uterine segment is enlarged with the placenta. If blood flow is not blocked, separation of the bladder at the area of placenta percreta should be performed as the last step, to reduce bleeding (Pelosi's method). At this time, after handling of the cardinal ligament, bladder separation can be performed more safely if the posterior vaginal wall is incised and exposed first.In cases of placenta accreta or partial placenta accreta/increta/percreta, a diagnosis of morbidly adherent placenta may not be obtained until separation of the placenta is performed. If bleeding from the placental separation surface cannot be controlled, total hysterectomy should be performed without hesitation.

scholarly journals Risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery during cesarean section

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190127
Author(s):  
Hiroyuki Tokue ◽  
Azusa Tokue ◽  
Yoshito Tsushima ◽  
Takeshi Kameda
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Massive Bleeding ◽  
Balloon Occlusion ◽  
Round Ligament ◽  
Internal Iliac ◽  
Angiographic Findings

Objective: We evaluated the risk factors for massive bleeding based on angiographic findings in patients with placenta previa and accreta who underwent balloon occlusion of the internal iliac artery (BOIA) during cesarean section. Methods: We performed a retrospective analysis using the clinical records of 42 patients with placenta previa and accreta who underwent BOIA during cesarean section between 2006 and 2017 in Gunma university hospital. We reviewed incidence of collateral arteries to the uterus on the initial aortography. We evaluated the visualization of the ovarian artery arising directly from the abdominal aorta, round ligament artery arising from the external iliac artery/inferior epigastric artery, and the iliolumbar artery. In addition, the clinical characteristics were reviewed. Patients with an estimated blood loss during delivery of >2500 ml, >4 packed red blood cell transfusions, uterine artery embolization after delivery, or hysterectomy were defined as the massive bleeding group. We compared between the massive and non-massive bleeding groups. Results: 20 patients (48%) had a massive bleeding. No procedure-related severe complications were observed. The massive and non-massive bleeding groups differed in terms of operation time (p < 0.001), hysterectomy (p < 0.001), post-operative hospital stay (p < 0.05), and visualization of round ligament arteries to the uterus [15/20 (75%) patients, p < 0.01]. Conclusion: The incidence of collateral blood supply from a round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section. Advances in knowledge: Angiographic visualization of collateral circulation from the round ligament artery to the uterus may be a risk factor for massive bleeding in patients with placenta previa and accreta who have undergone BOIA during cesarean section.

scholarly journals Pernicious placenta previa/placenta percreta complicating active systemic lupus erythematosus resulting in postoperative artery thrombosis

2019 ◽  
Vol 47 (12) ◽  
pp. 6365-6373
Author(s):  
Jiahuang Liu ◽  
Chao Liu ◽  
Xiaohang Zuo ◽  
Yue Teng
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Abdominal Aorta ◽  
Iliac Artery ◽  
Lupus Erythematosus ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Placenta Percreta ◽  
Close Monitoring ◽  
Systemic Lupus ◽  
Infrarenal Abdominal Aorta

Systemic lupus erythematosus (SLE) increases the risk of adverse pregnancy outcomes and fetal complications. Placenta percreta, involving placental attachment to another organ, is a rare but severe placental abnormality. We report a 26-year-old woman, G2P1, with a 6-year history of SLE with coexisting pernicious placenta previa and placenta percreta detected by second trimester ultrasound. She discontinued prednisone 5 months before admission, without consultation, and active SLE was diagnosed on admission. Because of her progressive condition, the patient underwent infrarenal abdominal aorta balloon occlusion and double J ureteral catheter placement, followed by elective cesarean at 27+6 weeks gestation. Despite aggressive management, she experienced severe bleeding requiring internal iliac artery ligation and peripartum hysterectomy. The placenta had penetrated the uterus walls and attached to the bladder apex, necessitating bladder repair. Thrombosis was detected in the common iliac artery and common femoral artery in the right leg 1 day postoperatively. Conservative antithrombotic therapy had little effect, and embolectomy by arteriotomy was performed on the 6th post-cesarean day, and an arterial thrombus was removed. Infrarenal abdominal aorta balloon occlusion may increase the risk of postoperative thrombosis in pregnant women with active SLE and coagulation disorders. These patients therefore require close monitoring and timely anticoagulation.

scholarly journals Antenatal diagnostic aspects of placenta percreta and its influence on the perinatal outcome: a clinical case and literature review

