Successful Conservative Management of Recurrent Focal Placenta Accreta, A Case Study

2017 ◽  
Vol 9 (3) ◽  
Author(s):  
AlSaif Batool ◽  
Aljarrash Majeda
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Fetal Outcome ◽  
Elective Cesarean Section ◽  
Mortality And Morbidity ◽  
Uterine Anomalies ◽  
Elective Cesarean ◽  
Almost All

Placenta accreta refers to an abnormality of placental implantation in which the anchoring placental villi attach to myometrium rather than decidua, resulting in a morbidly adherent placenta . It is a life-threatening diagnosis increasing in number due to the growing number of caesarean sections. For most patients, the method of choice is elective cesarean section followed by hysterectomy. For women who wish to preserve fertility, a conservative procedure may be considered. Almost all reported cases have known major risk factors which are previous caesarean section , current placenta previa , previous uterine surgery and known uterine anomalies .We report here an extremely rare case of recurrent focal placental accreta in 35 years old Saudi female, G3P2+0. 39 weeks pregnant, previous 1 cesarean section, breech with current focal accreta discovered late at 38wk +.Our case doesn’t have known major or even controversial minor risk factors in her 1st accreta.Risk factors for the second accreta were previous focal accreta at fundus and previous 1. In addition this is a successful uterine conservation for the 2nd time with no complications apart from mild bleeding of 2 liters- (the average usual bleeding is 6100 ). known complications for placental accreta include:Severe vaginal bleeding: 53 %, Sepsis: 6%, Secondary hysterectomy: 19% , death: 0.3 % 1 .Cesarean-hysterectomy is the best management of placenta accreta because it has reduced mortality and morbidity as well as injuries to nearby organs and hospital stay. It is important to report this case in order to keep in mind screening for suspicious of placenta accreta during perinatal US even if the patient has no risk factors in order to have planned delivery which will improve the mother and fetal outcome including most importantly decreasing the mortality rate due to postpartum hemorrhage and will increase the likelihood of successful uterine conservation especially in low parity patient.

scholarly journals Penggunaan Skor Indeks Plasenta Akreta (IPA) sebagai Prediktor Manajemen Perioperatif Seksio Sesarea Pasien dengan Plasenta Previa Totalis Suspek Akreta

2020 ◽  
Vol 3 (2) ◽  
pp. 111-18
Author(s):  
Dadik Wahyu Wijaya ◽  
Yusmein Uyun ◽  
Sri Rahardjo
Keyword(s):  
Cesarean Section ◽  
Perioperative Management ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Stable Condition ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Hemoglobin Level ◽  
Elective Cesarean Section ◽  
Elective Cesarean

Plasenta akreta adalah suatu kondisi kehamilan yang serius yang disebabkan oleh kelainan perlekatan plasenta yang membutuhkan perhatian khusus secara perioperatif. Kasus ini menggambarkan manajemen anestesi yang sesuai untuk seksio sesarea dan total abdominal histerektomi karena  plasenta previa totalis dugaan akreta. Seorang wanita berusia 33 tahun dipersiapkan untuk menjalani seksio sesarea elektif dan histerektomi total akibat plasenta previa totalis dengan kecurigaan tinggi terhadap akreta berdasarkan Indeks Skor Plasenta Akreta (IPA). Pemeriksaan penunjang dilakukan oleh dokter kandungan untuk mengkonfirmasi diagnosis. Pada pasien ini dilakukan tindakan anestesi umum untuk prosedur operasinya. Kadar hemoglobin pasien sebelum operasi adalah 9,1 g / dl. Dengan total perdarahan selama operasi adalah 2000 mL. Estimasi kehilangan darah yang ditolerir untuk pasien ini adalah 633 ml. Pasien menerima transfusi 2(dua) kantong darah PRC dan 1(satu) kantong darah WB. Kadar hemoglobin setelah transfusi adalah 8,9 g / dL Pasien dipulangkan dari rumah sakit dalam kondisi stabil setelah dirawat selama 3 hari diruangan. Sebagai kesimpulan, evaluasi dan persiapan perioperatif dan kolaborasi multidisiplin adalah kunci keberhasilan manajemen pasien dengan plasenta previa suspek akreta.   The Use of Placenta Acreta Index (PAI) Score as Perioperative Management Predictor of Sectio Caesarean Patient with Total Placenta Previa Suspected Acreta Placenta accreta is a serious pregnancy condition caused by disorder of placenta attachment that needs a special consideration perioperatively. This case was described the propriate anesthesia management for Cesarean Section and Total Abdominal Hysterectomy due to Total Placenta Previa suspected Accreta. A 33 years old woman considered for elective cesarean section and hysterectomy due to Total Placenta Previa with high suspicion of Accreta according to Placenta Accreta Index (PAI) Score. Supportive examination was done by the obstetrician to confirm the diagnosis. She underwent general anesthesia for the surgery. Patient’s hemoglobin level before surgery was 9.1 g/dL. With total bleeding during the surgery is 2000 mL. The allowable blood loss for the patient is 633 mL. Patient was transfused with 2 bags of PRC and 1 bag of Whole Blood. The hemoglobin level after transfusion was 8.9 g/dL She was discharged from the hospital in stable condition after being treated for 3 days at normal ward. As conclusion, perioperative evaluation and preparations and multidiscipline collaboration are the key for successful management for patient with Placenta previa/accreta  

