scholarly journals A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Kasraeian ◽  
Atefe Hashemi ◽  
Kamran Hessami ◽  
Shaghayegh Moradi Alamdarloo ◽  
Razie Vahdani ◽  
...  
Keyword(s):  
Blood Loss ◽  
Multidisciplinary Approach ◽  
Placenta Accreta ◽  
Antenatal Diagnosis ◽  
Neonatal Outcomes ◽  
Peripartum Hysterectomy ◽  
Resource Limited ◽  
Maternal And Neonatal Outcomes ◽  
Placenta Accreta Spectrum ◽  
The Mean

Abstract Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.

scholarly journals Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

2018 ◽  
Vol 7 (10) ◽  
pp. 3980
Author(s):  
Abdulrahman M. Rageh ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Hossam T. Salem
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Case Series ◽  
Bladder Injury ◽  
Operative Blood Loss ◽  
Ureteric Injury ◽  
Total Blood ◽  
Peripartum Hysterectomy ◽  
The Mean

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta.

Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series

2020 ◽  
Author(s):  
Christopher G. Smith ◽  
Hope M. Cottrill ◽  
John R. Barton
Keyword(s):  
Surgical Technique ◽  
Blood Loss ◽  
Red Blood Cells ◽  
Surgical Management ◽  
Blood Cells ◽  
Operative Time ◽  
Placenta Accreta ◽  
Case Series ◽  
Peripartum Hysterectomy ◽  
Placenta Accreta Spectrum

Objective This study aimed to describe a novel surgical technique for the management of antenatally suspected placenta accreta spectrum (PAS). Study Design This is a retrospective, case series of patients with suspected PAS undergoing peripartum hysterectomy with a reloadable articulating stapler at a tertiary care center. Results Eighteen patients with antenatally suspected PAS were identified and underwent peripartum hysterectomy with the aid of a reloadable stapler. Mean gestational age at delivery was 344/7 ± 11/7 weeks. Mean total operative time (skin-to-skin) was 117.3 ± 39.3 minutes, and 79.8 ± 19.8 minutes for the hysterectomy. Mean blood loss for the entire case was 1,809 ± 868 mL. Mean blood loss for the hysterectomy was 431 ± 421 mL. Mean units of intraoperative red blood cells transfused was 3 ± 1 units. Mean units of postoperative red blood cells transfused was 1 ± 0.5 units. Five cases were complicated by urological injury (two intentional cystotomies). Four patients were admitted to the intensive care unit (ICU) for a mean of ≤24 hours. Mean postoperative LOS was 4.11 ± 1.45 days. Three patients had final pathology that did not demonstrate PAS while four were consistent with accreta, six increta, and five percreta. Conclusion Use of a reloadable articulating stapler device as part of the surgical management of antenatally suspected PAS results in a shorter operative time (117 ± 39 minutes vs. 140–254 minutes previously reported), lower average blood loss (1,809 ± 868 mL vs. 2,500–5,000 mL previously reported) and shorter LOS (4.11 ± 1.45 days vs. 9.8 ± 13.5 days previously reported) compared with traditional cesarean hysterectomy. The reloadable stapling device offers an advantage of more rapidly achieving hemostasis in the surgical management of PAS. Key Points

scholarly journals Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Zhong ◽  
Fang Zhu ◽  
Shengqiong Li ◽  
Jin Chen ◽  
Fengya He ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Neonatal Outcomes ◽  
Adjusted Relative Risk ◽  
Emergency Procedures ◽  
Maternal And Neonatal Outcomes ◽  
Placenta Accreta Spectrum ◽  
Nicu Admission ◽  
Strength Of Association

Objective: To compare maternal and neonatal outcomes for women with placenta accreta syndrome (PAS) delivering via a planned or emergent approach.Methods: A systematic search for relevant studies was conducted by screening the PubMed, Scopus, Web of Science, and Google Scholar electronic databases. Included studies should have been retrospective record-based or prospective in design. They must have compared maternal and/or neonatal outcomes for PAS patients delivering via planned and emergency procedures. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0.Results: Nine articles were included in the meta-analysis. PAS patients undergoing planned deliveries had increased gestational ages, required fewer units of transfused blood, experienced shorter hospital stay durations, and presented reduced risks for maternal ICU admission and severe maternal morbidity. Neonates born to mothers undergoing planned deliveries had increased birth weights and decreased NICU admission risk.Conclusion: These findings indicate a planned approach for delivery is better for maternal and neonatal outcomes compared to urgent/emergency delivery for PAS patients.

