scholarly journals A rare case of placenta percreta causing uterine rupture and massive haemoperitoneum in 2nd trimester: an obvious near miss

2021 ◽  
Vol 10 (6) ◽  
pp. 2495
Author(s):  
Chirayu Parmar ◽  
Mittal Parmar ◽  
Gayatri Desai
Keyword(s):  
Uterine Rupture ◽  
Placenta Accreta ◽  
Hypovolemic Shock ◽  
Placenta Percreta ◽  
Near Miss ◽  
Second Trimester ◽  
Rare Occurrence ◽  
Third Trimester ◽  
Placenta Accreta Spectrum ◽  
Ruptured Uterus

Placenta accreta spectrum is very rarely encountered with ruptured uterus and is commonly seen in third trimester of pregnancy. Hereby, a case of placenta percreta with uterine rupture in second trimester of pregnancy is presented. 40 year old women with previous 2 LSCS presented in emergency department with ninteen weeks pregnancy and massive haemoperitoneum. Emergency laprotomy revealed uterine rupture alnong with placenta percreta for which obstetric hysterectomy was done. Although, a rare occurrence, obstetricians should consider patients placenta accreta spectrum in patients with previous surgeries presenting with haemoperitoneum and signs of hypovolemic shock in second trimester of pregnancy, considering the possibility of rupture at the site of placenta adherance.

Prevalence of Sonographic Markers of Placenta Accreta Spectrum in Low-Risk Pregnancies

2018 ◽  
Vol 36 (08) ◽  
pp. 733-780 ◽  
Author(s):  
Jennifer Philips ◽  
Margot Gurganus ◽  
Sarah DeShields ◽  
Tina Cunningham ◽  
Elena Sinkovskaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Bladder Wall ◽  
Low Risk ◽  
Second Trimester ◽  
Clear Zone ◽  
Third Trimester ◽  
The Third ◽  
Cesarean Deliveries ◽  
Placenta Accreta Spectrum

Objective This study was aimed to evaluate the prevalence of sonographic markers for placenta accreta spectrum (PAS) in pregnancies at low-risk for PAS. Study Design Pregnant women at low-risk for PAS presenting for routine second trimester ultrasound who enrolled in the study were evaluated prospectively for sonographic markers of PAS during two ultrasounds at 18 to 24 and 28 to 34 weeks. Frequencies of PAS markers were compared between the second and third trimester and between those with and without prior cesarean deliveries (CD). Results Overall, 174 women were included. Several markers were seen frequently in the second trimester: vascular cervical invasion (57%), lacunae (46%), subplacental hypervascularity (37%), and irregularity of the posterior bladder wall (37%). Other markers were seen infrequently or not at all: loss of the retroplacental clear zone, uterovesical interface < 1 mm, bridging vessels, placental bulge or focal exophytic mass. Frequencies of markers did not differ between women with and without prior CD. Lacunae were larger and more numerous in the third trimester. Two or more PAS markers were observed in 98% of second trimester ultrasounds. Conclusion Several PAS sonographic markers occur commonly in low-risk pregnancies. In the absence of risk factors, the independent predictive value of these markers is questionable.

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 Interstitial Pregnancy in the Third Trimester with Severe Preeclampsia: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shiho Nagayama ◽  
Hironori Takahashi ◽  
Shohei Tozawa ◽  
Risa Narumi ◽  
Rie Usui ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Severe Preeclampsia ◽  
Third Trimester ◽  
Interstitial Pregnancy ◽  
The Third ◽  
Emergency Cesarean ◽  
Placenta Accreta Spectrum ◽  
The Right

An interstitial pregnancy that continues beyond the second trimester is a rare phenomenon. We report a patient with an interstitial pregnancy undiagnosed until the third trimester. A multiparous woman was referred to us because of preeclampsia at 26 weeks of gestation. The placental position was the right fundus, and color Doppler ultrasound revealed myometrial thinning and subplacental hypervascularity, leading to a suspicion of placenta accreta spectrum (PAS). Emergency cesarean section was performed at 281/7 weeks of gestation due to severe preeclampsia. The right tubal horn to the isthmus of the fallopian tube bulged with placental adhesion and a part of the tube had ruptured, with the omentum adhering to the ruptured part. Interstitial and tubal isthmic pregnancy with uterine rupture was diagnosed.

scholarly journals Pregnancy Complications and Risk of Uterine Rupture Among Women With Singleton Pregnancies in China

