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.

scholarly journals A Case Report of Placenta Percreta

2021 ◽  
Vol 5 (4) ◽  
pp. 139-145
Author(s):  
Widiana Ferriastuti ◽  
Dwi P. R. Tampubolon ◽  
Qonita Qonita
Keyword(s):  
Case Report ◽  
Cesarean Delivery ◽  
Physiological Condition ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Abdominal Ultrasound ◽  
Placenta Percreta ◽  
Total Weight ◽  
Clot Retention ◽  
Placental Invasion

There has been an increased incidence of placenta accreta in recent decades, which is associated with an increase in cesarean delivery. A woman aged 39 years GIVP1111 at 8 months of gestation was a breech location with antepartum bleeding et. causa placenta previa totalis suspected percreta bladder infiltration and hematuria. The last abdominal ultrasound showed no visible clot retention and mild right-sided hydronephrosis (possibly a physiological condition). Due to doubts regarding the suspicion of placental invasion of the bladder, an MRI examination of the abdomen was performed. A network was irregular in shape and can not be oriented either right or left, some of which have been split. Attached to the placenta. It was not clear that the cervix and bladder were visible, the total weight was 500 grams, the size was 15x13x5 cm. Based on both macroscopic and microscopic histopathological examinations, it could be concluded that the uterus, adnexa, surgery: placenta percreta, adenomyosis uteri. Keywords: placenta percreta; uterus; antepartum bleeding

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 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 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  

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.

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)

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.

scholarly journals Management of placenta percreta. A case report

2020 ◽  
pp. 01-04
Author(s):  
DIOUF A ◽  
Thiam O ◽  
Ndour K ◽  
Gueye M ◽  
Ndiaye MD ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Multiple Organ ◽  
Placenta Percreta ◽  
High Parity ◽  
Surgical Wounds ◽  
History Of ◽  
Uterine Curettage ◽  
High Risk Situation ◽  
Previous Cesarean

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.

scholarly journals A Case Report and Literature Review of Midtrimester Termination of Pregnancy Complicated by Placenta Previa and Placenta Accreta

2014 ◽  
Vol 05 (01) ◽  
pp. e006-e011 ◽  
Author(s):  
Satoko Matsuzaki ◽  
Yutaka Ueda ◽  
Yusuke Tanaka ◽  
Mamoru Kakuda ◽  
Takeshi Kanagawa ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Termination Of Pregnancy

scholarly journals Management Placenta Percreta Succesfully With Total Abdominal Hysterectomy. A Case Review :

2019 ◽  
Vol 5 (1) ◽  
pp. 52
Author(s):  
Rajuddin Rajuddin ◽  
Roziana Roziana ◽  
Munawar Munawar ◽  
Muhammad Iqbal
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Cesarean Section ◽  
Antenatal Care ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Placenta Percreta ◽  
Risk Of Bleeding ◽  
Placenta Accreta Spectrum

Background: Placenta accreta spectrum is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. The management of placenta accrete spectrum will be discussed here and is essentially the same. The following discussion of management of placenta accreta spectrum applies to all depths of placental invasion. Incidence: In 1950 placentaaccreta was rare, occurring 1 in 30.000 deliveries in the United States. Duringbetween 2008 and 2011 in a cohort of over 115.000 deliveries in 25 hospitals in the United States reaching 1 in 731 deliveries. The marked increase has been attributed to the increasing prevalence of cesarean delivery in recent decades.The incidence of placenta accreta spectrum will also increase due to increasing of caesarean section rate. Case: Mrs.44 yo, G3P2 36-37weekslive, previous cesarean section 2 time,placenta previa totalis, placenta percreta. She’s comes with a chief complaint of lower abdominal cramps, patients regularly antenatal care at obstetrician. Ultrasound finding, a single fetus lives at transvers lie, dorso superior, corresponding to 36-37 weeks, placenta previa, placenta percreta (PAI:83%). This patient planned for elective conservative surgery management, due to cesarean section and or cesarean hysterectomy. Discussion:Surgical conservative management giving birth a baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion. The discovery of placenta accreta spectrum earlier when antenatal care, better birth planning than multidisciplinary science includedfetomaternal, gyneco-oncologist, anesthesiologist, thorac& cardiovascular surgeon, radiology intervention, intensivist - obstetric intensive care, urologist and neonatology can determine the success of handling cases of placenta accreta spectrum so as to reduce maternal, fetal morbidity and mortality. Conclusions:  The discovery of placenta accreta spectrum earlier when antenatal care, planning delivery is better than multidisciplinary science. Management with corporal incisions away from placental implantation, giving birth baby without a placenta, followed by a hysterectomy, has been shown to reduce the risk of bleeding and the need for blood transfusion.

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