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

2017 ◽  
Vol 40 (01) ◽  
pp. 40-46 ◽  
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.

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

QJM ◽  
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.

scholarly journals Obstetric complications of placenta previa percreta

2014 ◽  
Vol 71 (12) ◽  
pp. 1163-1166 ◽  
Author(s):  
Radmila Sparic ◽  
Ljiljana Mirkovic ◽  
Uros Ravilic ◽  
Tijana Janjic
Keyword(s):  
Uterine Rupture ◽  
Maternal Morbidity ◽  
Vaginal Bleeding ◽  
Placenta Previa ◽  
Bladder Wall ◽  
Fistula Formation ◽  
Ureteral Stricture ◽  
Uterine Incision ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Introduction. Placenta previa is related to severe maternal and fetal morbidity. The increasing incidence of cesarean delivery rate causes a marked increase in abnormally invasive placenta over the past decades. The abnormally invasive placenta is becoming the foremost cause of obstetric hemorrhage and postpartum hysterectomy, causing a significant maternal and fetal morbidity and even mortality. Maternal morbidity in such cases also comprise politransfusion, development of disseminated intravascular coagulation, uterine rupture, cystostomy, fistula formation, ureteral stricture, intensive care unit admission, infection, and prolonged hospitalization, adult respiratory distress syndrome, renal failure, septicemia and even death. Case report. A 38-year-old gravida 3, para 2, was admitted to our hospital at 27 weeks of gestation as an emergency due to vaginal bleeding, previously diagnosed with an anterior placenta previa. Following tocolytic therapy, bleeding stopped. The patient was informed on the diagnosis and the possibility of lifethreatening hemorrhage necessitating preterm delivery. She was given corticosteroids to enhance fetal lung maturity. At 28 weeks of gestation, she experienced massive vaginal bleeding, and a decision was made to perform emergency cesarean section. We made a corporeal transverse uterine incision well above the uterovesical fold and tortuous vessels, at the same time avoiding the superior edge of the placenta. The placenta was found to be densely adherent to the lower uterine segment, penetrating through it and infiltrating the posterior wall of the urinary bladder. An attempt to remove the placenta resulted in injury to the bladder wall and the uterine rupture at a previous cesarean scar. The decision was made to perform total abdominal hysterectomy with placenta left in situ. At present, both mother and the baby are well. Conclusion. Anticipation and the surgeon's judgment are leading factors for surgery, from the choice of uterine incision type to the decision to proceeding to hysterectomy in order to reduce maternal morbidity.

scholarly journals Management of Abnormally Invasive Placenta: One-center Experience

2017 ◽  
Vol 11 (3) ◽  
pp. 184-188
Author(s):  
Grigoriy Penzhoyan ◽  
Vladislava Novikova
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Combined Treatment ◽  
Total Blood ◽  
Multiparous Women ◽  
Perinatal Center ◽  
Invasive Placenta ◽  
Magnetic Resonance Imaging Mri ◽  
Abnormally Invasive Placenta

ABSTRACT Aim To present one-center experience of the management of abnormally invasive placenta (AIP). Materials and methods This was a retrospective cohort study of clinical cases of abnormally invasive placenta (the AIP) in Perinatal Center (PC), which is part of General Hospital— Regional Clinical Hospital N2 of Krasnodar city, in the period from 2014 to August 2016. Results The total number of childbirth for the period was 24 078, and AIP was diagnosed in 0.17%. The average age of women was 31.5 ± 0.8 years. About 97.5% were multiparous women and 85% women in the previous pregnancy had childbirth by cesarean section (CS): One CS—41.18%, two—32.35%, and three—23.53%. An AIP was first diagnosed in pregnancy at 11 to 39 weeks of pregnancy by ultrasound or magnetic resonance imaging (MRI). Cesarean section performed in the conditions of the X-ray operating of the endovascular department. The relative risk (RR) for accurate diagnosis of AIP by ultrasound was 1.789 ± 0.709 [95% confidence interval (CI) 0.446–7.186], and for MRI RR was 0.944 ± 0.142 (95% CI 0.715–1.246). At CS, in 85% of women balloon dilatation of the iliac vessels was performed, in 15%, uterine artery embolization (UAE), and in 72.5%, metroplasty. In 15% of women with AIP were the cause of hysterectomy without adnexa. The total blood loss was 1152.56 ± 107.67 (4,000–35,000) mL or 15.539 ± 1.7374 (5,0000–58,330) mL/kg. Maximum blood loss was in women with placenta previa and its localization in the area of the scar on the uterus that required a hysterectomy. Conclusion Despite increasing incidence of AIP, it is possible to prevent massive blood loss during delivery by combined treatment using radiological endovascular procedures for devascularization of the lower pelvis. Early diagnosis of placental abnormalities with regionalized approach in perinatal health makes it possible not only to preserve the women's reproductive health and fertility but also to minimize postpartum hemorrhage. How to cite this article Penzhoyan G, Novikova V. Management of Abnormally Invasive Placenta: One-center Experience. Donald School J Ultrasound Obstet Gynecol 2017;11(3):184-188.

