scholarly journals Placenta accreta in a referred post hysterotomy case: a bold step into the unknown

2021 ◽  
Vol 10 (2) ◽  
pp. 765
Author(s):  
Shrinivas N. Gadappa ◽  
Rupali A. Gaikwad ◽  
Anurag A. Sonawne ◽  
Ankita R. Shah ◽  
Shrutika O. Makde ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Multidisciplinary Care ◽  
Fold Increase ◽  
Tertiary Care Centre ◽  
Cesarean Deliveries ◽  
Multidisciplinary Care Team ◽  
Placenta Accreta Spectrum

Placenta accreta spectrum encompasses a range of pathological adherence of placenta and causes significant maternal and neonatal morbidity and mortality. With the increase in the number of cesarean deliveries over the last few decades, there has been an 8 fold increase in the incidence of placenta accreta. The single most important risk factor reported in about half the cases of PAS disorders is placenta previa. Management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta. We discuss a rare case of a patient who underwent hysterotomy in an outside hospital and was referred to our tertiary care centre as atonic PPH. Undiagnosed antenatally and at the time of hysterotomy, she was diagnosed as a case of placenta accreta on exploration at our institute and was surgically managed.

scholarly journals CLINICAL STUDY OF PLACENTA ACCRETA SPECTRUM DISORDERS IN TERTIARY CARE HOSPITAL

2020 ◽  
pp. 1-4
Author(s):  
Shrinivas Gadappa ◽  
Ankita Shah ◽  
Rupali Gaikwad ◽  
Susmita Pawar
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Elective Surgery ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Multidisciplinary Care ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Aims and objectives To study the range of Placenta Accreta Spectrum (PAS) disorders, management of PAS, maternal outcome in PAS and post-operative complications in patients managed either by conservative or non-conservative management. Methodology Patient were diagnosed antenatally by 2D grey scale USG (ultrasonography) as PAS 0, 1 ,2 and 3 along with colour doppler studies. The decision of conservative versus non conservative management was taken by MDT (multidisciplinary team) along with the patients and relatives and after written and informed consent and elective surgery was planned between 34-35 weeks of gestation. Results Total number of cases studied over the period of 1 year were 45. On 2D gray scale USG, PAS 0 was seen in 60% followed by PAS 3 in 17.77% and only 6.66% of PAS 2. According to weeks of gestation OH with IIAL (internal iliac ligation) was performed in 42.22 % and OH without IIAL was performed in 37.77% and 20% patients who were managed by conservative method, 6 of them needed peripartum hysterectomy. Massive transfusion protocol was activated in all the cases. Conclusion The highest risk of placenta accreta spectrum disorders are amongst women whose pregnancy is complicated by placenta previa and with a prior scar on the uterus, due to the abnormal placental implantation on the scar site. The management of PAS disorders should be at tertiary care centre along with multidisciplinary care team.

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.

scholarly journals Placenta praevia: percreta and accreta, our experience

2020 ◽  
Vol 9 (3) ◽  
pp. 928
Author(s):  
Preeti F. Lewis ◽  
Shreya Chinchoriya
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
History Of ◽  
Previous Cesarean

Background: morbidly adherent placenta has an increasing incidence over decades. The purpose of this study is to identify risk factors and etiology of placenta previa- accreta and percreta.Methods: A cross sectional observational study of patients with morbidly adherent placenta previa including placenta accreta and placenta percreta were studied over a period of three years from June 2017 to June 2019 in a tertiary care centre, Mumbai.Results: Cases showed a higher incidence in patients with previous cesarean delivery (CS), grandmultiparity, abortions without the history of check curettage and anterior/central placentae.Conclusions: History of uterine surgeries and previous cesarean are some important risk factors for accreta in placenta previa patients.

Placenta Accreta Spectrum: In Vitro Fertilization and Non-In Vitro Fertilization and Placenta Accreta Spectrum in a Massachusetts Cohort

2020 ◽  
Author(s):  
Anna M. Modest ◽  
Thomas L. Toth ◽  
Katherine M. Johnson ◽  
Scott A. Shainker
Keyword(s):  
In Vitro Fertilization ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Lower Prevalence ◽  
Vitro Fertilization ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Placenta Accreta Spectrum

Objective The incidence of placenta accreta spectrum (PAS) has been increasing in the United States. In addition, there has also been an increase in the utilization of in vitro fertilization (IVF). The IVF pregnancies confer an increased risk of adverse obstetric and neonatal outcomes, but there is limited data on whether IVF is associated with PAS. The aim of this study is to assess the association between IVF and the risk of PAS. Study Design This was a retrospective cohort study of deliveries from January 1, 2013 to August 1, 2018 at a tertiary hospital in the Massachusetts. IVF pregnancies were compared with non-IVF pregnancies, and PAS diagnosis was confirmed by histopathology reports. Hospital administrative data and medical record review were used, and supplemented with data from birth certificates from the Massachusetts Department of Public Health. Results We identified 28,344 pregnancies that met inclusion criteria, of which 1,418 (5.0%) were IVF pregnancies. The overall incidence of PAS was 0.4% (2.2% in the IVF group and 0.3% in the non-IVF group). Women who underwent IVF had 5.5 times the risk of PAS (95% confidence interval [CI]: 3.4–8.7) compared with women in the non-IVF group, adjusted for maternal age, nulliparity, and year of delivery (Table 5). Compared with women in the non-IVF group, the IVF group had fewer prior cesarean deliveries (22.6 vs. 64.2%) and a lower prevalence of placenta previa (19.4 vs. 44.4%). Conclusion Women with an IVF pregnancy carry an increased risk of PAS compared with non-IVF. Among women who underwent IVF, there was a lower prevalence of prior cesarean deliveries and placenta previa. Future work is needed to identify the mechanism of association for this increased risk as well as a reliable tool for antenatal detection in this cohort of women. Key Points

