Sonographic Detection of Placenta Percreta With Associated Placenta Previa and Succenturiate Lobe

2021 ◽  
Vol 37 (2) ◽  
pp. 194-199
Author(s):  
Melissa Detweiler ◽  
Emily Downs
Keyword(s):  
Placenta Accreta ◽  
Imaging Modality ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
Clinical Factors ◽  
Placenta Accreta Spectrum ◽  
Placental Invasion

Placenta percreta is the most complicated degree of the placenta accreta spectrum (PAS). It involves placental invasion through the uterine myometrium and into, or beyond, the uterine serosa, which can ultimately lead to severe maternal hemorrhage. Placenta previa is often associated with PAS and can be a significant indicator, along with other clinical factors. Sonography has historically been a highly accurate and safe imaging modality to assess the PAS. This specific case examines a patient with a pathologically proven percreta with an associated previa and succenturiate placental lobe.

Prior Cesarean Delivery Healthcare Facilities Variations in Pregnancy Outcomes of Placenta Accreta Spectrum with Placenta Previa: A retrospective study from a tertiary transferal center (Preprint)

2021 ◽  
Author(s):  
Xuan Gao ◽  
Shaoshuai Wang ◽  
Lijie Wei ◽  
Peng Gao ◽  
Jiaqi Li ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
County Level ◽  
Healthcare Facilities ◽  
Placenta Accreta Spectrum ◽  
Province Level ◽  
Rural Township ◽  
Previous Cesarean

BACKGROUND The prevalence of Placenta Accreta Spectrum(PAS) is increasing rapidly linked with the cesarean rate increase worldwide, creating a threatening condition from severe postpartum hemorrhage to various maternal morbidities. The socio-economic imbalance, geographical, qualification, and specialty variations of the previous cesarean delivery healthcare facilities resulted in assessment and management difficulties. OBJECTIVE To assess variations of prior cesarean delivery healthcare facilities on pregnancy outcomes on current PAS with Placenta Previa. METHODS This retrospective study was conducted in a tertiary referral center from Nov.2015 to Nov.2020 in central China. Healthcare facilities were classified by geographical, hospital grading, ownership, and specialty variations. The primary outcome was postpartum hemorrhage(PPH), secondary outcomes included Placenta Percreta and maternal-fetal morbidities. RESULTS In total, 252 patients were enrolled, 58(23%) patients had Placenta Accreta, 131(52%) had Placenta Increta and 63(25%) had Placenta Percreta. The overall incidence of PPH was 47.2%(119 out of 252). As the administrative geographical level becoming smaller and more distant, PPH incidence climbed up: province-level(10, 32.3%), prefecture-level(65, 48.5%), county-level(30, 42.3%), and rural township(14, 82.5%), P for trend= 0.019. The odds of PPH in rural township clinics was 5.84(P=0.03, 95%CI 1.18~28.77) compared to the province-level hospitals. Similarly, when hospital grades declined, PPH incidence raised: tertiary(26, 39.4%), secondary(28, 43.8%), primary(14, 38.9%) and unclassified(51, 59.3%), P for trend= 0.047. Unclassified hospitals had 2.16(P= 0.046, 95%CI 1.02~4.61) times odds of PPH compared to tertiary medical centers. PPH showed no statistical significance based on ownership or specialty variations. Also, Placenta Percreta increased when geographical location shifted from urban to rural: three (9.7%) from province-level, 34(25.6%) from prefecture-level, 18(25.4%) from county-level and eight(47.1%) from rural township clinics, P= 0.04, P for trend =0.018. Patients with previous rural township clinics cesarean delivery had a 7.49 times risk((P=0.011, 95%CI 1.59~35.19) of developing Placenta Percreta compared with province-level hospitals. CONCLUSIONS Healthcare facilities variations of the previous cesarean delivery have upcoming impacts on subsequent pregnancy. The tendency of experiencing adverse maternal outcomes is more significant with prior cesarean in the rural township clinics and unclassified hospitals. The findings call for physicians’ alertness, persistent efforts in urban-rural disparity reduction, and measures to achieve equitable management.

scholarly journals Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review :

2019 ◽  
Vol 5 (1) ◽  
pp. 52
Author(s):  
Rajuddin Rajuddin ◽  
Roziana Roziana ◽  
Munawar Munawar ◽  
Muhammad Iqbal
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Placenta Percreta ◽  
Risk Of Bleeding ◽  
Placenta Accreta Spectrum

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. The management of placenta accrete spectrum will be discussed here and is essentially the same. The following discussion of management of placenta accreta spectrum applies to all depths of placental invasion. Incidence: In 1950 placentaaccreta was rare, occurring 1 in 30.000 deliveries in the United States. Duringbetween 2008 and 2011 in a cohort of over 115.000 deliveries in 25 hospitals in the United States reaching 1 in 731 deliveries. The marked increase has been attributed to the increasing prevalence of cesarean delivery in recent decades.The incidence of placenta accreta spectrum will also increase due to increasing of caesarean section rate. Case: Mrs.44 yo, G3P2 36-37weekslive, previous cesarean section 2 time,placenta previa totalis, placenta percreta. She’s comes with a chief complaint of lower abdominal cramps, patients regularly antenatal care at obstetrician. Ultrasound finding, a single fetus lives at transvers lie, dorso superior, corresponding to 36-37 weeks, placenta previa, placenta percreta (PAI:83%). This patient planned for elective conservative surgery management, due to cesarean section and or cesarean hysterectomy. Discussion:Surgical conservative management giving birth a baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion. The discovery of placenta accreta spectrum earlier when antenatal care, better birth planning than multidisciplinary science includedfetomaternal, gyneco-oncologist, anesthesiologist, thorac& cardiovascular surgeon, radiology intervention, intensivist - obstetric intensive care, urologist and neonatology can determine the success of handling cases of placenta accreta spectrum so as to reduce maternal, fetal morbidity and mortality. Conclusions:  The discovery of placenta accreta spectrum earlier when antenatal care, planning delivery is better than multidisciplinary science. Management with corporal incisions away from placental implantation, giving birth baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion.