Clinical outcomes of a false positive antenatal diagnosis of placenta accreta spectrum

2021 ◽  
Author(s):  
Bahram Salmanian ◽  
Amir A. Shamshirsaz ◽  
Karin Fox ◽  
nazlisadat meshinchi asl ◽  
Hadi Erfani ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Resource Utilization ◽  
False Positive ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Antenatal Diagnosis ◽  
Estimated Blood Loss ◽  
Management Protocol ◽  
Significant Difference ◽  
Placenta Accreta Spectrum

Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

scholarly journals Placenta accreta spectrum disorders—experience of management in a German tertiary perinatal centre

2020 ◽  
Author(s):  
Anja Bluth ◽  
Axel Schindelhauer ◽  
Katharina Nitzsche ◽  
Pauline Wimberger ◽  
Cahit Birdir
Keyword(s):  
Caesarean Section ◽  
Blood Loss ◽  
Placenta Accreta ◽  
Caesarean Section Rate ◽  
Management Strategies ◽  
Management Approach ◽  
Optimal Setting ◽  
Placenta Accreta Spectrum ◽  
Management Approaches

Abstract Purpose Placenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies. Methods A monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy. Results 46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417). Conclusion PAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

A multidisciplinary management approach for patients with Klippel-Trenaunay syndrome and multifetal gestation with successful outcomes

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
James Hogg ◽  
Rebecca Pollack ◽  
Courtney Stephenson ◽  
Lorene Temming
Keyword(s):  
Multidisciplinary Approach ◽  
Congenital Disorder ◽  
Neonatal Outcomes ◽  
Management Approach ◽  
Multidisciplinary Management ◽  
Lymphatic Malformations ◽  
Multiple Gestations ◽  
Adverse Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes ◽  
Klippel Trenaunay Syndrome

Abstract Background Klippel-Trenaunay syndrome (KTS) is a complex congenital disorder characterized by the classic triad of capillary malformation, venous and lymphatic malformations and limb overgrowth. The incidence of pregnancies affected by KTS is unknown. There is a paucity of literature regarding management and outcomes of affected pregnancies, particularly in multifetal gestations. Case We present two cases of pregnancies affected by KTS and multiple gestations. A multidisciplinary approach with hematology, radiology and anesthesia resulted in two successful pregnancies with no adverse neonatal outcomes. Conclusion Management of pregnancies affected by KTS and multiple gestations should be personalized with a multi-disciplinary approach to avoid morbidity and improve maternal and neonatal outcomes.

scholarly journals The Choice of Anesthesia During Organ-Saving Operations Concerning Patients With Placenta Accreta Spectrum Disorders

2020 ◽  
Vol 9 (2) ◽  
pp. 221-230
Author(s):  
E. N. Plakhotina ◽  
T. N. Belousova ◽  
I. A. Kulikov ◽  
R. V. Latyshev ◽  
K. M. Pavlyutina
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Placenta Accreta ◽  
Pain Syndrome ◽  
Tissue Perfusion ◽  
Optimal Method ◽  
Clear Trend ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Abstract Placenta accreta (PAS-disorders) is one of the most serious complications of pregnancy, associated with the risk of massive uterine bleeding, massive hemotransfusion and maternal mortality. Peripartum hysterectomy is a common treatment strategy for patients with placenta accreta. Currently, there is a clear trend of changing surgical tactics in favor of organ-saving operations, but there are no studies devoted to anesthesiological support of such operations.The aim of the study is to substantiate an effective and safe method of anaesthesia in organ-saving operations for placenta accreta spectrum disorders.Materia l and methods The study involved 80 patients with a diagnosis of placenta accreta spectrum disorders, confirmed intraoperatively, who underwent organ-saving operations. The patients were randomized depending on the method of anesthesia into 3 groups: general anesthesia, spinal anesthesia with planned conversion to general after fetal extraction and epidural anesthesia with planned conversion to general also after fetal extraction. The comparison of intraoperative hemodynamics, efficiency of tissue perfusion, efficiency of antinociceptive protection at the stages of surgery was performed. A comparative analysis of the volume of blood loss and blood transfusion, time of patients activation in the postoperative period, severity of pain on the first day after surgery, duration of hospital stay before discharge and comparison of the assessment of the newborn according to Apgar score at first and fifth minute after extraction.Conclusion The study shows that the optimal method of anesthesia in organ-saving operations for placenta accreta spectrum disorders is epidural anesthesia with its planned conversion to general anesthesia with an artificial lung ventilation after fetal extraction. Such an approach to anesthesia allows to maintain stable hemodynamic profile with minimal vasopressor support, sufficient heart performance, providing effective tissue perfusion and a high level of antinociceptive protection at the intraoperative stage and reduce the volume of intraoperative blood loss and hemotransfusion. In the current study there were no differences in neonatal outcomes and duration of hospitalization depending on the method of anesthesia. The advantage of epidural anesthesia with its conversion to general anesthesia was earlier activation after surgery and lower intensity of postoperative pain syndrome.

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