Management of placenta percreta. A case report

The placenta accreta designates an abnormality of the placental insertion characterized, on the anatomopathological level, by an absence of deciduous deciduous between the placenta and the myometrium. This insertion anomaly may interest all or only part of the placenta. We distinguish within this terminology the terms of - placenta accreta when the placenta is simply attached to the Myometrium. - placenta increta when the placenta invades the myometrium. - placenta percreta when the placenta enters the serosa uterine, or even the neighboring organs (bladder, peritoneum, etc.) [1]. Placentas accretas are a high-risk situation for severe postpartum hemorrhage and its inherent complications such as disseminated intravascular coagulation, hemostasis hysterectomy, surgical wounds to the ureters, bladder, multiple organ failure, or even maternal death, particularly in the case of placenta percreta [2,3]. Risk factors for placenta percreta include a history of cesarean, uterine curettage or manual removal of placenta, presence of placenta previa, endometriosis, high parity and advanced maternal age [4]. We report the case of a 30-year-old woman, IIGIIP, who had a previous cesarean section during her first pregnancy and who had a placenta percreta and who underwent hysterectomy without cystectomy and without ligation of the hypogastric arteries.

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PLACENTA ACCRETA IN PLACENTA PREVIA

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.05.2493 ◽

2018 ◽

Vol 21 (05) ◽

pp. 892-896

Author(s):

Farzana Majid ◽

Robina Ali ◽

Shazia Shaheen

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Cross Sectional Study ◽

Sectional Study ◽

Inclusion Criteria ◽

Cross Sectional ◽

History Of ◽

Scarred Uterus ◽

Demographic Features ◽

Previous Cesarean

Objective: To calculate the frequency of placenta accreta in placenta previawith or without scarred uterus and compare clinico demographic features of cases with orwithout placenta accreta. Study Design: Cross sectional study. Place and Duration of Study:Department of Obst & Gynae Allied Hospital, Faisalabad from 1st June 2007 to 31st May 2008.Methodology: 200 patients of placenta previa, 100 with history of previous cesarean sectionand 100 without history of previous C-section fulfilling inclusion criteria were taken. They wereevaluated by history, examination and ultrasound noting placental location and type. Placentaaccreta was diagnosed during delivery. Results: Out of 200 patients, frequency of placentaaccreta was significantly increased with history of previous C-section. It was 20% in patientswith previous C-sections and 6% in patients without previous C-sections. Conclusions: Ourdata suggests that frequency of placenta accreta is greater in patients with previous C-sectionand its frequency increases with increasing number of C-sections especially with anterior andcentral placenta previa.

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Prior Cesarean Delivery Healthcare Facilities Variations in Pregnancy Outcomes of Placenta Accreta Spectrum with Placenta Previa: A retrospective study from a tertiary transferal center (Preprint)

10.2196/preprints.28694 ◽

2021 ◽

Author(s):

Xuan Gao ◽

Shaoshuai Wang ◽

Lijie Wei ◽

Peng Gao ◽

Jiaqi Li ◽

...

Keyword(s):

Cesarean Delivery ◽

Placenta Accreta ◽

Placenta Previa ◽

Placenta Percreta ◽

County Level ◽

Healthcare Facilities ◽

Placenta Accreta Spectrum ◽

Province Level ◽

Rural Township ◽

Previous Cesarean

BACKGROUND The prevalence of Placenta Accreta Spectrum(PAS) is increasing rapidly linked with the cesarean rate increase worldwide, creating a threatening condition from severe postpartum hemorrhage to various maternal morbidities. The socio-economic imbalance, geographical, qualification, and specialty variations of the previous cesarean delivery healthcare facilities resulted in assessment and management difficulties. OBJECTIVE To assess variations of prior cesarean delivery healthcare facilities on pregnancy outcomes on current PAS with Placenta Previa. METHODS This retrospective study was conducted in a tertiary referral center from Nov.2015 to Nov.2020 in central China. Healthcare facilities were classified by geographical, hospital grading, ownership, and specialty variations. The primary outcome was postpartum hemorrhage(PPH), secondary outcomes included Placenta Percreta and maternal-fetal morbidities. RESULTS In total, 252 patients were enrolled, 58(23%) patients had Placenta Accreta, 131(52%) had Placenta Increta and 63(25%) had Placenta Percreta. The overall incidence of PPH was 47.2%(119 out of 252). As the administrative geographical level becoming smaller and more distant, PPH incidence climbed up: province-level(10, 32.3%), prefecture-level(65, 48.5%), county-level(30, 42.3%), and rural township(14, 82.5%), P for trend= 0.019. The odds of PPH in rural township clinics was 5.84(P=0.03, 95%CI 1.18~28.77) compared to the province-level hospitals. Similarly, when hospital grades declined, PPH incidence raised: tertiary(26, 39.4%), secondary(28, 43.8%), primary(14, 38.9%) and unclassified(51, 59.3%), P for trend= 0.047. Unclassified hospitals had 2.16(P= 0.046, 95%CI 1.02~4.61) times odds of PPH compared to tertiary medical centers. PPH showed no statistical significance based on ownership or specialty variations. Also, Placenta Percreta increased when geographical location shifted from urban to rural: three (9.7%) from province-level, 34(25.6%) from prefecture-level, 18(25.4%) from county-level and eight(47.1%) from rural township clinics, P= 0.04, P for trend =0.018. Patients with previous rural township clinics cesarean delivery had a 7.49 times risk((P=0.011, 95%CI 1.59~35.19) of developing Placenta Percreta compared with province-level hospitals. CONCLUSIONS Healthcare facilities variations of the previous cesarean delivery have upcoming impacts on subsequent pregnancy. The tendency of experiencing adverse maternal outcomes is more significant with prior cesarean in the rural township clinics and unclassified hospitals. The findings call for physicians’ alertness, persistent efforts in urban-rural disparity reduction, and measures to achieve equitable management.