scholarly journals BREECH PRESENTATION AT TERM;

2013 ◽  
Vol 20 (04) ◽  
pp. 526-529
Author(s):  
BUSHRA MUKHTAR, ◽  
BUSHRA KHAN ◽  
NUZHAT RASHEED
Keyword(s):  
Cesarean Section ◽  
Neonatal Mortality ◽  
Apgar Score ◽  
Breech Presentation ◽  
Fetal Outcome ◽  
Vaginal Birth ◽  
Elective Cesarean Section ◽  
Mortality And Morbidity ◽  
Elective Cesarean ◽  
Group B

Objective: To compare the fetal outcome of elective cesarean section with elective vaginal birth for Term Breechpresentation in terms of APGAR Score, Respiratory Distress Syndrome, Admission in Neonatology Unit and Neonatal mortality. Design:Quasi experimental study. Setting: Department of Obstetrics & Gynaecololgy Bahawal Victoria Hospital, Bahawalpur. Methods: Total 120cases were included in the study divided into two groups, each having 60 fulfilling the inclusion criteria. Group 'A' had those who deliveredby planned cesarean and Group 'B' comprised those having planned vaginal delivery. Results: It was found that neonatal mortality was3.33 in vaginal and 0 in cesarean group. Mean APGAR Score at 1 and 5 minute was 8.47 and 9.53 in vaginal and 8.58 and 9.62 incesarean group. RDS was more in cesarean (5) than vaginal group (1.6). Admission in Neonatalogy Unit was more in vaginally deliveredgroup (8.33) as compared to the cesarean section group (5). Conclusion: Planned cesarean delivery in breech presentation at term isassociated with a reduction in neonatal mortality and morbidity as compared to the planned vaginal birth.

scholarly journals Conservative Surgical Treatment of a Case of Placenta Accreta

2018 ◽  
Vol 40 (08) ◽  
pp. 494-496 ◽  
Author(s):  
Ismail Biyik ◽  
Fatih Keskin ◽  
Elif Keskin
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placental Tissue ◽  
Uterine Wall ◽  
Elective Cesarean Section ◽  
Triple P ◽  
Cesarean Hysterectomy ◽  
Uterine Incision ◽  
Fertility Sparing

AbstractPlacenta accreta syndromes are associated with increased maternal mortality and morbidity. Cesarean hysterectomy is usually performed in cases of placenta accreta syndrome. Fertility sparing methods can be applied. In the present study, we report a successful segmental uterine resection method for placenta accreta in the anterior uterine wall in a cesarean section case. A 39-year-old woman underwent an elective cesarean section at 38 + 2 weeks. A placental tissue with an area of 10 cm was observed extending from the anterior uterine wall to the serosa, 2 cm above the uterine incision line. The placental tissue was removed with the help of monopolar electrocautery. The uterine incision was continuously sutured. The patient was discharged on the second postoperative day. The placental pathology was reported as placenta accreta. The American College of Obstetricians and Gynecologists (ACOG) generally recommends cesarean section hysterectomy in cases of placenta accreta because removal of placenta associated with significant hemorrhage. Conservative and fertility sparing methods include placenta left in situ, cervical inversion technique and triple-P procedure. There are several studies reporting that segmental uterine resection is performed with and without balloon placement or artery ligation. Segmental uterine resection may be an alternative to cesarean hysterectomy to preserve fertility or to protect the uterus in cases of placenta accreta when there is no placenta previa.

