scholarly journals Conservative Management of Placenta Percreta: Three Cases and a Review of the Literature regarding Conservative Management of Placenta Accreta Spectrum (PAS) Disorders.

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
M. Patabendige ◽  
J. M. P. Sanjeewa ◽  
A. M. A. K. G. Amarasekara ◽  
R. P. Herath
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Expectant Management ◽  
Placenta Percreta ◽  
Resonance Imaging ◽  
Case Presentation ◽  
Beta Hcg ◽  
Obstetric Haemorrhage ◽  
Placenta Accreta Spectrum

Background. The incidence of placenta accreta spectrum (PAS) disorders has risen over the last decades, and there has been a gradual shift towards expectant management. Conservative management of PAS is known to reduce major obstetric haemorrhage and salvage hysterectomy. There is a lack of consensus on the follow-up of patients undergoing conservative approaches. Here, we describe the follow-up of three patients with placenta percreta who were conservatively managed and review the literature for the conservative management of PAS. Case Presentation. We have successfully managed three cases of placenta percreta expectantly using combined methods involving symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass. Conclusions. Use of a combined approach with symphysial-fundal height, serum beta-HCG, and ultrasonographic volume of placental mass with colour Doppler may guide the surveillance of these conservatively managed cases. However, at least one magnetic resonance imaging three months postoperatively may predict a further risk of delayed haemorrhage.

Hepatic pregnancy managed conservatively

2010 ◽  
Vol 40 (2) ◽  
pp. 121-122 ◽  
Author(s):  
S R Ramphal ◽  
J Moodley ◽  
D Rajaruthnam
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Magnetic Resonance ◽  
Conservative Management ◽  
Imaging Techniques ◽  
Expectant Management ◽  
Resonance Imaging ◽  
Hepatic Pregnancy

We present a case of hepatic pregnancy and discuss expectant management, use of newer imaging techniques and approaches to management, such as leaving the placenta in situ, the use of magnetic resonance imaging and sonography in the follow-up of placental involution. This case report illustrates that conservative management is feasible.

scholarly journals Conservative Management of Placenta Accreta Spectrum

2018 ◽  
Vol 61 (4) ◽  
pp. 783-794 ◽  
Author(s):  
LOÏC SENTILHES ◽  
GILLES KAYEM ◽  
ROBERT M. SILVER
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Placenta Accreta Spectrum

scholarly journals Placenta Percreta Presents with Neoangiogenesis of Arteries with Von Willebrand Factor-Negative Endothelium

2021 ◽  
Author(s):  
Alexander Schwickert ◽  
Wolfgang Henrich ◽  
Martin Vogel ◽  
Kerstin Melchior ◽  
Loreen Ehrlich ◽  
...  
Keyword(s):  
Von Willebrand Factor ◽  
Placenta Accreta ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Elastic Fibers ◽  
Histological Structure ◽  
Eph Receptor ◽  
Placenta Accreta Spectrum ◽  
Von Willebrand ◽  
Willebrand Factor

Abstract In placenta percreta cases, large vessels are present on the precrete surface area. As these vessels are not found in normal placentation, we examined their histological structure for features that might explain the pathogenesis of neoangiogenesis induced by placenta accreta spectrum disorders (PAS). In two patients with placenta percreta (FIGO grade 3a) of the anterior uterine wall, one strikingly large vessel of 2 cm length was excised. The samples were formalin fixed and paraffin-embedded. Gomori trichrome staining was used to evaluate the muscular layers and Weigert-Van Gieson staining for elastic fibers. Immunohistochemical staining of the vessel endothelium was performed for Von Willebrand factor (VWF), platelet endothelial cell adhesion molecule (CD31), Ephrin B2, and EPH receptor B4. The structure of the vessel walls appeared artery-like. The vessel of patient one further exhibited an unorderly muscular layer and a lack of elastic laminae, whereas these features appeared normal in the vessel of the other patient. The endothelium of both vessels stained VWF-negative and CD31-positive. In conclusion, this study showed VWF-negative vessel endothelia of epiplacental arteries in placenta accreta spectrum. VWF is known to regulate artery formation, as the absence of VWF has been shown to cause enhanced vascularization. Therefore, we suppose that PAS provokes increased vascularization through suppression of VWF. This process might be associated with the immature vessel architecture as found in one of the vessels and Ephrin B2 and EPH receptor B4 negativity of both artery-like vessels. The underlying pathomechanism needs to be evaluated in a greater set of patients.

Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Cecilia Cavalli ◽  
Claudia Maggi ◽  
Sebastiana Gambarini ◽  
Anna Fichera ◽  
Amerigo Santoro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Color Doppler ◽  
Histopathological Diagnosis ◽  
Resonance Imaging ◽  
Placenta Accreta Spectrum ◽  
Clinically Significant ◽  
Placental Lacunae

Abstract Objectives We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge ≤2 cm from the internal uterine orifice, ≥260/7 weeks’ gestation) with and without a history of previous Caesarean section. Methods Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization. Results A total of 39 women were included: 7/39 had clinically significant PAS. There were 6/18 cases of PAS with anterior placenta: hypoechoic space interruption and placental lacunae were the most sensitive sonographic signs (83%), while abnormal hyperechoic interface was the most specific (83%). On MRI, focal myometrial interruption and T2 intraplacental dark bands showed the best sensitivity (83%), bladder tenting had the best specificity (100%). 1/21 women with posterior placenta had PAS. There was substantial agreement between US and MRI in patients with anterior placenta (κ=0.78). Conclusions US and MRI agreement in antenatal diagnosis of clinically significant PAS was maximal in high-risk women. Placental lacunae on ultrasound scan and T2 intraplacental hypointense bands on MRI should trigger the suspicion of PAS.

