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 Placenta Previa Accreta Spectrum: Cesarean Hysterectomy

2021 ◽  
Author(s):  
Satoru Takeda ◽  
Jun Takeda ◽  
Yoshihiko Murayama
Keyword(s):  
Blood Flow ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Autologous Blood ◽  
Vaginal Wall ◽  
Balloon Occlusion ◽  
Bladder Injury ◽  
Ureteric Injury ◽  
Cardinal Ligament ◽  
Cesarean Hysterectomy

AbstractWhen cesarean hysterectomy is scheduled in cases of placenta previa accreta/increta/percreta, it is necessary that the departments of obstetrics, anesthesiology, blood transfusion, urology, and radiology hold a preoperative conference to assure full preparation for the surgery. A ureteral stent inserted just before cesarean section serves as a marker. A uterine incision should be made at a site free of placental contact. The presence/absence of bladder invasion by villi, adhesions, and the degree of vascularization greatly influence the amount of bleeding, and bleeding control is a key point. For prevention of massive hemorrhage, methods of blood flow blockage, such as balloon occlusion catheterization of the aorta or common iliac artery, should be considered. Stored autologous blood and Cell Saver should be prepared. When hysterectomy is performed with the placenta left in situ, handling of the elongated cardinal ligament, ureteric injury, and bladder injury are important issues because the lower uterine segment is enlarged with the placenta. If blood flow is not blocked, separation of the bladder at the area of placenta percreta should be performed as the last step, to reduce bleeding (Pelosi's method). At this time, after handling of the cardinal ligament, bladder separation can be performed more safely if the posterior vaginal wall is incised and exposed first.In cases of placenta accreta or partial placenta accreta/increta/percreta, a diagnosis of morbidly adherent placenta may not be obtained until separation of the placenta is performed. If bleeding from the placental separation surface cannot be controlled, total hysterectomy should be performed without hesitation.

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.

scholarly journals Efficacy of Precesarean Infrarenal Abdominal Aorta Balloon Occlusion Among Women With Pernicious Placenta Previa and Placenta Accreta: A Retrospective Cohort Analysis

2021 ◽  
Author(s):  
Xuemin Wei ◽  
Yan Chen ◽  
Weiwei Cheng
Keyword(s):  
Blood Loss ◽  
Abdominal Aorta ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Neonatal Outcomes ◽  
Control Group ◽  
Study Group ◽  
Estimated Blood Loss ◽  
Infrarenal Abdominal Aorta

Abstract Purpose To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta among women with pernicious placenta previa and placenta accreta.Methods This retrospective study included 110 patients with pernicious placenta previa and placenta accreta. The control group consisted of 55 patients who underwent cesarean section alone, and the study group included 55 patients who underwent precesarean prophylactic balloon occlusion of the infrarenal abdominal aorta. In addition, both of the groups were further divided according to FIGO clinical grading standards. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes included operative duration, estimated blood loss, blood transfusion, intensive care unit admission, total hospital stay (days), and puerperal morbidity, and these data were compared between the two groups. Additionally, the neonatal outcomes were compared.Results There were no significant differences in maternal and neonatal outcomes in the PAS 2 and PAS 3 groups (P > 0.05). However, in the PAS 4 and PAS 5 groups, the amount of bleeding in the study group was significantly less than that in the control group (3533.3 ± 2391.4 vs 4293.6 ± 1235.4, P < 0.05), and the total hysterectomy rate was also lower (7.8% vs 13.2%, P < 0.05).Conclusion Precesarean infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa and placenta accreta and can effectively reduce the risk of hysterectomy and intraoperative blood loss in women with PAS grade 4-5.

The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

2021 ◽  
Author(s):  
Ling Hong ◽  
Aner Chen ◽  
Jinliang Chen ◽  
Xiuxiu Li ◽  
Wenming Zhuang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Iliac Artery ◽  
Caesarean Delivery ◽  
Internal Iliac Artery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Balloon Occlusion ◽  
Control Group ◽  
Estimated Blood Loss ◽  
Internal Iliac

Abstract Objective: This study aimed to evaluate the clinical efficacy of internal iliac artery(IIA) balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta. Background: Pernicious placenta previa is frequently reported to be complicated with placenta accreta, which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods: Fifty-eight pernicious placenta previa patients complicated with placenta accreta were retrospectively reviewed. The ballon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL), cesarean hysterectomy, and blood transferring volume. The secondary outcomes were operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.Results: No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis , surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10[43.48%] vs. 11[31.43%],P=0.350).Complications related to occlusion of IIA did not occur.The duration of the surgery of the balloon group was significantly longer than that of the control group(123.52 min±74.76 versus 89.17±48.68,P=0.038), and the total hospitalization cost was also significantly higher than that of the control group(45116.67±9358.67 yuan versus 30615.41±11587.44yuan,P=0.000).Conclusion: IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta did not reduce the hysterectomy rate during cesarean section, nor did it reduce blood loss and blood transfusion, but it prolonged the duration of the surgery and increased the total cost.

Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa

2021 ◽  
Author(s):  
Andrea Dall’Asta ◽  
Francesco Forlani ◽  
Harsha Shah ◽  
Gowrishankar Paramasivam ◽  
Joseph Yazbek ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
3D Ultrasound ◽  
Perioperative Outcomes ◽  
Pathology Report ◽  
Full Bladder ◽  
Estimated Blood Loss ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum

Abstract Purpose To evaluate perioperative outcomes and the prognostic role of the tramline sign in a cohort of women with anterior placenta previa. Materials and Methods Retrospective analysis of 3D ultrasound volumes from women with anterior placenta previa who underwent ultrasound examination beyond 32 weeks. 3D and 3D color volumes were obtained from a sagittal section of the uterus bisecting a partially full bladder and processed using Crystal Vue and Crystal Vue Flow rendering to look for the “tramline sign”. “Partial obliteration” was defined as a loss of some or part of the uterine-serosal interface and “full obliteration” as when both interfaces were interrupted. Postnatal ascertainment of placenta accreta spectrum (PAS) was confirmed by findings recorded intraoperatively or on a pathology report. Results 65 cases were included. The tramline sign was “partially” (17) or “fully” (19) obliterated in 36 cases (55.4 %), and present in 29 (44.6 %). Obliteration was associated with earlier gestational age at delivery (35 + 1 (26 + 3–38 + 3) vs. 36 + 4 (25 + 3–38 + 0) weeks, p = 0.005), greater estimated blood loss (800 (400–11 000) vs. 600 (300–2100) mls, p = 0.003), longer operative time (155 (60–240) vs. 54 (25–80) minutes, p < 0.001), higher rate of hysterectomy (97.2 % vs. 0.0 %, p < 0.001), longer postoperative admission (7 (3–19) vs. 3 (1–5) days, p < 0.001) and a 100 % rate of postnatal diagnosis of PAS. The finding of an “obliterated” tramline sign identified all women that required hysterectomy and all cases of PAS. Conclusion A “partially or fully obliterated” tramline sign is strongly associated with indicators of operative complexity, the postnatal confirmation of PAS, and the need for peripartum hysterectomy.

scholarly journals Evaluation of Maternal Hemorrhage in Placenta Accreta

2016 ◽  
Vol 22 (1) ◽  
Author(s):  
Elif Ağaçayak ◽  
Senem Yaman Tunç ◽  
Bircan Alan ◽  
Serdar Başaranoğlu ◽  
Fatih Mehmet Fındık ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Maternal Mortality ◽  
Placenta Accreta ◽  
Multidisciplinary Care ◽  
Mortality And Morbidity ◽  
Factors Affecting ◽  
Transfusion Requirements ◽  
Maternal Mortality And Morbidity ◽  
Parity Number

<p>Objective: The aim of the present study is to provide a retrospective evaluation of placenta accreta cases to identify the factors affecting the blood transfusion requirement, which stands as one of the most important causes of maternal mortality and morbidity.<br />study desıgn: A total of 110 patients who presented to the outpatient clinic of gynaecology and obstetrics of the Faculty of Medicine of Dicle University and were diagnosed with placental attachment before or during a caesarean section (C-section) between January 2006 and June 2015 were included in this study. The patients’ data were collected from the hospital’s records.<br />Results: During the study period, 21674 births were realised and 110 (1/200) of these patients exhibited placenta accreta. 86 of these 110 patients (78,2%) received at least one unit of blood. The group of patients that had received blood transfusion exhibited significantly higher values in age, parity, number of C-sections, length of stay (p = 0.003, 0.004, 0.024, 0.000, respectively). Multiple logistical regression analysis led to the identification of a significant association between the length of stay and the blood transfusion requirements (OR 95% Cl 2.005(1.213-3.314) p= 0.007).<br />Conclusion: Patients of advanced age as well as grand multiparous patients and patients with a history of multiple repeat caesarean deliveries should be evaluated more carefully during pregnancy. These patients should be referred to hospitals that provide multidisciplinary care and management before the delivery or even at the early stages of pregnancy in an effort to decrease maternal mortality and morbidity rates. <br /><br /></p>