Risk factors for chronic pain after elective cesarean section in healthy women

2005 ◽  
Vol 6 (3) ◽  
pp. S32
Author(s):  
S. Genot ◽  
P. Lavand’homme ◽  
F. Roelants ◽  
H. Waterloos
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Cesarean Section ◽  
Elective Cesarean Section ◽  
Healthy Women ◽  
Elective Cesarean

scholarly journals Incidence and Risk Factors of Postpartum Hemorrhage in China: A Multicenter Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Sijian Li ◽  
Jinsong Gao ◽  
Juntao Liu ◽  
Jing Hu ◽  
Xiaoxu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Cesarean Section ◽  
Subgroup Analysis ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Predictive Performance ◽  
Vaginal Deliveries ◽  
Twin Pregnancies

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide but the incidence and its risk factors in China is limited. The objective of this study is to investigate the incidence and the risk factors of PPH in Chinese women.Methods: A multi-center retrospective study of pregnant women at ≥28 weeks of gestation was conducted. Logistic regression was used to identify potential risk factors of PPH and receiver operating characteristic curve was used to evaluate the predictive performance of the identified risk factors. Subgroup analysis focusing on the number of fetus and the mode of delivery was conducted.Results: A total of 99,253 pregnant women were enrolled and 804 (0.81%) experienced PPH. The subgroup analysis revealed that the incidence of PPH was 0.75, 2.65, 1.40, and 0.31% in singletons, twin pregnancies, cesarean sections, and vaginal deliveries, respectively. Placenta previa and placenta accreta were the predominant risk factors of PPH in the overall population and all subgroups. A twin pregnancy was a risk factor for PPH regardless of the mode of delivery. Obesity, and multiparity were risk factors for PPH in both singletons and cesarean section cases, but the latter predicted a reduced probability of PPH in vaginal deliveries. Macrosomia was associated with increased risk of PPH in singletons or vaginal deliveries. In women who delivered vaginally, preeclampsia was associated with a higher risk of PPH. The areas under the curve for the overall cohort, singletons, twin pregnancies, cesarean section cases, and vaginal deliveries were 0.832 (95% confidence interval [CI] 0.813–0.851), 0.824 (95% CI 0.803–0.845), 0.686 (95% CI 0.617–0.755), 0.854 (95% CI 0.834–0.874), and 0.690 (95% CI 0.646–0.735), respectively.Conclusions: The risk factors of PPH varied slightly based on the number of fetuses and the mode of delivery, while placenta previa and placenta accreta were the two major risk factors. A combination of the identified risk factors yielded a satisfactory predictive performance in determining PPH in the overall cohort, singletons pregnancies, and women who delivered by cesarean section, whereas the performance was moderate in twin pregnancies and in women delivering vaginally.

scholarly journals Incidence And Risk Factors Of Maternal And Fetal Outcomes Among Patients Of Placenta Previa With And Without Placenta Accreta

2018 ◽  
Vol 09 (01) ◽  
pp. 57-61
Author(s):  
Samina Naseem Khattak ◽  
Umbreen Akram ◽  
Erum Pervaiz ◽  
Maria Anayat ◽  
Tahir Ahmad Munir ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Military Hospital ◽  
Fetal Outcomes ◽  
Maternal Risk ◽  
Neonatal Deaths ◽  
The Mean

Objective: The aim of the study was to evaluate maternal and fetal outcomes among patients of placenta previa (PP) with and without placenta accreta (PA). Methodology: All patients who underwent cesarean section for PP and PA were analyzed retrospectively at a tertiary care Combined Military Hospital Kharian, Pakistan, from February 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. Results: PA was found in 37 patients from 111 patients of PP and 74 were without PA with the rate of approximately 2/1000 and 4/1000 respectively were included in the study. The mean age was 31.16±2.65 (range 22–37) years, mean gravidity of 3.69 ±1.40 (range 1 - 9), mean parity 2.57±1.01 (range 1–5), mean number of cesarean sections 2.10±0.66, (range 1-3) and a mean gestational age at the time of cesarean section was 35.65±2.46 (range 28–41) weeks. The maternal risk factors revealed marked differences between placenta previa with accreta and without accrete. The mean intraoperative blood loss in PA was 3,000ml, with a loss of 2,000ml occurring in 60%, and 3,000 ml in 21% of the PA cases. The mean pRBC transfusion was 4 units, while 17% received 6 units. Fetal growth restriction was not seen. A total of 12 neonates were admitted in NICU, with 03 neonatal deaths. There was no maternal death. Neonates born to women with placenta accreta had significantly lower birth weight, Apgar scores at 1 min and 12% required admission to NICU with 3 neonatal deaths. Conclusion: The advanced maternal age, past cesarean or uterine surgery, high parity as well as multiple gravidity were the risk factors for adverse fetal and maternal outcomes.

