scholarly journals Conservative Management of Placenta Accreta in a Multiparous Woman

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Jennifer C. Hunt
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Placental Tissue ◽  
Intrauterine Infection ◽  
Small Bowel Resection ◽  
Fertility Treatment ◽  
Retained Placenta ◽  
Future Fertility ◽  
Close Observation

Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissuein situwith subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.

scholarly journals PLACENTA ACCRETA

2018 ◽  
Vol 25 (02) ◽  
pp. 335-339
Author(s):  
Afshan Ambreen ◽  
Farhat ul Ain Ahmed ◽  
Sobia Zafar ◽  
Abeer Saeed ◽  
Sundus Mushtaq ◽  
...  
Keyword(s):  
Informed Consent ◽  
Conservative Management ◽  
Placenta Accreta ◽  
Uterine Cavity ◽  
Placental Tissue ◽  
Morbidity And Mortality ◽  
Future Fertility ◽  
Obstetrical Emergency

Placenta accreta is an obstetrical emergency associated with significantmaternal morbidity and mortality. Traditionally, hysterectomy at the time of cesarean sectionhas been the mainstay of therapy especially in cases where diagnosis is made antenatally. Inrecent years different conservative treatments for partly or totally adherent placental tissue inthe uterine cavity have been reported in patients willing to preserve fertility. We report a case ofsuccessfully managed placenta accreta with methotrexate in our department. The patient washaemodynamically stable, had desire for future fertility and gave informed consent to all thepossible risks of conservative management including repeated episodes of bleeding, multipleblood transfusions, pain, infection, delayed hysterectomy and prolonged follow up. We useda regimen of two doses of methotrexate given a week apart. Further studies are required tostudy the effectiveness of methotrexate and to establish its dose and schedule in conservativemanagement of placenta accreta.

scholarly journals Latvian experience in conservative management of abnormally invasive placenta: two case reports

2020 ◽  
Vol 26 (3) ◽  
pp. 153-158
Author(s):  
Diana Bokučava ◽  
Sandra Vītiņa ◽  
Maira Jansone ◽  
Mara Tirāne ◽  
Zane Krastiņa ◽  
...  
Keyword(s):  
Conservative Management ◽  
Case Reports ◽  
Placental Tissue ◽  
University Hospital ◽  
Tertiary Referral Hospital ◽  
Excessive Bleeding ◽  
Section Operation ◽  
Invasive Placenta ◽  
New Treatment

Background. Abnormally invasive placentation (AIP) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). Historically, the treatment of choice for this condition is hysterectomy. Lately, the new treatment option, conservative management of the AIP, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). However, the use of conservative AIP management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. Case reports. We present the first two cases of conservative management of AIP in Latvia. Most of prenatally diagnosed AIP cases country-wide are referred to the Paul Stradinš University Hospital, which is a tertiary referral hospital. The annual rate of AIP in the hospital varies from five to ten cases. Two pregnant women were diagnosed with AIP prenatally, both of them refused hysterectomy and therefore went for the conservative management of AIP. During Caesarean section operation, placentas were left in situ after delivery of the baby. During the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. Conclusion. These two cases demonstrate that conservative management of AIP can be safely applied in small countries/areas with small AIP rate and management experience.

scholarly journals A case series on conservative management in pregnancies with abnormal placentation in obstetrics: placenta accrete, increta and percreta

2018 ◽  
Vol 7 (12) ◽  
pp. 5193
Author(s):  
Fasiha Tasneem ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Post Partum ◽  
Case Series ◽  
Chemotherapeutic Agents ◽  
Morbidly Adherent Placenta ◽  
Decidua Basalis ◽  
Adherent Placenta ◽  
Caesarean Delivery Rate

Adherent placenta is one of the important causes of post- partum hemorrhage. Placenta accreta-related pathologies are an increasing contributor to maternal death from hemorrhage. With the rising caesarean delivery rate the incidence of placenta accreta has significantly increased. Morbidly adherent placenta (MAP) occurs when there is a defect in the decidua basalis, resulting in an abnormal invasion of the placenta into the substance of the uterus. A multidisciplinary approach is relevant in managing these patients in order to reduce morbidity and mortality associated with morbidly adherent placenta. A non-surgical conservative method is to leave the placenta in situ to reabsorb and institute treatment with chemotherapeutic agents, such as methotrexate. With improvement in the medical services conservative management for adherent placenta has gained significance.