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 Severe preeclampsia leads to higher prevalence of mortality and morbidity affecting maternal outcomes in single tertiary hospital

2020 ◽  
Vol 28 (3) ◽  
pp. 99
Author(s):  
Khonsa’ Tsabitah ◽  
Budi Wicaksono ◽  
Samsriyaningsih Handayani
Keyword(s):  
Placenta Previa ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Severe Preeclampsia ◽  
Sectio Caesarea ◽  
Maternal Outcomes ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
Cross Sectional Design

Objective: The purpose of this study was to determine the maternal outcomes of severe preeclampsia at RSUD Dr. Soetomo Surabaya in January 2013-December 2014.Materials and Methods: This research was a descriptive study with cross-sectional design to observe maternal characteristics and maternal outcomesof severe preeclampsia. Data were retrieved from medical records of severe preeclampsia patients admitted to Obstetric Ward of Dr Soetomo Hospital, from January 2013 to December 2014. This study used total sampling for collecting its data. These data were proccessed descriptively and presented in graphic, tables, and short description.Results: From January 2013 to December 2014 there were 386 (44.2%) cases of severe preeclampsia that were included in this study from a total of 874 cases available. The maternal outcomes of severe preeclampsia consisted of 42 cases (10.9%) of HELLP syndrome, 36 cases (9.3%) of pulmonary edema, 225 cases (58.3%) of sectio caesarea, 7 cases(1.8%) of antepartum bleeding with 5 cases (1.3%) of placenta previa and 2 cases (0.5%) of solutio placenta, 2 cases (0.5%) of postpartum bleeding, 8 cases (2.1%) of eclampsia, 31 cases (8%) of impending eclampsia, 5 cases (1.3%) of acute kidney injury, and 2 cases (0.5%) of maternal death.Conclusion: In conclusion, this study shows that severe pre-eclampsia patients have high prevalence of mortality and morbidities that affects maternal outcomes. It also reccommends that all patients with severe preeclampsia need to receive intensive maternal and fetal care. It is necessary to do careful complication examination, prevention of seizures using magnesium sulfate, and continous fetal and maternal monitoring.

scholarly journals Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

2020 ◽  
Vol 1 (2) ◽  
pp. 78-84
Author(s):  
Teddy Wijaya
Keyword(s):  
High Risk ◽  
Multidisciplinary Approach ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Risk Map ◽  
Secondary Complications ◽  
Repeat Surgery ◽  
Mortality And Morbidity ◽  
Fetal Position ◽  
Transverse Lie

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

scholarly journals Case Report: Anaesthetic Management of Placenta Percreta

2022 ◽  
Vol 9 (1) ◽  
pp. 39-44
Author(s):  
Subir Kumar Ghosh ◽  
Babita Ramdev ◽  
Noorjit Sidhu
Keyword(s):  
Case Report ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Bladder Wall ◽  
Hemodynamic Instability ◽  
Placenta Percreta ◽  
Elective Cesarean Section ◽  
Mortality And Morbidity ◽  
Risk Pregnancy ◽  
Perioperative Bleeding

Background: The placenta is a complicated organ and is partially understood. It is the essential part for physiological changes leading to a successful pregnancy. Placenta percreta is the most severe and least common form of placenta accreta in which villi penetrate the entire myometrial thickness and reach or traverse the serosa to encroach adjacent organs. Patients with placenta percreta are at a greater risk of life-threatening perioperative bleeding as well as massive and deadly thromboembolic events. Case report: Our patient was a 34-year-old gravida 5female who underwent elective cesarean section at 37 weeks of gestation with a diagnosis of placenta accreta or percreta. Intraoperative findings showed placenta percreta with bladder wall involvement. Hence, hysterectomy was done. Anticipated intraoperative haemorrhage and hemodynamic instability were managed properly. Discussion: Placenta percreta is the most serious among abnormal placentation, sometimes leading to catastrophic blood loss and very high maternal mortality and morbidity up to 10%. The most important risk factor in placenta percreta is placenta previa (low lying placenta) after cesarean delivery. Our patient met all these risk factors. Prenatal diagnosis of an invasive placenta is paramount for reducing maternal morbidity and mortality by implementing a multidisciplinary approach. Keywords: haemorrhage, placenta percreta, hysterectomy, high-risk pregnancy.

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