scholarly journals Uterine Incision at the Fundus,Transitory Devascularisation, and Myometrial Resection for Uterine Preservation in Anterior Accretism: A Case Report

2021 ◽  
pp. 54-59
Author(s):  
Rayra Amana Macêdo Maciel ◽  
Caio Ribeiro Vieira Leal ◽  
Bárbara Flecha D’Abreu ◽  
Mário Dias Corrêa Júnior ◽  
Admário Silva Santos Filho
Keyword(s):  
Case Report ◽  
Placenta Accreta ◽  
Elective Caesarean Section ◽  
Placental Tissue ◽  
Individual Characteristics ◽  
Placenta Increta ◽  
Uterine Preservation ◽  
Uterine Incision ◽  
Placenta Accreta Spectrum ◽  
The Individual

Placenta accreta spectrum is a serious obstetric condition related to abnormal adherence of placental tissue to the myometrium and high maternal and fetal morbidity. In order to achieve the best outcome, the management of this condition must be carried out by an experienced multidisciplinary team and the individual characteristics of the patient must be taken into consideration, such as comorbidities and desire for reproductive preservation. This case report presents the conservative surgical management of placenta accreta spectrum in a 23-year-old patient who underwent an elective caesarean section with uterine preservation because of anterior placenta increta. The authors performed a transverse uterine incision at the fundus with transitory uterine devascularisation of the lower uterine segment with partial myometrial removal. This technique was successful for controlling the haemorrhage and preserving the uterus, with no complications.

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.

scholarly journals Metabolic profiling of placental tissue and maternal plasma to identify biomarkers of placenta accreta spectrum

2022 ◽  
Vol 226 (1) ◽  
pp. S14-S15
Author(s):  
Sarah E. Miller ◽  
Kevin Contrepois ◽  
Basil Michael ◽  
Giovanna Cruz ◽  
Ian Simms ◽  
...  
Keyword(s):  
Metabolic Profiling ◽  
Placenta Accreta ◽  
Placental Tissue ◽  
Maternal Plasma ◽  
Placenta Accreta Spectrum

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.

scholarly journals “You only live twice”: multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
David Atallah ◽  
Hicham Abou Zeid ◽  
Malak Moubarak ◽  
Maya Moussa ◽  
Nadine Nassif ◽  
...  
Keyword(s):  
Case Report ◽  
Placenta Accreta ◽  
Multidisciplinary Management ◽  
Placenta Accreta Spectrum

Surgery for Uterine Preservation in Placenta Accreta Spectrum: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Yi-Lei Li ◽  
Tao Li ◽  
Wen Peng ◽  
Xiang-Bin Liu ◽  
Hong-Mei Wang
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Psychological Trauma ◽  
Uterine Preservation ◽  
Cesarean Scar ◽  
Estimated Blood Loss ◽  
Placenta Accreta Spectrum ◽  
Placental Invasion ◽  
Cervical Involvement ◽  
Surgery Duration

Abstract Background: Owing to high risks of maternal morbidity, surgical complications, and loss of fertility, including psychological trauma caused by cesarean hysterectomy, innovative approaches for uterine preservation have been investigated. This study aimed to determine the efficacy of a novel eight-step surgical protocol for uterine preservation in placenta accreta spectrum (PAS) overlying the previous cesarean scar.Methods: We retrospectively studied consecutive patients with PAS overlying the cesarean scar, who were treated between December 2015 and October 2019 using the protocol. The depth and extension of placental invasion and severity of pelvic adhesion were assessed intraoperatively. Information regarding the gestational week at surgery, surgery duration, estimated blood loss (EBL), bladder injury, and post-procedural recovery was retrieved from the hospital database. Multiple linear regression was used to analyze factors influencing surgical blood loss. EBL was compared between the perioperative aortic balloon and non-balloon groups in severe cases using t-tests.Results: Overall, 115 patients with PAS were included. The mean EBL and surgery duration were 1666.1±1379.0 mL and 2.2±0.8 h, respectively. The uterus was successfully preserved in all patients with one surgery. Incidences of placenta accreta, increta, and percreta were 40 (35.8%), 46 (40.0%), and 29 (25.2%) cases, respectively. Extensive placental invasion and cervical involvement were observed in 41.7% and 28.7% of patients, respectively. EBL was significantly correlated with the extent of placental invasion, cervical involvement, and pelvic adhesion. No difference was seen in EBL between the balloon and non-balloon groups among the 44 patients with severe PAS.Conclusion: The eight-step protocol is effective for uterine preservation in PAS overlying the cesarean scar. EBL is affected by the extent of placental invasion, cervical involvement, and severity of pelvic adhesion. Perioperative aortic balloon should be used conservatively.

scholarly journals Maternal and fetal outcome in placenta accreta spectrum (PAS) associated with placenta previa: a retrospective analysis from a tertiary center

2021 ◽  
Vol 14 (3) ◽  
pp. 367-375
Author(s):  
◽  
◽  
◽  
Valentin Nicolae Varlas ◽  
Roxana Georgiana Bors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Delivery ◽  
Conservative Management ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Maternal Blood ◽  
Uterine Preservation ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
The Mean

Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.

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