scholarly journals Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yoshikazu Nagase ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Takeya Hara ◽  
Aiko Okada ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Loss ◽  
Cesarean Delivery ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Multivariate Regression ◽  
Placenta Previa ◽  
Control Group ◽  
Intraoperative Blood Loss ◽  
Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

scholarly journals Cesarean Hysterectomy in Abnormally Invasive Placenta: The Role of Prenatal Diagnosis

Diseases ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 56
Author(s):  
Ana Maria Cubo ◽  
Ana Villalba Yarza ◽  
Irene Gastaca ◽  
María Victoria Lapresa-Alcalde ◽  
Maria José Doyague ◽  
...  
Keyword(s):  
Decisive Role ◽  
Massive Bleeding ◽  
High Rate ◽  
Severe Bleeding ◽  
Cesarean Hysterectomy ◽  
Invasive Placenta ◽  
Postsurgical Recovery ◽  
Dangerous Condition ◽  
Abnormally Invasive Placenta

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.

scholarly journals Adjunctive intrauterine Foley’s Catheter Balloon adding to hypogastric artery ligation in the conservative management of morbid adherent placenta previa

2018 ◽  
Vol 7 (6) ◽  
pp. 2093
Author(s):  
Hany F. Sallam ◽  
Nahla W. Shady
Keyword(s):  
Blood Loss ◽  
Placenta Previa ◽  
Hypogastric Artery ◽  
Artery Ligation ◽  
Cesarean Hysterectomy ◽  
Adherent Placenta ◽  
Group I ◽  
Estimated Blood Loss ◽  
Group Ii ◽  
Foley’S Catheter

Background: Objective of present study was to demonstrate the efficacy of Foley’s catheters balloon tamponade as an adjuvant to control blood loss during and after a caesarian section in patient undergone hypogastric artery ligation (HAL) due to morbid adherent placenta previa (MAPP).Methods: A single-center retrospective case-control clinical trial was carried out in a tertiary university hospital between March 2015 and March 2018, 124 women were undergoing cesarean delivery for MAPP, were managed conservatively either with HAL or HAL plus inflated Intrauterine Foley’s Catheter Balloon to control post-partum hemorrhage secondary to MAPP. In the case of conservative treatment protocol failure, cesarean hysterectomy was performed.Results: 124 women were enrolled (n=62 in each group). group of women received HAL plus Intrauterine Foley’s Catheter Balloon (group II)) showed a significant reduction in intraoperative and 4 hours post-operative blood loss compared with (Group I) which received HAL without Intrauterine Foley’s Catheter Balloon. (P = 0.0001,0.0.015), so the overall estimated blood loss in group II showed significant reduction compared with group I (P = 0.0001).Conclusions: Adjunctive intrauterine Foley's catheter balloon adding to HAL ligation in the management of MAPP is a novel combination approach have proved to be effective to control of intraoperative and PPH and to preserve the uterus as possible and change in the concept of MAPP management always mandates hysterectomy. And may become an alternative valid option to planned cesarean-hysterectomy in well-selected cases who have a strong desire for future fertility.

scholarly journals Study on Maternal and Immediate Fetal outcome of placenta previa

2017 ◽  
Vol 11 (2) ◽  
pp. 24-27
Author(s):  
Sushma Lama ◽  
S Ranjit
Keyword(s):  
Blood Loss ◽  
Medical Records ◽  
Placenta Previa ◽  
Fetal Outcome ◽  
Intrauterine Fetal Death ◽  
Dilatation And Curettage ◽  
Life Threatening ◽  
Study Population ◽  
Risks Factors ◽  
Caesarean Hysterectomy

Aims:  This study aimed to analyze the demographic profile, maternal and fetal outcome of placenta previa.Methods:  This was a retrospective study done at Patan Academy of Health Sciences. The study population  comprised of all the patients that had caesarean section   for placenta previa  from April 2012 to October 2015. All patients diagnosed with placenta previa clinically, ultrasonograph or incidentally  during caesarean sections were recruited in this study.  The data were obtained from medical records and hospital database system. Individual charts were reviewed  and data on various  parameters were collected.Results:  In Patan hospital, there were total 126 placenta previa cases out of 21,552 deliveries during the two and half year period hence the incidence  was 0.58 %.  We were able to retrieve patient records of only 108 of 126 cases. The incidence of placenta previa was higher with increasing maternal age ≥30 years (41.67%), more common in multigravida (65.74%). We found that associated risks factors  included previous CS, multiparity and dilatation and curettage (40.74%).  Eleven patients required blood transfusion, seven of them had blood loss of 1000-1400 ml, one had blood loss of 2000 ml. Also, Caesarean hysterectomy were performed in two patients. In term of fetal outcomes, 37.04% were preterm birth and 29.63% of the babies had low birth weight.  There was one incident of congenital anomaly, one intrauterine fetal death and six neonatal deaths.Conclusions: Placenta previa is an obstetrics complication that is potentially life threatening to both the mother and the baby.

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