2021 ◽  
Author(s):  
Jing Tao ◽  
Yi Mu ◽  
Peiran Chen ◽  
Yanxia Xie ◽  
Juan Liang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Pregnancy Complications ◽  
Uterine Rupture ◽  
Placental Abruption ◽  
Placenta Percreta ◽  
Near Miss ◽  
Increased Risk

Abstract Background: The goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age. Methods: We obtained all data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups. Results: Compared with women without pregnancy complications, those with different complications (except for preeclampsia) had a 1- to 3-fold greater risk of UR. These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. A large for gestational age (LGA) foetus increased the risk of UR in women with gestational diabetes mellitus, especially at 32 to 36 weeks gestation. Conclusions: Better quality antenatal care and early intervention for women with these pregnancy complications are needed to minimize the incidence of UR.

Prior Cesarean Delivery Healthcare Facilities Variations in Pregnancy Outcomes of Placenta Accreta Spectrum with Placenta Previa: A retrospective study from a tertiary transferal center (Preprint)

2021 ◽  
Author(s):  
Xuan Gao ◽  
Shaoshuai Wang ◽  
Lijie Wei ◽  
Peng Gao ◽  
Jiaqi Li ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
County Level ◽  
Healthcare Facilities ◽  
Placenta Accreta Spectrum ◽  
Province Level ◽  
Rural Township ◽  
Previous Cesarean

BACKGROUND The prevalence of Placenta Accreta Spectrum(PAS) is increasing rapidly linked with the cesarean rate increase worldwide, creating a threatening condition from severe postpartum hemorrhage to various maternal morbidities. The socio-economic imbalance, geographical, qualification, and specialty variations of the previous cesarean delivery healthcare facilities resulted in assessment and management difficulties. OBJECTIVE To assess variations of prior cesarean delivery healthcare facilities on pregnancy outcomes on current PAS with Placenta Previa. METHODS This retrospective study was conducted in a tertiary referral center from Nov.2015 to Nov.2020 in central China. Healthcare facilities were classified by geographical, hospital grading, ownership, and specialty variations. The primary outcome was postpartum hemorrhage(PPH), secondary outcomes included Placenta Percreta and maternal-fetal morbidities. RESULTS In total, 252 patients were enrolled, 58(23%) patients had Placenta Accreta, 131(52%) had Placenta Increta and 63(25%) had Placenta Percreta. The overall incidence of PPH was 47.2%(119 out of 252). As the administrative geographical level becoming smaller and more distant, PPH incidence climbed up: province-level(10, 32.3%), prefecture-level(65, 48.5%), county-level(30, 42.3%), and rural township(14, 82.5%), P for trend= 0.019. The odds of PPH in rural township clinics was 5.84(P=0.03, 95%CI 1.18~28.77) compared to the province-level hospitals. Similarly, when hospital grades declined, PPH incidence raised: tertiary(26, 39.4%), secondary(28, 43.8%), primary(14, 38.9%) and unclassified(51, 59.3%), P for trend= 0.047. Unclassified hospitals had 2.16(P= 0.046, 95%CI 1.02~4.61) times odds of PPH compared to tertiary medical centers. PPH showed no statistical significance based on ownership or specialty variations. Also, Placenta Percreta increased when geographical location shifted from urban to rural: three (9.7%) from province-level, 34(25.6%) from prefecture-level, 18(25.4%) from county-level and eight(47.1%) from rural township clinics, P= 0.04, P for trend =0.018. Patients with previous rural township clinics cesarean delivery had a 7.49 times risk((P=0.011, 95%CI 1.59~35.19) of developing Placenta Percreta compared with province-level hospitals. CONCLUSIONS Healthcare facilities variations of the previous cesarean delivery have upcoming impacts on subsequent pregnancy. The tendency of experiencing adverse maternal outcomes is more significant with prior cesarean in the rural township clinics and unclassified hospitals. The findings call for physicians’ alertness, persistent efforts in urban-rural disparity reduction, and measures to achieve equitable management.

Placenta accreta spectrum: maternal near miss

2020 ◽  
Vol 23 (20) ◽  
Author(s):  
Amal Abdul Mahdi Kadhim ◽  
Amel Faraj Flaih ◽  
Hanaa Hameed Abbas Alheidery
Keyword(s):  
Placenta Accreta ◽  
Near Miss ◽  
Maternal Near Miss ◽  
Placenta Accreta Spectrum
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