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 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.

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.

scholarly journals Can introvoxel incoherent motion MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kui-de Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Motion Mri ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants ◽  
And Diffusion

Abstract Background The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28 + 0 and 39 + 6 weeks. IVIM MRI was performed on a 1.5 T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p = 0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P = 0.018 and 0.033 respectively), but was not lower than in patients with increta(p = 1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

scholarly journals A Literature Review of Placenta Accreta Spectrum Disorder: The Place of Expectant Management in Ethiopian Setup

2020 ◽  
Vol 30 (2) ◽  
Author(s):  
Yifru Berhan ◽  
Tadesse Urgie
Keyword(s):  
Literature Review ◽  
Placenta Accreta ◽  
Large Body ◽  
Expectant Management ◽  
Spectrum Management ◽  
Observational Research ◽  
Team Approach ◽  
Management Options ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

In the last three to four decades, the increasing caesarean delivery rate has contributed to several fold increment in the incidence of placenta accreta spectrum disorders globally. Placenta accreta spectrum with its subtypes (accreta, increta and percreta) is one of the devastating obstetric complications. As a result, it is the commonest indication for peripartum hysterectomy and common cause of severe maternal morbidity. However, in recent years, there is a growing interest in and practice of expectant management either to minimize emergency hysterectomy related maternal complications or to preserve the fertility potential of a woman with an intact uterus. A large body of observational research findings has demonstrated the success rate of expectant management in many of well selected cases. Similarly, the experience on delayed hysterectomy was encouraging in order to have less hemorrhage. For the best success of placenta accreta spectrum management, multidisciplinary team approach, antenatal diagnosis and managing such cases in a hospital with center of excellence has been strongly recommended. This literature review provides a robust synthesis of up-to-date knowledge and practice on the challenges and successes of placenta accreta spectrum disorders management. The currently practiced management options in the high and middle income countries are also summarized under seven categories. Therefore, the purpose of this review was to shed light on the applicability of the PAS disorder management modalities in our setup.

scholarly journals Can IVIM MRI be used to differentiate patients with placenta accreta spectrum disorders?

2019 ◽  
Author(s):  
Tao Lu ◽  
Hong Pu ◽  
Kuide Li ◽  
Jie Mei ◽  
Meng-wei Huang ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Comparisons ◽  
Placental Perfusion ◽  
Perfusion Fraction ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Study Participants

Abstract Objective Background The incidence of PAS disorders increased rapidly in recent years, and introvoxel incoherent motion (IVIM) MRI has been applied in the assessment of placenta. The study aims to investigate whether the parameters from IVIM can be used to differentiate patients with PAS disorders complicating placenta previa and secondly to differentiate different categories of PAS disorders. Methods The study participants were comprised of 99 patients with placenta previa, including 16 patients with placenta accreta, 51 patients with increta, 8 patients with percreta and 24 patients without PAS disorders between 28+0 and 39+6 weeks. IVIM MRI was performed on a 1.5T scanner. Perfusion fraction (f), pseudodiffusion coefficient (D*) and standard diffusion coefficient (D) were calculated. Results Women with PAS disorders had a higher perfusion fraction (p=0.019) than women without the disease. Multiple comparisons showed perfusion fraction in patients without PAS disorders was significantly lower than in patients with placenta accreta and percreta(P=0.018 and 0.033 respectively), but was not lower than in patients with increta(p=1). Conclusion Patients with placenta accreta and percreta differed in placental perfusion fraction from women with increta and without PAS disorders.

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