scholarly journals Neuraxial Anesthesia During Cesarean Delivery for Placenta Previa With Suspected Morbidly Adherent Placenta

2018 ◽  
Vol 127 (4) ◽  
pp. 930-938 ◽  
Author(s):  
John C. Markley ◽  
Michaela K. Farber ◽  
Nicola C. Perlman ◽  
Daniela A. Carusi
Keyword(s):  
Cesarean Delivery ◽  
Placenta Previa ◽  
Neuraxial Anesthesia ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

scholarly journals Use of a Fibrin Sealant Patch at Cesarean for Conservative Management of Morbidly Adherent Placenta

2018 ◽  
Vol 08 (04) ◽  
pp. e325-e327 ◽  
Author(s):  
James Greenberg ◽  
Julian Robinson ◽  
Jean Carabuena ◽  
Michaela Farber ◽  
Daniela Carusi
Keyword(s):  
Cesarean Delivery ◽  
Fibrin Sealant ◽  
Maternal Morbidity ◽  
Placenta Previa ◽  
Morbidity And Mortality ◽  
Artery Embolization ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Repeat Cesarean Delivery

Background Morbidly adherent placenta represents a surgical challenge and source of maternal morbidity and mortality. We report the use of a fibrin sealant patch to address hemorrhage associated with a morbidly adherent placenta during cesarean delivery. Case A patient underwent repeat cesarean delivery with complete anterior placenta previa and anticipated morbidly adherent placenta. Bleeding persisted following delivery and removal of the placenta, despite uterine artery embolization. A fibrin sealant patch was applied as an adjuvant intervention to the placental bed and hemostasis was achieved without resorting to a hysterectomy. Conclusion Postpartum hemorrhage is an ongoing leading source of maternal morbidity and mortality. A case is presented in which a fibrin sealant patch provided control of focal placental bed bleeding, allowing removal of a focal morbidly adherent placenta and avoidance of hysterectomy.

Alpha Feto-Protien as a Biochemical Marker in Prediction of Morbidly Adherent Placenta

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hassan Tawfik Khairy ◽  
Mohammed Saeed Eldin El Safty ◽  
Rasha Medhat Abd El Hadi ◽  
Kyrollos Refat Khalf Marzok
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Power Doppler ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
3D Power Doppler ◽  
Tertiary Center ◽  
Previous Cesarean

Abstract Background Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Aim of the Work To compare between alpha-fetoproteine as biological marker & ultrasound & Doppler findings for prenatal predication of morbid adherent placentation in anterior placenta on scar of previous cesarean section. Patients and Methods The current study is a prospective cohort study, conducted at a tertiary center: Ain Shams University Maternity Hospital during the period between February 2018 and April 2019,where 150 pregnant women having placenta previa covering scar of previous uterine surgery had been recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service, but 50 patients were dropped out due to loss in follow up because of emergency antepartum haemorrhage & C.S., others escaped follow up. Results The results of the current study showed a significant association between all criteria of the 3DPD with multislice view and presence of placental adherence, need for added surgical steps, CS hysterectomy and bladder injury with sensitivity 83% & specificity 57%, PPV 76%, NPV 66%. Conclusion The current study suggests that AFP assay, it isn't good test alone as regards its sensitivity &specificity &its level of accuracy 55% as compared to 2D &3D power doppler with multislice view, so it is unreliable test alone for antenatal diagnosis of morbidly adherent placenta.

scholarly journals Is Neuraxial Anesthesia Appropriate for Cesarean Delivery in All Cases of Morbidly Adherent Placenta?

2018 ◽  
Vol 127 (5) ◽  
pp. e80-e81 ◽  
Author(s):  
Mohamed Mohamed Tawfik ◽  
Mohamed Ahmed Tolba ◽  
Sarah Salah Moawad ◽  
Khalid Samir Ismail ◽  
Mohamed Elsayed Taman
Keyword(s):  
Cesarean Delivery ◽  
Neuraxial Anesthesia ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

scholarly journals Delayed bleeding after prophylactic bilateral internal iliac artery balloon occlusion in elective caesarean hysterectomy for the management of placenta accreta

