scholarly journals Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2017 to January 2018

2021 ◽  
Vol 29 (3) ◽  
pp. 129
Author(s):  
Fita Maulina ◽  
Mohammad Adya Firmansha Dilmy ◽  
Yudianto Budi Saroyo ◽  
Yuditiya Purwosunu
Keyword(s):  
Caesarean Section ◽  
Surgical Technique ◽  
Placenta Accreta ◽  
Conservative Surgery ◽  
Massive Bleeding ◽  
Maternal Outcome ◽  
Bladder Injury ◽  
Previous Caesarean Section ◽  
Intraoperative Bleeding ◽  
The Mean

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

scholarly journals INCIDENCE OF PLACENTA PREVIA IN POST CAESAREAN PREGNANCY AND MATERNAL OUTCOME

2019 ◽  
pp. 1-3
Author(s):  
Sasindra Kumar Das
Keyword(s):  
Caesarean Section ◽  
Placenta Previa ◽  
Maternal Outcome ◽  
Bladder Injury ◽  
Previous Caesarean Section ◽  
Artery Ligation ◽  
Medical College ◽  
Internal Iliac ◽  
History Of ◽  
Previous Cesarean

BACKGROUND: Placenta previa, the most catastrophic complication not only poses a risk to the fetus but also endangers the mother's life. AIM:To find the incidence of placenta previa in patients with previous caesarean section and to study the maternal outcome. METHODS: A hospital based prospective study carried out in the Department of Obstetrics and Gynaecology of Gauhati Medical College and Hospital, Guwahati, Assam from 1st June 2018 to 31st May 2019. During this period, 2100 patients with history of previous caesarean section were identified and 66 patients were found to have placenta previa. RESULTS:The incidence of placenta previa was found to be 3.14%. The incidence increases with increase in number of caesarean section. Maximum patients were unbooked from rural area within the age group of 26-30 years. Outcome was studied by need of blood transfusion in 87.7%, postpartum haemorrhage in 19.6%, adherent placenta previa in 10.7%, hysterectomy in 15.1%, Internal iliac artery ligation in 6% and bladder injury in 9.09%. CONCLUSION:Incidence of placenta previa is high in patients with previous cesarean section.

scholarly journals PLACENTA ACCRETA - A MANAGEMENT ENIGMA

2019 ◽  
pp. 1-3
Author(s):  
Bhakti Bawankule ◽  
Sushree Patra ◽  
Sushil Kumar
Keyword(s):  
Caesarean Section ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Previous Caesarean Section ◽  
Artery Ligation ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
The Mean

AIMS AND OBJECTIVES: 1. To analyse maternal and foetal outcomes 2. To analyse types of interventions. MATERIALS AND METHODS: It is a retrospective study conducted over a period of 3years (Jan2017-August 2019), in Department of Obstetrics & Gynaecology at our hospital. Out of 9000deliveries conducted in 3years, 12patients were found to have accreta during caesarean section. Cases were analysed for interventions and maternal and foetal outcome. RESULTS: The mean age of patient included was 25.7yrs ranging from 21-35 yrs. 7patients were gravida 2, 3were gravida 3 and 2 were gravida 4. The mean gestational age was 34.4 weeks ranging from 27.1 to 37.5 weeks. History of D&C was present in 1case, H/O previous LSCS was present in all cases, H/O placenta previa in current pregnancy was present in7/12 cases. H/O previous caesarean section with placenta previa in this pregnancy was present in 7cases. Hysterectomy alone was done in 9patients. Hysterectomy with Internal Iliac Artery Ligation was done in 3patients. Average blood loss was around 1700 ml & blood transfusion was required in all patients. Total 6 patients required ICU care, with 1maternal death and 2 IUFD. CONCLUSION: Antenatal diagnosis of placenta accreta is a challenge. With increasing frequency of previous caesarean section and placenta previa the prevalence of placenta accreta is increasing. With advent of newer interventions and availability of interventional radiologists death due to massive haemorrhage is reducing. Obstetric hysterectomy and Internal Iliac artery Ligation still remains the mainstay of treatment. However, morbidly adherent placenta is a threat to both patient and obstetrician.

scholarly journals The marks that humans’ leave are too often scars

2020 ◽  
Vol 9 (12) ◽  
pp. 5163
Author(s):  
Nandita Sushilkumar Kaushal ◽  
Shrikrushna Vasant Chavan ◽  
Arundhati Gundu Tilve ◽  
C. V. Hegde
Keyword(s):  
Caesarean Section ◽  
Surgical Technique ◽  
Chorionic Gonadotropin ◽  
Innovative Approach ◽  
Previous Caesarean Section ◽  
Caesarean Scar ◽  
Obstetric Emergency ◽  
Beta Hcg ◽  
Beta Human Chorionic Gonadotropin ◽  
Products Of Conception