2017 ◽  
Vol 23 (4) ◽  
pp. 219-226 ◽  
Author(s):  
Jelena Volochovič ◽  
Diana Ramašauskaitė ◽  
Ramunė Šimkevičiūtė
Keyword(s):  
Clinical Case ◽  
Placenta Previa ◽  
Massive Bleeding ◽  
Placenta Percreta ◽  
Optimal Care ◽  
Iliac Arteries ◽  
Internal Iliac ◽  
Life Threatening ◽  
Caesarean Hysterectomy ◽  
Internal Iliac Arteries

Background. Placenta percreta is a very rare, but extremely life-threatening obstetrical pathology for the mother and the child, especially in the cases when it is not diagnosed before the birth and when it results in massive bleeding and a dramatic deterioration of condition. It is extremely important to diagnose this pathology as early as possible and plan further optimal care of patients in order to minimize life-threatening complications. Case report. The paper presents an illustrated clinical case of placenta percreta determined before the birth. Features of visual diagnostics are discussed. A 32-year-old pregnant woman with a history of two caesarean deliveries arrived at the tertiary level hospital at 22 weeks of gestation due to abdomen pain. Placenta previa was diagnosed and ultrasound, magnetic resonance imaging suggesting placenta percreta were seen. On the  32nd week, the  planned caesarean hysterectomy was performed. The balloon catheters to occlude the internal iliac arteries and minimize bleeding during the surgery were used. Conclusions. Antenatal diagnosis of placenta percreta is especially important. Methods of visual diagnostics are complementary. The optimal surgical approach during caesarean hysterectomy remains controversial. In the case of the slow oozing without a clearly identified source of bleeding after hysterectomy and internal iliac arteries balloons deflation, ligation of one of the internal iliac arteriescan be reasonable to avoid residual haemorrhage and relaparotomy.

ACRETISMO PLACENTÁRIO: PLACENTA PERCRETA.

2021 ◽  
Vol 8 (1) ◽  
pp. 8-10
Author(s):  
Helaine Bueno Moraes ◽  
Carolina Rodrigues Costa ◽  
Karol-layne Macena Martins ◽  
Rômulo Braga Pires ◽  
Pedro Miranda Portugal Júnior ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Placenta Percreta

INTRODUÇÃO: O acretismo placentário é uma complicação gestacional, definida pela implantação anômala da placenta, que se caracteriza conforme o grau de profundidade da implantação em: placenta acreta quando as vilosidades coriônicas aderem ao miométrio até um terço de sua parede, com ausência de decídua basal, increta quando penetram profundamente o miométrio e percreta quando chegam à serosa uterina podendo invadir órgãos adjacentes.  A placenta percreta é pouco comum, mas uma causa importante de morbimortalidade materna, devido ao alto risco de complicações. DESCRIÇÃO: O seguinte relato apresenta o caso de uma gestante de 36 anos, proveniente de Porto Nacional-TO, GV PCIII NII A0 com 39 semanas, realizou 08 consultas de pré-natal e obteve diagnóstico de placenta percreta no momento do parto. DISCUSSÃO: Tem-se como objetivo, alertar os profissionais de saúde sobre a gravidade da placenta percreta e a importância do diagnóstico precoce do acretismo placentário.  Por meio de, uma anamnese detalhada afim da identificação de fatores de risco como: cesáreas anteriores, placenta prévia e multiparidade, associada a exames de imagem (ultra INTRODUÇÃO: O acretismo placentário é uma complicação gestacional, definida pela implantação anômala da placenta, que se caracteriza conforme o grau de profundidade da implantação em: placenta acreta quando as vilosidades coriônicas aderem ao miométrio até um terço de sua parede, com ausência de decídua basal, increta quando penetram profundamente o miométrio e percreta quando chegam à serosa uterina podendo invadir órgãos adjacentes.  A placenta percreta é pouco comum, mas uma causa importante de morbimortalidade materna, devido ao alto risco de complicações. DESCRIÇÃO: O seguinte relato apresenta o caso de uma gestante de 36 anos, proveniente de Porto Nacional-TO, GV PCIII NII A0 com 39 semanas, realizou 08 consultas de pré-natal e obteve diagnóstico de placenta percreta no momento do parto. DISCUSSÃO: Tem-se como objetivo, alertar os profissionais de saúde sobre a gravidade da placenta percreta e a importância do diagnóstico precoce do acretismo placentário.  Por meio de, uma anamnese detalhada afim da identificação de fatores de risco como: cesáreas anteriores, placenta prévia e multiparidade, associada a exames de imagem (ultrassom, ressonância magnética e ultrassom com doppler) que podem facilitar o diagnóstico. Descritores: Acretismo placentário, placenta percreta, complicações na gestação. ssom, ressonância magnética e ultrassom com doppler) que podem facilitar o diagnóstico. Descritores: Acretismo placentário, placenta percreta, complicações na gestação.

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