scholarly journals ElNoury - Webster bundle: a pre-emptive surgical approach for the management of morbidly low or adherent placenta

2020 ◽  
Author(s):  
Amr Elnouri ◽  
Dr Sophia Webster ◽  
Diaa Abdelhalim
Keyword(s):  
Placenta Accreta ◽  
Case Series ◽  
Placenta Praevia ◽  
Uterine Preservation ◽  
Healthcare Settings ◽  
Adherent Placenta ◽  
Obstetric Haemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy

Placenta accreta spectrum and placenta praevia are a significant cause of obstetric haemorrhage, maternal morbidity and mortality worldwide. We report a novel surgical technique, which pre-emptively and prophylactically reduces intrapartum bleeding during caesarean sections for these conditions and hence reducing the risk for a caesarean hysterectomy. This technique is particularly useful in low resource healthcare settings where interventional radiology is not readily available and where the woman is keen on uterine preservation. In this report we present the surgical and clinical outcomes of a case series of 16 patients on whom this technique was piloted demonstrating its feasibility and safety.

Resurgence of classical caesarean section in current obstetric practice- A case series

2021 ◽  
Vol 8 (4) ◽  
pp. 592-594
Author(s):  
Priyanka Mathe ◽  
Sanjana Narula Wadhwa ◽  
Taru Gupta
Keyword(s):  
Multidisciplinary Approach ◽  
Placenta Accreta ◽  
Case Series ◽  
Cesarean Sections ◽  
Obstetric Hemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
Placenta Accreta Spectrum ◽  
High Index Of Suspicion ◽  
Lower Segment Uterine

Although, the incidence of placenta accreta spectrum (PAS) and large fibroids is rare but still these cases contributes to a large number of maternal morbidity and mortality. Major obstetric hemorrhage is one the dreadful complication of these types of cases and thus early diagnosis and intervention in such cases helps the physician to minimize the risk to mother and the fetus. Also, current widespread use of ultrasound has helped us to manage these cases judiciously, predict and prevent life threatening obstetric hemorrhage. Here we present three complicated obstetric cases of placenta accreta, large lower segment uterine fibroid and large cervical fibroid which necessitated classical cesarean sections (CCS) thus emphasizing prowess in CCS in modern obstetric era. High index of suspicion, Multidisciplinary approach alongwith expert surgical personnel should be available in high risks cases like placenta accreta syndrome and large fibroids in pregnancy.

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 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.

Expectant management of retained abnormally adherent placenta complicated by uterine prolapse after vaginal delivery

2020 ◽  
Vol 50 (2) ◽  
pp. 160-162
Author(s):  
Nnabuike C Ngene ◽  
Amon Siveregi
Keyword(s):  
Vaginal Delivery ◽  
Placenta Accreta ◽  
Uterine Prolapse ◽  
Expectant Management ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adherent Placenta ◽  
Prenatal Imaging ◽  
Placenta Accreta Spectrum

The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography in some health facilities delays the diagnosis, particularly if the prenatal period is asymptomatic. Following vaginal delivery, it often manifests as failure to remove a retained placenta manually. In the absence of haemorrhage, expectant management involving leaving the placenta in situ, is an option. In the presence of haemorrhage and/or sepsis, hysterectomy is usually recommended. We present a case of an expectantly managed PAS following a spontaneous preterm vaginal birth. The patient developed puerperal uterine prolapse with the placenta in situ, a previously unreported complication, but this was successfully reduced manually.

scholarly journals Evaluation of outcome of pregnancy in placenta accreta spectrum

2021 ◽  
Vol 10 (9) ◽  
pp. 3331
Author(s):  
Uma Veludandi ◽  
B. Aruna Suman ◽  
S. Nagamani ◽  
Medha Hothur
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Placenta Accreta ◽  
Intrauterine Device ◽  
Tertiary Care ◽  
Bladder Injury ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy ◽  
Placenta Accrete