scholarly journals Maternal and Fetal Outcome in Elective versus Emergency Cesarean Section

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Anupama Suwal ◽  
Veena R Shrivastava ◽  
Amrita Giri
Keyword(s):  
Cesarean Section ◽  
Teaching Hospital ◽  
College Teaching ◽  
Fetal Outcome ◽  
Elective Cesarean Section ◽  
Emergency Cesarean Section ◽  
Medical College ◽  
Emergency Cesarean ◽  
Significant Difference ◽  
Elective Cesarean

Introduction: The complications of cesarean section are seen more commonly in emergency than in elective cases. The aim of this study was to find out the incidence of cesarean section in Nepal Medical College Teaching Hospital and to compare the maternal and fetal outcome in elective and emergency cesarean section. Methods: A prospective study of all the cases undergoing cesarean section in Nepal Medical College Teaching Hospital was carried out during the period of six months from Asar 2069 to Mangsir 2069. Results: The incidence of cesarean section was 254 (22.30%) out of which emergency cesarean section accounted for 167 (65.7%) and elective cesarean section for 87 (34.3%). The usual indications of emergency cesarean section were fetal distress, previous cesarean section in labour, non progress of labour and prolonged second stage of labour. The usual indications of elective cesarean section were previous cesarean section, breech, cephalopelvic disproportion and cesarean section on demand. There was found to be no significant difference in age, period of gestation, blood loss and blood transfusion in emergency vs. elective cesarean section. There was significant difference seen in the length of hospital stay, fever, urinary tract infection, wound infection and low APGAR in five minutes indicating that these were more common in emergency cesarean section. Significant difference was also seen in the incidence of postpartum haemorrhage indicating that it was seen more in elective cesarean section. Conclusions: The incidence of cesarean section in Nepal Medical College Teaching Hospital is high and the overall complication rate is higher in emergency cesarean section than in elective cesarean section.Keywords: cesarean section; fetal and maternal outcome.

scholarly journals PLACENTA PREVIA;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
IFAT BALOCH ◽  
Naseem Bajari ◽  
Sabrina Talpur ◽  
Saima Naz Shaikh
Keyword(s):  
Cesarean Section ◽  
Placenta Previa ◽  
Tertiary Care ◽  
University Hospital ◽  
Elective Cesarean Section ◽  
Care Hospital ◽  
Obstetric Hemorrhage ◽  
Emergency Cesarean ◽  
Precise Diagnosis ◽  
Elective Cesarean

Objectives: To determine the maternal and fetal outcomes in patients presented with major degree of placenta previa at tertiary care Hospital. Study Design: Descriptive cases series study. Setting: Department of Gynaecology and Obstetrics of Liaquat University Hospital Hyderabad. Period: One year from March 2015 to February 2016. Subject and Methods: All patients with major degrees of placenta previa were included in study. Following delivery the examination of neonate was carried out thoroughly including congenital abnormalities, weight of baby and Apgar score. Babies and mothers were examined within postoperative wards till stitches removal and systematically examined for any postoperative complication. All the data was entered in the proforma. Results: Total 50 patients with major degrees of placenta previa were selected. Majority of the women 40% belonged to the age group of 30-35 years. Most of the women 92.0%, were symptomatic and presented with painless vaginal bleeding. Elective cesarean section was performed among 20% patients while 80% patients underwent emergency cesarean section. 70% patients delivered preterm and 30% delivered at term. 3(6%) fetals were still births and 1(2.0%) presented macerated still birth. 16% fetuses developed respiratory distress syndrome, 6% had intrauterine growth restriction and only one had congenital abnormality (spina bifida). Neonatal weight less than 2500-grams was among 90%. Perinatal mortality was 6(12.0%), and according to maternal outcome, mortality rate was low i.e. just 1 subjects passed away. Conclusion: Major degree of placenta previais a significant contributor of obstetric hemorrhage in 02nd and 03rd trimesterof pregnancy as well as it adversely correlates with feto-maternal outcomes. Instant moving the case of obstetric hemorrhage to hospitals, precise diagnosis, sufficient transfusion provision, intervention without delay can reduce the fetomaternal morbidity and mortality.

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