Expectant management of retained abnormally adherent placenta complicated by uterine prolapse after vaginal delivery

2020 ◽  
Vol 50 (2) ◽  
pp. 160-162
Author(s):  
Nnabuike C Ngene ◽  
Amon Siveregi
Keyword(s):  
Vaginal Delivery ◽  
Placenta Accreta ◽  
Uterine Prolapse ◽  
Expectant Management ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adherent Placenta ◽  
Prenatal Imaging ◽  
Placenta Accreta Spectrum

The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography in some health facilities delays the diagnosis, particularly if the prenatal period is asymptomatic. Following vaginal delivery, it often manifests as failure to remove a retained placenta manually. In the absence of haemorrhage, expectant management involving leaving the placenta in situ, is an option. In the presence of haemorrhage and/or sepsis, hysterectomy is usually recommended. We present a case of an expectantly managed PAS following a spontaneous preterm vaginal birth. The patient developed puerperal uterine prolapse with the placenta in situ, a previously unreported complication, but this was successfully reduced manually.

scholarly journals A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup

2020 ◽  
Vol 30 (2) ◽  
Author(s):  
Yifru Berhan ◽  
Tadesse Urgie
Keyword(s):  
Literature Review ◽  
Placenta Accreta ◽  
Large Body ◽  
Expectant Management ◽  
Spectrum Management ◽  
Observational Research ◽  
Team Approach ◽  
Management Options ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

In the last three to four decades, the increasing caesarean delivery rate has contributed to several fold increment in the incidence of placenta accreta spectrum disorders globally. Placenta accreta spectrum with its subtypes (accreta, increta and percreta) is one of the devastating obstetric complications. As a result, it is the commonest indication for peripartum hysterectomy and common cause of severe maternal morbidity. However, in recent years, there is a growing interest in and practice of expectant management either to minimize emergency hysterectomy related maternal complications or to preserve the fertility potential of a woman with an intact uterus. A large body of observational research findings has demonstrated the success rate of expectant management in many of well selected cases. Similarly, the experience on delayed hysterectomy was encouraging in order to have less hemorrhage. For the best success of placenta accreta spectrum management, multidisciplinary team approach, antenatal diagnosis and managing such cases in a hospital with center of excellence has been strongly recommended. This literature review provides a robust synthesis of up-to-date knowledge and practice on the challenges and successes of placenta accreta spectrum disorders management. The currently practiced management options in the high and middle income countries are also summarized under seven categories. Therefore, the purpose of this review was to shed light on the applicability of the PAS disorder management modalities in our setup.

Accuracy and Interobserver Reliability of Magnetic Resonance Imaging for Placenta Accreta Spectrum Disorders

2020 ◽  
Author(s):  
Brett D. Einerson ◽  
Christina E. Rodriguez ◽  
Robert M. Silver ◽  
Meghan A. Donnelly ◽  
Anne M. Kennedy ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Predictive Value ◽  
Placenta Accreta ◽  
Interobserver Reliability ◽  
Diagnostic Testing ◽  
Kappa Statistics ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Placenta Accreta Spectrum

Abstract Objective This study aims to define the accuracy, predictive value, and interobserver reliability of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta spectrum (PAS) disorders. Study Design Two experienced radiologists independently interpreted the MRI studies of patients with possible PAS from two referral centers. Radiologists were blinded to sonographic and clinical information. We calculated diagnostic testing characteristics and kappa statistics of interobserver reliability for MRI findings of PAS. Results Sixty-eight MRI cases were evaluated. Confirmed PAS and severe PAS were present in 44 (65%) and 20 (29%) cases. For the diagnosis of any PAS, MRI had a sensitivity 66%, specificity 71%, positive predictive value (PPV) 81%, negative predictive value (NPV) 53%, and accuracy 68%. For the diagnosis of severe PAS (percreta), MRI had a sensitivity 85%, specificity 79%, PPV 63%, NPV 93%, and accuracy 81%. The accuracy of individual signs of PAS was lower (44–65%). Interobserver agreement was almost perfect for previa; substantial for myometrial interruptions, PAS, severe PAS, and placental bulging/balling; and moderate to slight for other signs of PAS. Conclusion Although the interobserver reliability of MRI for a diagnosis of PAS is substantial, the accuracy and predictive value are modest and lower than previously reported.

scholarly journals Post-traumatic rectourethral fistula in an adolescent managed via a transperineal approach using a local gluteal tissue interposition flap: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Toshinori Hirano ◽  
Hiroki Ohge ◽  
Yusuke Watadani ◽  
Shinnosuke Uegami ◽  
Norimitsu Shimada ◽  
...  
Keyword(s):  
Conservative Management ◽  
Fecal Diversion ◽  
Rectourethral Fistula ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Fistula Repair ◽  
Case Presentation ◽  
Clinical Presentations ◽  
Post Traumatic ◽  
Tissue Flap

Abstract Background Rectourethral fistula is a rare disease with a wide variety of etiologies and clinical presentations. A definitive surgical procedure for rectourethral fistula repair has not been established. Case presentation A 13-year-old boy sustained a penetrating injury to the perineum, and developed a symptomatic rectourethral fistula thereafter. Conservative management through urinary diversion and transanal repair was unsuccessful. Fecal diversion with loop colostomy was performed, and three months later, a fistula repair was performed via a transperineal approach with interposition of a local gluteal tissue flap. There were no postoperative complications, and magnetic resonance imaging studies confirmed the successful closure of the fistula. The urinary and fecal diversions were reverted 1 and 6 months after the fistula repair, respectively, and postoperative excretory system complications did not occur. Conclusions The transperineal approach with interposition of a local gluteal tissue flap provides a viable surgical option for adolescent patients with rectourethral fistulas who are unresponsive to conservative management.

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