Abnormally invasive placenta (AIP): pre-cesarean amnion drainage to facilitate exteriorization of the gravid uterus through a transverse skin incision

2018 ◽  
Vol 47 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Thorsten Braun ◽  
Katharina Weizsäcker ◽  
Mustafa Zelal Muallem ◽  
Janina Tillinger ◽  
Larry Hinkson ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Operative Management ◽  
The United States ◽  
Skin Incision ◽  
Uterine Wall ◽  
Gravid Uterus ◽  
Invasive Placenta ◽  
Transverse Skin Incision ◽  
Abnormally Invasive Placenta

Abstract The number of pregnant women with abnormally invasive placenta (AIP) including clinical relevant placenta increta and percreta has markedly increased with a reported incidence of as high as one in 731, By 2020 in the United States, there will be an estimated 4504 new cases of AIP and 130 AIP-associated maternal deaths annually. The preoperative diagnosis and operative management of AIP is challenging. In a planned cesarean delivery, a vertical lower abdominal skin incision is widely used in order to have enough space to perform a hysterotomy above the cranial edge of the placenta to avoid significant fetal and/or maternal hemorrhage. We have used preoperative drainage of the amniotic fluid after epidural anesthesia and immediately before a planned cesarean delivery through a transverse skin incision in five patients with AIP of the anterior uterine wall. With less uterine volume, exteriorization of the gravid uterus is easily performed through a transverse laparotomy. The combination of amnion drainage, transverse laparotomy and exteriorization of the gravid uterus facilitates identification of the exact site of placental implantation, provides adequate space for performing fundal or high anterior or even posterior uterine wall incisions and to deliver the fetus safely while minimizing the risk of placental separation and subsequent uncontrolled blood loss. Furthermore, this technique provides the chance to leave the untouched placenta in situ or to remove the placenta in toto with a uterine wall segment.

scholarly journals Evidence-Based Cesarean Delivery for the Nonobstetrician

2015 ◽  
Vol 02 (01) ◽  
pp. e1-e6 ◽  
Author(s):  
Joshua Dahlke ◽  
Hector Mendez-Figueroa ◽  
Jeffrey Sperling ◽  
Lindsay Maggio ◽  
Brendan Connealy ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Postpartum Hemorrhage ◽  
Surgical Techniques ◽  
The United States ◽  
Skin Incision ◽  
Adhesion Prevention ◽  
Evidence Based ◽  
Skin Closure ◽  
Thromboembolism Prophylaxis ◽  
Surgical Morbidity

Cesarean delivery (CD) is one of the most common major surgeries performed in the United States and worldwide. Surgical techniques evaluated in well-designed randomized controlled trials (RCTs) that demonstrate maternal benefit should be incorporated into practice. The objective of this review is to provide a summary of surgical techniques of the procedure and review the evidence basis for them for the nonobstetrician. The following techniques with the strongest evidence should be commonly performed, when feasible: (1) prophylactic antibiotics with a single dose of ampicillin or first-generation cephalosporin prior to skin incision; (2) postpartum hemorrhage prevention with oxytocin infusion of 10 to 40 IU in 1 L crystalloid over 4 to 8 hours; (3) low transverse skin incision; (4) blunt or sharp subcutaneous and fascial expansion; (5) blunt, cephalad–caudad uterine incision expansion; (6) spontaneous placental removal; (7) blunt-tip needle usage during closure; (8) subcutaneous suture closure (running or interrupted) if thickness is ≥2 cm; and (9) skin closure with suture. Although the number of RCTs designed to optimize maternal and neonatal outcomes of this common procedure is encouraging, further work is needed to minimize surgical morbidity. Optimal methods for postpartum hemorrhage prevention, adhesion prevention, and venous thromboembolism prophylaxis remain ongoing areas of active research, with outcomes that could markedly improve maternal morbidity and mortality. If evidence of a surgical technique appears preferred over another, clinicians should be comfortable adopting the evidence-based technique when performing and teaching CD.

scholarly journals AIP (abnormally invasive placenta) - from a retained placenta to destruction of the uterine wall

2013 ◽  
Vol 92 (4) ◽  
pp. 367-368 ◽  
Author(s):  
Jens Langhoff-Roos ◽  
Frédéric Chantraine ◽  
Reynir Tómas Geirsson
Keyword(s):  
Uterine Wall ◽  
Retained Placenta ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

scholarly journals Maternal and neonatal outcomes in transverse and vertical skin incision for placenta previa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dazhi Fan ◽  
Huishan Zhang ◽  
Jiaming Rao ◽  
Dongxin Lin ◽  
Shuzhen Wu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Placenta Previa ◽  
Skin Incision ◽  
Neonatal Outcomes ◽  
Lower Percentage ◽  
Estimated Blood Loss ◽  
Maternal And Neonatal Outcomes ◽  
Transverse Skin Incision ◽  
Vertical Skin Incision