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A Planned Cesarean Section-Hysterectomy For Placenta Previa Totalis Percreta In Patient With History Of Two Cesarean Sections

Medicinus ◽

10.19166/med.v5i1.1176 ◽

2018 ◽

Vol 5 (1) ◽

Author(s):

Julita Nainggolan

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Health Resources ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Cesarean Sections ◽

History Of ◽

Rising Incidence ◽

Previous Cesarean

The presence of placenta previa may be associated with placenta accreta[1]. Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase[2]. Here, we present a case of placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.Keywords: Cesarean Section-Hysterectomy, placenta accreta, placenta percreta, placenta previa

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Placenta praevia: percreta and accreta, our experience

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200512 ◽

2020 ◽

Vol 9 (3) ◽

pp. 928

Author(s):

Preeti F. Lewis ◽

Shreya Chinchoriya

Keyword(s):

Risk Factors ◽

Placenta Accreta ◽

Placenta Previa ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

History Of ◽

Previous Cesarean

Background: morbidly adherent placenta has an increasing incidence over decades. The purpose of this study is to identify risk factors and etiology of placenta previa- accreta and percreta.Methods: A cross sectional observational study of patients with morbidly adherent placenta previa including placenta accreta and placenta percreta were studied over a period of three years from June 2017 to June 2019 in a tertiary care centre, Mumbai.Results: Cases showed a higher incidence in patients with previous cesarean delivery (CS), grandmultiparity, abortions without the history of check curettage and anterior/central placentae.Conclusions: History of uterine surgeries and previous cesarean are some important risk factors for accreta in placenta previa patients.

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The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

Perinatal Journal ◽

10.2399/prn.20.0283006 ◽

2020 ◽

Vol 28 (3) ◽

pp. 176-182

Author(s):

Şener Gezer ◽

Mehmet Zeki Türe ◽

Sibel Balcı ◽

İzzet Yücesoy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Maternal Morbidity ◽

Blood Product ◽

Placenta Accreta ◽

Placenta Previa ◽

Previous Cesarean Section ◽

Short Term ◽

History Of ◽

Previous Cesarean

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone.

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A Planned Cesarean Section-Hysterectomy for Placenta Previa Totalis Percreta in Patient with History of Two Cesarean Sections

Medicinus ◽

10.19166/med.v7i1.1442 ◽

2019 ◽

Vol 7 (1) ◽

pp. 13

Author(s):

Julita Nainggolan

Keyword(s):

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Health Resources ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Cesarean Sections ◽

History Of ◽

Rising Incidence ◽

Previous Cesarean

The presence of placenta previa may be associated with placenta accreta[1]. Maternal and fetal morbidity and mortality from placenta previa accreta are considerable and are associated with high demands on health resources. With the rising incidence of caesarean sections combined with increasing maternal age, the number of cases of placenta praevia and its complications, including placenta accreta, will continue to increase[2]. Here, we present a case of placenta previa totalis percreta in previous cesarean section twice. In this case, patient with placenta previa totalis-percreta we diagnosed and prepared proper management with the involvement of multidisciplinary team. We reduced blood loss by performing total abdominal hysterectomy immediately after delivered the baby and the postoperative course was uneventful.

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Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

10.21203/rs.3.rs-122477/v1 ◽

2020 ◽

Author(s):

Yingyu Liang ◽

lizi Zhang ◽

Shilei Bi ◽

Jingsi Chen ◽

Shanshan Zeng ◽

...