2017 ◽  
Vol 6 (4) ◽  
pp. 1656
Author(s):  
Abdul Karim Othman ◽  
Noraslawati Razak ◽  
Mohd Hanif Che Mat
Keyword(s):  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
Internal Iliac ◽  
Life Threatening ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Morbidly adherent placenta (MAP) can be divided into placenta accrete, placenta increta and placenta percreta. It is associated with high parity, multifetal gestation, advanced maternal age, assisted reproductive technologies, placenta previa, and more importantly a history of caesarean section or uterine surgery. Globally, the incidence of placenta accrete has increased and seems to be in parallel with the increasing rate of caesarean section delivery.Despite rapidly evolving diagnostic imaging, and growing of surgical expertise, morbidly adherent placenta (MAP) remains an important cause of maternal morbidity and mortality, especially related with life-threatening postpartum haemorrhage. Although the choice of treatment for placenta accrete is puerperal hysterectomy, this procedure itself involves a greater risk of intra-operative haemorrhage.Elective caesarean hysterectomy using prophylactic bilateral internal iliac artery balloon occlusion offer an interesting approach which can minimize the risk of intra-operative haemorrhage. However, our case report describes the case of a 28-year old Gravida 3 Para 2 morbidly obese parturient diagnosed to have placenta previa type 3 posterior with accrete who experienced a complication of life threatening massive bleeding post-operatively after an elective caesarean hysterectomy using a prophylactic bilateral internal iliac artery balloon occlusion intra-operatively.

scholarly journals Anesthetic management in cesarean delivery of women with placenta previa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Huishan Zhang ◽  
Zixing Zhou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Transfusion ◽  
Blood Loss ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Placenta Previa ◽  
Neuraxial Anesthesia ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes

Abstract Background The incidence of placenta preiva is rising. Cesarean delivery is identified as the only safe and appropriate mode of delivery for pregnancies with placenta previa. Anesthesia is important during the cesarean delivery. The aim of this study is to assess maternal and neonatal outcomes of patients with placenta previa managed with neuraxial anesthesia as compared to those who underwent general anesthesia during cesarean delivery. Methods A retrospective cohort study was performed of all patients with placenta preiva at our large academic institution from January 1, 2014 to June 30, 2019. Patients were managed neuraxial anesthesia and general anesthesia during cesarean delivery. Results We identified 1234 patients with placenta previa who underwent cesarean delivery at our institution. Neuraxial anesthesia was performed in 737 (59.7%), and general anesthesia was completed in 497 (40.3%) patients. The mean estimated blood loss at neuraxial anesthesia of 558.96 ± 42.77 ml were significantly lower than the estimated blood loss at general anesthesia of 1952.51 ± 180 ml (p < 0.001). One hundred and forty-six of 737 (19.8%) patients required blood transfusion at neuraxial anesthesia, whereas 381 out of 497 (76.7%) patients required blood transfusion at general anesthesia. The rate neonatal asphyxia and admission to NICU at neuraxial anesthesia was significantly lower than general anesthesia (2.7% vs. 19.5 and 18.2% vs. 44.1%, respectively). After adjusting confounding factors, blood loss was less, Apgar score at 1- and 5-min were higher, and the rate of blood transfusion, neonatal asphyxia, and admission to NICU were lower in the neuraxial group. Conclusions Our data demonstrated that neuraxial anesthesia is associated with better maternal and neonatal outcomes during cesarean delivery in women with placenta previa.

Interpregnancy Interval in Placenta Previa With Morbidly Adherent Placenta [15O]

2017 ◽  
Vol 129 ◽  
pp. S157
Author(s):  
Amir A. Shamshirsaz ◽  
Hadi Erfani ◽  
Bahram Salmanian ◽  
Karin A. Fox ◽  
Alex C. Vidaeff
Keyword(s):  
Placenta Previa ◽  
Interpregnancy Interval ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

Role of placenta accreta index in prediction of morbidly adherent placenta: A reliability study

Ultrasound ◽  
2020 ◽  
pp. 1742271X2095974
Author(s):  
Shubhra Agarwal ◽  
Arjit Agarwal ◽  
Shruti Chandak
Keyword(s):  
Scoring System ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Intraclass Correlation ◽  
Interrater Agreement ◽  
Baseline Risk ◽  
Individual Risk ◽  
Predictive Values ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta

Objective To estimate the level of interobserver agreement in the calculation of placenta accreta index (PAI) as well as to evaluate the accuracy of PAI in prediction of morbidly adherent placenta. Materials and methods This was a prospective study where 45 pregnant women (from 28 to 37 weeks of gestational age) with at least one previous Caesarean section and ultrasound-proven placenta previa were included. A known and previously published scoring system, the PAI, was evaluated independently by two radiologists and the cases were followed for the delivery and histopathology outcome. The accuracy of the PAI and the level of interrater agreement was analysed using cross-table analysis, intraclass correlation efficient and Cohen’s kappa as statistical variables. Results Adherent placenta was found in 15 patients accounting for 33% of cases. The PAI showed nearly 90% sensitivity, specificity and the predictive values. Interrater agreement in calculation of PAI by the two radiologists was perfect with an intraclass correlation efficient of 0.959. An easy-to-use morbid adherent placenta score was also predicted to simplify the results of PAI, which showed moderate agreement (κ = 0.746). Conclusions The PAI can be helpful in stratifying the individual risk of placental invasion above the baseline risk. The PAI-derived, simplified scoring system called morbid adherent placenta score can be used as a simple tool to interpret and convey the results of PAI.

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