Management of two placenta percreta cases

2016 ◽  
Vol 5 (1) ◽  
pp. 15-18
Author(s):  
Ebru Celik ◽  
Salih Burcin Kavak ◽  
Seyda Yavuzkir ◽  
Sehmus Pala ◽  
Selcuk Kaplan ◽  
...  
Keyword(s):  
Management Strategy ◽  
Placenta Accreta ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Full Thickness ◽  
Management Options ◽  
Placental Invasion

Abstract Placental invasion anomalies are divided into three according to invasion of uterine wall as placenta accreta, increta and percreta. In placenta percreta, the most severe but the least common form, the placenta invades the full thickness of the uterine wall and also it can attach to adjacent organs in the abdomen like the bladder and rectum. It is a potentially life treating condition. There is no recommended management strategy for placenta percreta. We herein report two cases managed differently and discuss the management options in the light of the literature.

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 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

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.

Ultrasound predictors of placental invasion: the Placenta Accreta Index

2015 ◽  
Vol 212 (3) ◽  
pp. 343.e1-343.e7 ◽  
Author(s):  
Martha W.F. Rac ◽  
Jodi S. Dashe ◽  
C. Edward Wells ◽  
Elysia Moschos ◽  
Donald D. McIntire ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placental Invasion

O290 MANAGEMENT OPTIONS OF PLACENTA PERCRETA DURING CESAREAN SECTION

2012 ◽  
Vol 119 ◽  
pp. S362-S363
Author(s):  
U. Gupta ◽  
Manisha ◽  
S. Tahmina
Keyword(s):  
Cesarean Section ◽  
Placenta Percreta ◽  
Management Options

scholarly journals Conservative Surgical Treatment of a Case of Placenta Accreta

2018 ◽  
Vol 40 (08) ◽  
pp. 494-496 ◽  
Author(s):  
Ismail Biyik ◽  
Fatih Keskin ◽  
Elif Keskin
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placental Tissue ◽  
Uterine Wall ◽  
Elective Cesarean Section ◽  
Triple P ◽  
Cesarean Hysterectomy ◽  
Uterine Incision ◽  
Fertility Sparing

AbstractPlacenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending from the anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa.

scholarly journals Managing Woodland Caribou in West-Central British Columbia

Rangifer ◽  
1996 ◽  
Vol 16 (4) ◽  
pp. 119 ◽  
Author(s):  
Deborah B. Cichowski
Keyword(s):  
British Columbia ◽  
Management Strategy ◽  
Forest Cover ◽  
Planning Process ◽  
Timber Harvesting ◽  
Range Management ◽  
Management Options ◽  
Winter Habitat ◽  
Specific Level ◽  
Winter Range

Initial long term planning for logging on the Tweedsmuir-Entiako caribou winter range began in the early 1980s. Because little information was available on which to base winter range management, the British Columbia Fish and Wildlife Branch began studies on radio-collared caribou in 1983, and an intensive study on caribou winter habitat requirements was conducted from 1985 to 1988. Terrestrial lichens were identified as the primary winter food source for the caribou, and in 1987, caribou winter range ecosystem maps, which emphasized abundance of terrestrial lichens, were produced. The ecosystem maps and information from the caribou study, including potential direct and indirect effects of timber harvesting on the caribou population, were used to develop a management strategy for the winter range. The management strategy comprised two levels of management: a landscape level (Caribou Management Zones); and a site-specific level (caribou habitat/timber values). Timber information associated with BC Ministry of Forests forest cover maps was integrated using a Geographic Information System. Six winter range management options were proposed ranging from harvesting low value caribou habitats only throughout the winter range to total protection of the entire winter range. Impacts of those options on both the caribou population and on the timber supply were evaluated. The options were reviewed through a public planning process, the Entiako Local Resource Use Plan, and recommendations from that process were forwarded to the British Columbia Protected Areas Strategy.

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.

The intriguing tale of an iatrogenic perforation

2017 ◽  
Vol 9 (2) ◽  
pp. 30-34
Author(s):  
H Murali ◽  
Suchetha A ◽  
Shamina Bawa ◽  
Apoorva S M ◽  
Lakshmi P
Keyword(s):  
Case Report ◽  
Bone Graft ◽  
Root Canal ◽  
Management Strategy ◽  
Graft Material ◽  
Full Thickness ◽  
Canine Tooth ◽  
Maxillary Canine ◽  
Iatrogenic Perforation ◽  
Mucoperiosteal Flap

INTRODUCTION: Iatrogenic perforations are one of the most exasperating complications of root canal treatment. The prognosis of the root with iatrogenic perforation depends on the location and the procedures undertaken to manage the problem. This case report gives an account of a lateral perforation on a canine tooth and the management strategy under the circumstances. It also gives an overview of some of possible approaches to prevent iatrogenic perforations. METHODS: A right maxillary canine which had an iatrogenic perforation was carefully re-treated and the defect in the bone was exposed using a full thickness mucoperiosteal flap and packed with bone graft material A clinical re-evaluation was done at the end of 3 months. RESULTS: After 3 months the tooth was asymptomatic. There was no tenderness on palpation and on percussion. CONCLUSION: A thorough knowledge of the anatomy of the tooth, combined with the use of appropriate techniques can help in reducing the complications that may occur during endodontic therapy. However, if a problem does occur, a scrupulous management would help in salvaging the involved tooth.

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