scholarly journals Expectant Management of Placenta Accreta Spectrum Disorders

2021 ◽  
Author(s):  
Eiji Kondoh
Keyword(s):  
Placenta Accreta ◽  
Expectant Management ◽  
Team Approach ◽  
Limited Data ◽  
Minimum Requirement ◽  
Future Fertility ◽  
Life Threatening ◽  
Placenta Accreta Spectrum ◽  
Secondary Postpartum Hemorrhage

AbstractPlacenta accreta spectrum (PAS) disorder is a potentially life-threatening complication. The incidence of PAS has increased over the past few decades, mainly due to the increased cesarean section rate. While cesarean hysterectomy remains the most standard treatment for the management of PAS, expectant management is becoming increasingly prevalent to avoid serious maternal morbidity and maintain future fertility. Expectant management is defined as leaving the placenta either partially or fully in situ, and waiting for its spontaneous resorption or expulsion. The success rate of expectant management is high, but intraoperative uncontrolled hemorrhage results in hysterectomy. Moreover, some individuals fail expectant management and require delayed hysterectomy due to complications such as secondary postpartum hemorrhage, sepsis, uterine necrosis, and vesicouterine fistula. As a result of the very limited data currently available, there is no consensus on the optimal strategy for the expectant management of PAS. However, it is clear that a multidisciplinary team approach in tertiary centers is essential for women with PAS. In addition, meticulous preparation is the key to successful expectant management. Here, we describe a surgical strategy designed to reduce perioperative blood loss, which is a minimum requirement to ensure maternal safety. This article also addresses practical issues in expectant management of PAS, based on the published literature and our own experience.

Role of office hysteroscopic morcellation and 3-dimensional transvaginal ultrasound in conservative management of retained placenta accreta

2018 ◽  
Vol 230 ◽  
pp. 199-200
Author(s):  
Sira Capote ◽  
Montserrat Cubo-Abert ◽  
Manel Casellas-Caro ◽  
José-Luis Sánchez-Iglesias ◽  
Juan José Gomez-Cabeza ◽  
...  
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Transvaginal Ultrasound ◽  
Retained Placenta ◽  
3 Dimensional

scholarly journals Conservative Management of Retained Placenta Accreta Postpartum

Perinatology ◽  
2021 ◽  
Vol 32 (2) ◽  
pp. 75
Author(s):  
Eun Hui Joo ◽  
Ji Eun Ko ◽  
Hee lim Lee ◽  
Hyeon Chul Kim ◽  
Young Ran Kim
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Retained Placenta

scholarly journals A Unique Case of Nonradical Management of Retained Placenta Accreta

2014 ◽  
Vol 6 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Rahul Manchanda ◽  
Soma Ghoshal ◽  
Anushree Mittal ◽  
BC Manjula
Keyword(s):  
Placenta Accreta ◽  
Placental Tissue ◽  
Unique Case ◽  
Retained Placenta ◽  
Tissue Invasion ◽  
Placental Site ◽  
Biopsy Report ◽  
Β Hcg ◽  
Hysteroscopic Resection ◽  
Previous Cesarean

ABSTRACT Retained placenta is a serious cause of postpartum hemorrhage and maternal mortality. The optimal management of placenta accreta remains a topic of debate. We report here a 37-year-old woman with previous two cesareans and two curettages, with postdelivery retained placenta accreta who was diagnosed properly and underwent successful conservative treatment with hysteroscopic resection, with conservation of uterus. Placental tissue invasion at the scar site was diagnosed by ultrasound and MRI in a relatively asymptomatic patient. β-hCG value was on lower side and with a differential diagnosis of placental site trophoblastic tumor (PSTT). Hysteroscopic tissue biopsy was done and a ball of tissue approximately 655 cm invading the previous cesarean scar was visualized. Biopsy report came out to be retained placental tissue. Hysteroscopic resection was done with laparoscopic guidance. Patient followup done with repeat ultrasound and β-hCG. How to cite this article Ghoshal S, Manchanda R, Manjula BC, Mittal A. A Unique Case of Nonradical Management of Retained Placenta Accreta. J South Asian Feder Obst Gynae 2014;6(3):195-198.

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