Keyword(s):

Risk Factors ◽

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Cesarean Sections ◽

Han Ethnicity ◽

Parity Number ◽

History Of ◽

Independent Risk Factors ◽

Previous Cesarean

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta.Methods: This retrospective study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in 7 provinces of China between January 2017 and December 2017. According to the intraoperative findings or the pathologic diagnosis after delivery, the study population was divided into placenta accreta (PA) and non-PA groups. We compared the pregnancy outcomes between the 2 groups, used multivariate logistic regression to analyze the risk factors for placental accreta, and used receiver operating characteristic curves to evaluate the value of the risk factors.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage, severe postpartum hemorrhage, diffuse intravascular coagulation, puerperal infection, intraoperative bladder injury, hysterectomy, and blood transfusion was significantly increased in the placenta accreta group (P<0.05)). At the same time, the rate of neonatal low-birth weight, the probability of neonatal comorbidities, and the rate of neonatal intensive care unit admission also increased significantly (P<0.05). Weight, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membrane, previous cesarean-section transverse incisions, history of placenta previa, and the combination of prenatal hemorrhage and placenta previa were all independent risk factors for placenta accreta; while non-Han ethnicity was an independent protective factor for placenta accreta (P<0.05). The area under the ROC curve (AUC) was 0.93 (95% CI=0.92-0.94); and the specificity, sensitivity, and accuracy rate were 0.87, 0.93, and 0.93, respectively.Conclusions: There was an increased risk of adverse outcomes in pregnancies complicated by placenta accreta in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, Han ethnicity, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with placenta accreta in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placental accreta in pregnancies of women with a history of cesarean section.

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Placenta increta presenting with threatened miscarriage during the first trimester in rhesus-negative mother: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03030-x ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Nik Lah Nik-Ahmad-Zuky ◽

Azmel Seoparjoo ◽

Engku Ismail Engku Husna

Keyword(s):

Placenta Accreta ◽

Histopathological Examination ◽

Placenta Previa ◽

Major Complication ◽

First Trimester ◽

Management Plan ◽

Placenta Increta ◽

Threatened Miscarriage ◽

History Of ◽

Previous Cesarean

Abstract Background Placenta accreta is known to be associated with significant maternal morbidity and mortality—primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon. Case presentation A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta. Conclusion A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.

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Anesthesia Management in Patient with Placenta Percreta Performed Intra-aortic Ballooning Caesarean Section

Solo Journal of Anesthesi, Pain and Critical Care (SOJA) ◽

10.20961/soja.v1i1.49481 ◽

2021 ◽

Vol 1 (1) ◽

pp. 16

Author(s):

RTh. Supraptomo ◽

Alma Hepa Allan

Keyword(s):

Caesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Placenta Percreta ◽

Anesthetic Technique ◽

Hemodynamic Changes ◽

Risk Of Bleeding ◽

History Of ◽

Operation Duration ◽

Placenta Accreta Spectrum

Placenta accreta spectrum is one of maternal mortality’s causes which is related with severe obstetric bleeding that requires hysterectomy. The incidence rate of the spectrum placenta increases with increasing caesarean section. Placenta accreta spectrum is also close-related to placenta previa. The aim of this study is to understand perioperative management in patient with placenta percreta performed with intra-aortic ballooning in caesarean section. We are following a case on a 36 year old female patient, multigravida at term pregnant with placenta percreta and history of caesarean section 5 and 2 years ago. The surgeries performed were caesarean section surgery as well as intra-aortic ballooning. Anesthetic technique used was general anesthesia. Operation duration approximately ± 180 minutes, bleeding 1500 cc. After the operation, the patient was admitted to the ICU. The patient going well and discharged from ICU to ward on the second day. After three days in ward, the patient discharged to home. Hemodynamic changes during balloon intra-aortic procedures are of particular concern to anesthetists. This is because the stopping of blood flow to the aorta in this case can cause an increase in blood vessel pressure, where the administration of nitroglycerin at low doses can reduce venous tone resulting in venous vasodilation which will maintain hemodynamic stability during the process of blocking blood vessels with a balloon. From the case we may conclude that anesthesia in pregnant women with placenta accreta spectrum should be carried out with caution and involve a multidisciplinary specialist given its high risk of bleeding. The intra-aortic balloon insertion technique can be an option used to reduce the risk of bleeding in patients with placenta accreta spectrum.

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Placenta Accreta Spectrum: A preventable nearly iatrogenic disorder.

10.32512/jmr.3.2.2020/24.25 ◽

2021 ◽

pp. 24-25

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Uterine Wall ◽

Subsequent Pregnancy ◽

Team Approach ◽

Fetal Life ◽

Risk Increase ◽

History Of ◽

Placenta Accreta Spectrum ◽

Threatening Situation

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. PAS disorder is a maternal and fetal life-threatening situation due to the high risk of intrapartum uncontrollable bleeding. The common described risk factors are the placenta previa and history of Caesarean section (CS) [1]. We herein report our experience with five patients referred to our department for suspected PAS. These patient were selected for targeted prepartum ultrasound assessment due to their history of multiple C-sections. PAS risk increase with the number of previous CS and could reach7% [2]. In Nicaragua , the rate of c-section in obstetrical practice is still high and approximating 40% in some centers. Uterine wall dehiscence result in locally defective decidualisation and abnormal placental adherence with important trophoblastic invasion in a subsequent pregnancy [3]. We still believe that this disorder is preventable if we “go back” a little to obstetrical good practices. Dramatic situations can be avoided by selecting suspected PAS on ultrasound or MRI to be referred. PAS is the commonest cause of intrapartum hysterectomy and must be managed always in specialized centers with multidisciplinary team approach.

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