scholarly journals A Case Report of Placenta Percreta

2021 ◽  
Vol 5 (4) ◽  
pp. 139-145
Author(s):  
Widiana Ferriastuti ◽  
Dwi P. R. Tampubolon ◽  
Qonita Qonita
Keyword(s):  
Case Report ◽  
Cesarean Delivery ◽  
Physiological Condition ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Abdominal Ultrasound ◽  
Placenta Percreta ◽  
Total Weight ◽  
Clot Retention ◽  
Placental Invasion

There has been an increased incidence of placenta accreta in recent decades, which is associated with an increase in cesarean delivery. A woman aged 39 years GIVP1111 at 8 months of gestation was a breech location with antepartum bleeding et. causa placenta previa totalis suspected percreta bladder infiltration and hematuria. The last abdominal ultrasound showed no visible clot retention and mild right-sided hydronephrosis (possibly a physiological condition). Due to doubts regarding the suspicion of placental invasion of the bladder, an MRI examination of the abdomen was performed. A network was irregular in shape and can not be oriented either right or left, some of which have been split. Attached to the placenta. It was not clear that the cervix and bladder were visible, the total weight was 500 grams, the size was 15x13x5 cm. Based on both macroscopic and microscopic histopathological examinations, it could be concluded that the uterus, adnexa, surgery: placenta percreta, adenomyosis uteri. Keywords: placenta percreta; uterus; antepartum bleeding

scholarly journals Anesthesia Management in Patient with Placenta Percreta Performed Intra-aortic Ballooning Caesarean Section

2021 ◽  
Vol 1 (1) ◽  
pp. 16
Author(s):  
RTh. Supraptomo ◽  
Alma Hepa Allan
Keyword(s):  
Caesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
Anesthetic Technique ◽  
Hemodynamic Changes ◽  
Risk Of Bleeding ◽  
History Of ◽  
Operation Duration ◽  
Placenta Accreta Spectrum

<p>Placenta accreta spectrum is one of maternal mortality’s causes which is related with severe obstetric bleeding that requires hysterectomy. The incidence rate of the spectrum placenta increases with increasing caesarean section. Placenta accreta spectrum is also close-related to placenta previa. The aim of this study is to  understand perioperative management in patient with placenta percreta performed with intra-aortic ballooning in caesarean section. We are following a case on a 36 year old female patient, multigravida at term pregnant with placenta percreta and history of caesarean section 5 and 2 years ago. The surgeries performed were caesarean section surgery as well as intra-aortic ballooning. Anesthetic technique used was general anesthesia. Operation duration approximately ± 180 minutes, bleeding 1500 cc. After the operation, the patient was admitted to the ICU. The patient going well and discharged from ICU to ward on the second day. After three days in ward, the patient discharged to home. Hemodynamic changes during balloon intra-aortic procedures are of particular concern to anesthetists. This is because the stopping of blood flow to the aorta in this case can cause an increase in blood vessel pressure, where the administration of nitroglycerin at low doses can reduce venous tone resulting in venous vasodilation which will maintain hemodynamic stability during the process of blocking blood vessels with a balloon. From the case we may conclude that anesthesia in pregnant women with placenta accreta spectrum should be carried out with caution and involve a multidisciplinary specialist given its high risk of bleeding. The intra-aortic balloon insertion technique can be an option used to reduce the risk of bleeding in patients with placenta accreta spectrum.</p>

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.

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

Placenta Accreta Spectrum: A preventable nearly iatrogenic disorder.

2021 ◽  
pp. 24-25
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Wall ◽  
Subsequent Pregnancy ◽  
Team Approach ◽  
Fetal Life ◽  
Risk Increase ◽  
History Of ◽  
Placenta Accreta Spectrum ◽  
Threatening Situation

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. PAS disorder is a maternal and fetal life-threatening situation due to the high risk of intrapartum uncontrollable bleeding. The common described risk factors are the placenta previa and history of Caesarean section (CS) [1]. We herein report our experience with five patients referred to our department for suspected PAS. These patient were selected for targeted prepartum ultrasound assessment due to their history of multiple C-sections. PAS risk increase with the number of previous CS and could reach7% [2]. In Nicaragua , the rate of c-section in obstetrical practice is still high and approximating 40% in some centers. Uterine wall dehiscence result in locally defective decidualisation and abnormal placental adherence with important trophoblastic invasion in a subsequent pregnancy [3]. We still believe that this disorder is preventable if we “go back” a little to obstetrical good practices. Dramatic situations can be avoided by selecting suspected PAS on ultrasound or MRI to be referred. PAS is the commonest cause of intrapartum hysterectomy and must be managed always in specialized centers with multidisciplinary team approach.

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