PLACENTA PREVIA AND PLACENTA ACCRETA SPECTRUM (PAS) DISORDER: INCIDENCE, RISK FACTOR AND FETOMATERNAL OUTCOME IN A TERTIARY CARE CENTER

2021 ◽  
pp. 15-17
Author(s):  
Ramona Perhar ◽  
Rubi Devi ◽  
Ruchi Patel ◽  
Jagriti Jagriti
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Adherent Placenta ◽  
Placenta Accreta Spectrum

Introduction: Placenta Previa is characterised by Placental implantation into the lower uterine segment covering whole or part of the cervix . It complicates 0.4% of pregnancy at term The average incidence is 0.3% or 1 case per 300 to 400 deliveries. The presence of placenta previa can also increase a woman's risk for placenta accreta spectrum (PAS). This spectrum of conditions includes placenta accreta, increta, and percreta. Uncontrolled postpartum hemorrhage from placenta previa or PAS may necessitate a blood transfusion, hysterectomy thus leaving the patient infertile, admission to the ICU, or even death. Material and method: Study was conducted in department of obstetrics & gynecology , swaroop rani hospital, Allahabad for 1 year . A total of 102 pregnant women presenting to antenatal OPD or admitted in IPD with history of antepartum hemorrhage and conrmed case of PP or MAP in Ultrasonography were selected. The follow up till the fetomaternal outcome was done and risk factors were evaluated for 102 cases. Result: Out of the total 2342 deliveries in one year 95 patients had PP and the incidence was 4.04% and 7 patients had morbidily adherent Placenta which accounts to an incidence of 0.29%. Previous LSCS, Multiparity, increase maternal age, Dialatation and curettage were risk factors in both Placenta Previa and Morbidily Adherent Placenta. Antenatal complication were antepartum hemmorrhage , Anemia, preterm labor. Emergency LSCS is more common mode of delivery in cases of Placenta previa. Caesarean hysterectomy were done in 3.2% cases of Placenta Previa and all cases of Morbidily adherent placenta . Most common perinatal complications in both groups were prematurity and low birth weight. Conclusion: Now a days Placenta previa and Morbidily adherent placenta are very common. Incidence increases as the rate of cesaerean section or abdominal surgery were increases.Earlydiagnosis and pre plan mode of delivery will decrease the risk of prematurity and low birth weight.

scholarly journals PLACENTA ACCRETA SPECTRUM - A CASE SERIES

2020 ◽  
pp. 1-4
Author(s):  
Medha Dadaji Davile ◽  
Anil Charandas Humane ◽  
Ashwini Kuchnur
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Obstetric Hemorrhage ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
Placenta Accreta Spectrum

Morbidly adherent placenta is a major cause for massive obstetric hemorrhage, which leads to maternal morbidity and mortality. Most accepted hypothesis for etiology of placenta accreta spectrum is defect in the endometrial–myometrial interface which leads to failure of normal decidualization in the uterine scar, which allows abnormal deep infiltration of placental anchoring villi and trophoblast. Maternal morbidity and mortality can occur as a result of massive and sometimes life-threatening obstetric hemorrhage which often requires blood transfusion. It becomes exponential and life threatening when placenta previa is associated with placenta accreta spectrum. There are several risk factors for placenta accreta spectrum, most common being previous caesarian section. Antenatal diagnosis of placenta accreta is highly desirable as outcomes are optimized when timely delivery occurs at a tertiary care facility accustomed to handle such cases. Here we are reporting six cases of placenta accreta spectrum managed by conventional and expectant way at our tertiary care hospital. Methods: Study was carried out in Government Medical College & Hospital, Nagpur. Case records of patients with placenta accreta syndrome between December 2019 and March 2020 were reviewed and analysed. Results: Six cases of placenta accreta syndrome were studied.100% patients had history of previous caesarean section, 5 patients had associated placenta previa. One out of six patients one had history of dilatation and evacuation for missed abortion.4 out of six underwent caesarean hysterectomy and 2 underwent conservative management with uterine preservation. Average blood loss was 2500 ml. Conservative management was successful in two patients. There was no maternal mortality in series. Conclusion : Among many risk factors, previous caesarean section is the most common. Therefore reducing rate of caesarean deliveries can reduce the prevalence of placenta accreta syndromes. Adherent placenta should be suspected in cases of previous caesarean with placenta previa, high parity, uterine curettage, and uterine surgeries.Conservative management should be reserved for selected patients. MRI is not mandatory for diagnosis of the condition.

scholarly journals Anaesthetic Practices and Maternal Outcome in Rising Placenta Accreta Spectrum in Tertiary Care Hospital

2020 ◽  
Vol 24 (2) ◽  
pp. 108-111
Author(s):  
Sumbal Rana ◽  
Ali Arslan Munir ◽  
Qudsia Anjum Quraishi ◽  
Amim Muhammad Akhtar ◽  
Erum Pervaiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multidisciplinary Team ◽  
Maternal Age ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Care Hospital ◽  
Placenta Accreta Spectrum ◽  
Team Interventions ◽  
Previous Cesarean

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

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