Caesarean scar ectopics are the newest member of this obstetric emergency. Although rare, are associated with torrential haemorrhage. Gravida 3 para 2 with previous two caesarean sections with spotting per vaginum. Ultrasound showed a pregnancy embedded in the scar of previous caesarean section. MRI confirmed it. Beta human chorionic gonadotropin (HCG) was 15000 which dropped to 5000 after. An innovative approach was taken to laparoscopically evacuate the pregnancy. The products of conception were removed and the incision sutured so as to achieve haemostasis. Beta HCG was 15000 which dropped to 5000. Patient was haemodynamically stable and discharged on day 3. An innovative approach with skilled surgical technique not only decreased the morbidity but also avoided an unnecessary hysterectomy.

scholarly journals Indications for Caesarean Section and its Fetal and Maternal Outcome in a Teaching Hospital, Province Five, Nepal

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Asha Panth ◽  
Saraswoti Kumari Gautam Bhattarai ◽  
Sunita Acharya
Keyword(s):  
Caesarean Section ◽  
Teaching Hospital ◽  
Neonatal Intensive Care ◽  
Post Partum ◽  
Previous History ◽  
Structured Interview ◽  
Maternal Outcome ◽  
Previous Caesarean Section ◽  
Obstructed Labor ◽  
Cross Sectional

Introduction: Cesarean section (CS) is an operative technique by which a fetus is delivered through an abdominal and uterine incision and is effective in saving maternal and infant lives but caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. The objective of the study was to find out the indications for caesarean section and its fetal and maternal outcomes in a Teaching Hospital, Province Five, Nepal. Methods: A descriptive, cross-sectional study was conducted in a teaching hospital, Nepal. A total of 150 purposively selected postnatal mothers after caesarean section were interviewed by face to face technique using a structured interview schedule. Analysis and interpretation of the findings were done with the help of descriptive and inferential statistics. Results: The study shows that the majority (93.3%) of mothers had undergone an emergency caesarean section and the majority (92%) had maternal indications for caesarean section. Among them, one third had a previous caesarean section followed by 14.5% obstructed labor. Fetal indications include breach (44.4%), fetal distress (29.6%), big baby (11.1) and twins and triplets (3.7%). Only (10.7%) had an unfavorable fetal outcome which includes the need for Neonatal Intensive Care Unit (NICU) (31.2%) followed by neonatal death (25%). Only three mothers (2%) had an unfavorable maternal outcome which includes Post-Partum Hemorrhage (PPH); need for blood transfusion and fever respectively. There is no statistically significant association between sociodemographic characteristics and type of caesarean section. There is a statistically significant association between the previous history of caesarean section and type of caesarean section (P= .005). Conclusions: Previous caesarean section was the most common indication for caesarean section. Unfavorable outcome after caesarean section was considerably present which needs to be addressed.

scholarly journals Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

2018 ◽  
Vol 7 (10) ◽  
pp. 3980
Author(s):  
Abdulrahman M. Rageh ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Hossam T. Salem
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Case Series ◽  
Bladder Injury ◽  
Operative Blood Loss ◽  
Ureteric Injury ◽  
Total Blood ◽  
Peripartum Hysterectomy ◽  
The Mean

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta.