Abstract Background Placenta previa, a serious obstetric issue, should be managed by experienced teams. The safe and appropriate mode of delivery for placenta previa is by cesarean delivery. However, no studies were found comparing either maternal or neonatal outcomes for different skin incision in women with placenta previa. The aim of this study was to compare maternal and neonatal outcomes by skin incision types (transverse compared with vertical) in a large cohort of women with placenta previa who were undergoing cesarean delivery. Methods This was a retrospective cohort study carried out between January 2014 and June 2019. All pregnant women with placenta previa had confirmed by ultrasonologist before delivery and obstetrician at delivery. The primary outcome was the estimated blood loss during the surgery and within the first 24 hours postoperatively. Mean (standard deviation), median (interquartile range) or frequency (percentage) was reported to variables. Appropriate parametric and nonparametric tests were used to analyses. Results The study included 1098 complete records, 332 (30.24%) cases in the vertical skin incision group and 766 (69.76%) cases in the transverse skin incision group. Those with vertical incision showed a higher percentage of preterm delivery, anterior placenta, abnormally invasive placenta, and history of previous cesarean delivery, and a lower percentage of first pregnancy, in vitro fertilization, and emergency cesarean delivery. After controlling for confounding factors, higher incidence of post-partum hemorrhage (OR 5.47, 95% CI 3.84–7.79), maternal intensive care unit (OR 4.30, 95% CI 2.86–6.45), transfusion (OR 5.97, 95% CI 4.15–8.58), and 5-min APGAR< 7 (OR 9.03, 95% CI 1.83–44.49), a more estimated blood loss (β 601.85, 95%CI 458.78–744.91), and a longer length of hospital stay after delivery (β 0.54, 95%CI 0.23–0.86) were found in the vertical skin incision group. Conclusions Our data demonstrated that transverse skin incision group showed the better perinatal outcomes in women with placenta previa. Future collaborative studies are needed to be done by centers for placenta previa to have a better understanding of the characteristics and the outcomes of the disease in the choosing skin incision.

scholarly journals Uterine Artery Embolization for Management of Placenta Accreta, a Single-center Experience and Literature Review

2017 ◽  
Vol 01 (01) ◽  
pp. 37-42
Author(s):  
Abdallah Noufaily ◽  
Raja Achou ◽  
Mitri Ashram ◽  
Miziana Mokbel ◽  
Emile Dabaj ◽  
...  
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Placenta Accreta ◽  
Rectal Wall ◽  
Artery Embolization ◽  
Single Center Experience ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Abstract“Morbidly adherent placenta” is a term that describes the continuum of placenta accreta, increta, and percreta. Placenta accreta is the least invasive form, whereas placenta percreta represents a complete penetration of the trophoblast through the uterus that reaches the serosal surface and potentially invades the bladder, rectal wall, and pelvic vessels. Leaving the placenta in situ in the setting of abnormally invasive placenta is now widely practiced. We herein present three cases of abnormal placental implantation diagnosed by antenatal ultrasound and magnetic resonance imaging, in which uterine artery embolization was performed to induce placental infarction and eventually rapid regression but most importantly to minimize peripartum and postpartum bleeding. As we do this, we sought to review the risks of placenta accreta, increta, and percreta and evaluate the role of endovascular therapy to improve maternal outcomes when abnormal placental implantation occurs.

scholarly journals Maternal morbidity associated with skin incision type at cesarean delivery in obese patients: a systematic review

2020 ◽  
pp. FSO669
Author(s):  
Dani Zoorob ◽  
Oxana Zarudskaya ◽  
James Van Hook ◽  
Hind N Moussa
Keyword(s):  
Systematic Review ◽  
Cesarean Delivery ◽  
Selection Criteria ◽  
Web Of Science ◽  
Skin Incision ◽  
Cochrane Library ◽  
Wound Complications ◽  
Transverse Skin Incision ◽  
The Relationship ◽  
Vertical Skin Incision

Aim: To describe the relationship between cesarean skin incision type and postoperative wound complications (WCs) in obese pregnant patients. Materials & methods: MEDLINE (PubMed and OVID), Embase, Scopus, Web of Science Core Collection, Cochrane Library and ClinicalTrials.gov databases were used for publication search. Selection criteria consisted of articles studying pregnant patients with BMI ≥30 kg/m2 undergoing cesarean delivery and assessing the effect of skin incision type on postoperative maternal outcomes. Results: Ten publications met criteria for a systematic review of a total of 2946 patients. The transverse skin incision was associated with a lower rate of WC compared with the vertical skin incision. The pooled risk ratio for WCs was 0.47 (95% CI: 0.37–0.58; p < 0.00001). Conclusion: Transverse skin incision may be preferable to vertical skin incision at cesarean delivery in pregnant patients with obesity as it may be associated with a lower rate of WCs. PROSPERO registration ID: CRD42020151106

1367-P: Risk and Indications for Cesarean Delivery among Women with Diabetes in the United States

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1367-P
Author(s):  
JENNIFER GRASCH ◽  
KATHERINE MILLER ◽  
DAVID HAAS ◽  
METHODIUS TUULI ◽  
CHRISTINA M. SCIFRES
Keyword(s):  
United States ◽  
Cesarean Delivery ◽  
The United States

Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kelvin Allenson ◽  
Laura Moore
Keyword(s):  
Maternal Death ◽  
Motor Vehicle ◽  
Operative Management ◽  
Balloon Occlusion ◽  
Motor Vehicle Accidents ◽  
Gravid Uterus ◽  
Intrauterine Pregnancy ◽  
Vehicle Accidents ◽  
Pelvic Hemorrhage ◽  
Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death.  The gravid uterus is at risk for injury, particularly during motor vehicle accidents.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma.  We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

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