Background: Aim of the study was to evaluate the outcome of pregnancy in placenta accrete spectrum in third trimester pregnancy at tertiary care centreMethods: This hospital based retrospective study was carried out from 2017 to 2019.  The case records of all women identified as placenta accrete spectrum from the hospital registers were retrieved. A total of 166 patients with the diagnosis of placenta accrete spectrum were included in the study.Results: The incidence of morbidly adherent placenta is 5 per 10,000 deliveries with mean age being 32.4±4.2 (23-39) years. and showed its relation with risk factors such as previous caesarean section (CS), placenta praevia and multiparity. The mean duration of MICU stay in placenta previa was 6.7±1.9 days (range 2-12 days). With complications in 18 cases of which urinary bladder injury (3%), infection (9%), PPH and coagulopathy (4.2%). The placenta was removed successfully in 141 while 25 cases had caesarean hysterectomy (2.4%). In total 166 cases 26 (16.8%) cases are intrauterine device (IUD) and still births. 5 (3%) cases are very low birth weight, 24 cases (14.5%) are low birth weight babies, 76 (45.8%) cases had neonatal intensive care unit (NICU) admissions followed by 10 (6%) cases with <5 APGAR score.Conclusions: Placenta accreta spectrum can be identified antenatally with a high index of suspicion in the presence of known risk factors and proper radiological studies, allowing for planned attempts to avoid life-threatening haemorrhage and caesarean hysterectomy.

scholarly journals Diagnostic Limitation and Outcome of Definitive Surgical Approach in Placenta Accreta Spectrum Disorders - A Prospective Case Series Study

2021 ◽  
Vol 8 (07) ◽  
pp. 359-363
Author(s):  
Suman Poddar ◽  
Shilpi Sharma
Keyword(s):  
Surgical Approach ◽  
Internal Iliac Artery ◽  
Case Series ◽  
Bladder Injury ◽  
Artery Ligation ◽  
Total Hysterectomy ◽  
Obstetric Haemorrhage ◽  
Internal Iliac ◽  
Placenta Accreta Spectrum ◽  
Prospective Case Series

BACKGROUND Placenta accreta spectrum (PAS) disorders have become an emerging obstetric issue associated with risk of massive obstetric haemorrhage on placental separation following delivery. Antenatal diagnosis is of utmost importance but miserably limited due to lack of imaging expertise in this issue. We wanted to evaluate antenatal diagnosis of PAS disorders and analyse the outcome of definitive surgical approach. METHODS This is a prospective case series analysis done in the Department of Obstetrics and Gynaecology, RG Kar Medical College & Hospital, Kolkata. In a series, we have discussed 10 cases dealt well in our institution in the last one year (pre-Covid-era). Main outcome measures were operative blood loss, bladder injury, high dependency unit (HDU) admission, component transfusion, and neonatal morbidity. RESULTS Imaging expertise for prenatal diagnosis of PAS disorders was found miserably limited where 7 out of 10 cases were diagnosed intra-operatively. During Caesarean section (CS), longitudinal fundal incision was given to take out the baby with blood loss even less than usual CS. Bladder injury was diagnosed in one occasion intra-operatively. Peripartum total hysterectomy without touching placental bed was done in all cases, where uneventful bladder dissection and bilateral internal iliac artery ligation minimised component transfusion (8 out of 10) and HDU support (5 out of 10). Neonatal outcome was good in cases of planned CS at 36 weeks (6 out of 10). CONCLUSIONS Clinical suspicion plays an important role in our scenario due to lack of imaging experience & expertise to diagnose PAS disorders. Planned Caesarean delivery at late preterm period in equipped centre in expert hands improves outcome of such cases. Peripartum total hysterectomy without touching placental bed is the most definitive (surgical) approach with sound post-operative recovery. KEYWORDS Massive Obstetric Haemorrhage, Prenatal Diagnosis, Clinical Suspicion, Peripartum Total Hysterectomy, Internal Iliac Artery Ligation

MORBID ADHERENT PLACENTA: PREDICTION, DIAGNOSIS AND MANAGEMENT

2007 ◽  
Vol 18 (4) ◽  
pp. 357-381 ◽  
Author(s):  
JM PALACIOS JARAQUEMADA ◽  
CH BRUNO ◽  
WA CLAVELLI
Keyword(s):  
Caesarean Section ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Close Relation ◽  
Morbidity And Mortality ◽  
Vital Importance ◽  
Diagnosis And Management ◽  
On Demand ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality

Morbid adherent placenta (MAP), also known as placenta accreta, increta or percreta, is one of the main causes of maternal morbidity and mortality. Its incidence has noticeably increased in the last few decades, a fact directly related to the increase in caesarean sections. There is a close relation between iterative caesarean sections and MAP. This connection is of vital importance, since caesarean rates have risen worldwide, especially in the countries where there is the possibility of caesarean section on demand.

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