Maternal Outcomes of Hysterectomy and Conservative Surgery in Placenta Accreta

2020 ◽  
Vol 16 (3) ◽  
pp. 201-205
Author(s):  
Muara Panusunan Lubis ◽  
Muhammad Rizki Yaznil ◽  
Melvin N.G. Barus ◽  
Edwin Martin Asroel ◽  
Michelle Faustine
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Multidisciplinary Care ◽  
Conservative Surgery ◽  
Emerging Disease ◽  
Bladder Injury ◽  
Maternal Outcomes ◽  
Mortality And Morbidity ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Background: Abnormal invasive placentation or placenta accreta spectrum (PAS) has been an emerging disease in developing countries where cesarean sections are routinely performed. Here we report our own data to contribute to the variety of techniques for reducing morbidity and mortality in placenta accreta cases across the world. Objective: This study aims to analyze maternal outcomes, associated risk factors, and our surgery technique in placenta accreta patients treated at Haji Adam Malik Hospital, Indonesia. Methods: We conducted a retrospective study in a tertiary hospital in North Sumatra, with a total of 70 patients suspected to have placenta accreta between January 2017 and June 2019. We compared age, gestational age, previous cesarean section, history of antepartum bleeding, placenta accreta index score, and intraoperative data, including the type of anesthesia, estimated blood loss, the need for transfusion, duration of surgery, complication, and management of the patient. Results: From 70 suspected cases of placenta accreta, 52 (74.2%) patients were diagnosed with placenta accreta and 18 (25.7%) were diagnosed with placenta previa (non-accreta) during surgery. Of the 52 placenta accreta patients, hysterectomy was performed in 42 and the other 10 were treated with conservative surgical procedures. Morbidities such as bladder injury (5.8%; 3/42) and iliac vein injury (4.8%; 2/42) were reported during hysterectomy. There were two (4.8%) mortalities reported. Conclusion: PAS is an emerging disease with high mortality and morbidity rates, which requires comprehensive management including referral to a multidisciplinary care team for diagnosis and management.

scholarly journals Non-descent vaginal hysterectomy in women with previous caesarean section scar: our experience

2018 ◽  
Vol 7 (6) ◽  
pp. 2404
Author(s):  
G. D. Maiti ◽  
Ashok Pillai ◽  
Tony Jose ◽  
P. R. Lele
Keyword(s):  
Caesarean Section ◽  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Bladder Injury ◽  
Previous Caesarean Section ◽  
Technological Advancement ◽  
Scarred Uterus

Background: Hysterectomy is one of the common gynaecological major surgeries performed worldwide. In spite of technological advancement with laparoscopic and robotic hysterectomy conventional hysterectomy through vaginal route of nonprolapse uterus popularly known as, Non-Descent Vaginal Hysterectomy (NDVH) remains a justifiable cost effective, cosmetically appealing option especially in resource-crunched developing country. NDVH in post caesarean scarred uterus too a technically challenged procedure requiring skills and expertise.Assessment of technical feasibility and safety of non-descent vaginal hysterectomy in women with previous caesarean section scar were studied.Methods: The study was a prospective observational study of 72 patients with LSCS scar requiring hysterectomy for benign conditions were selected based on the inclusion and exclusion criteria carried out from June 2012 to May 2017. Operating time, blood loss, surgical techniques, intra/postoperative challenges, conversion to laparotomy or laparoscopic assistance and length of hospital stay were recorded for each case. Patients were followed up till 03 months of surgery.Results: Vaginal hysterectomy was successful in all cases. Morcellation, bisection or myomectomy, were done in 86% cases. Two patients had bladder injury, which was repaired vaginally, two cases required support of laparoscopy.  No patients needed blood transfusion. None of the patients were converted to laparotomy.Conclusions: Vaginal hysterectomy is a safe and effective procedure for benign non-prolapsed uteri in women with previous caesarean section scar when uterine size is less than 14 weeks. Standby operating laparoscopy provides added advantages to surgeon in doubtful or difficult cases to avoid conversion laparotomy.

scholarly journals Histological and histopathological study of the lower uterine segment after previous caesarean section and placenta accreta

2017 ◽  
Vol 6 (4) ◽  
pp. 90
Author(s):  
Reem Abdulazim Hussein Abdulsalam ◽  
Mohamed Ezz El Deen Ali Azzam ◽  
Amr Mohammed Abd El Fatah El Helaly ◽  
Marwa Labib Badr Ahmed
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Placenta Accreta ◽  
Lower Uterine Segment ◽  
Histopathological Study ◽  
Previous Caesarean Section ◽  
Underlying Mechanisms

Although the risk factors for placenta accreta are well established, the underlying mechanisms leading to abnormal placental adhesions are less well understood. This study was undertaken to evaluate the histology and histopathology of the lower uterine segment in CS in a trial to understand the possible pathogenesis of placenta accreta.

scholarly journals Prediction of Placenta Accreta Using Hyperglycosylated Human Chorionic Gonadotropin

2018 ◽  
Vol 8 (2) ◽  
pp. 142-146
Author(s):  
Maad Mahdi Shalal ◽  
Shaymaa Kadhim Jasim ◽  
Huda Khalil Abd
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Chorionic Gonadotropin ◽  
Gestational Age ◽  
Human Chorionic Gonadotropin ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Control Group ◽  
Previous Caesarean Section ◽  
Hyperglycosylated Human Chorionic Gonadotropin

Objectives: Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta. Materials and Methods: In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up. Results: Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy. Conclusions: The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

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