Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Background: Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case: Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions: REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.

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Predicting Value of Different Ultrasound Markers for Diagnosing Morbidly Adherent Placenta and Associated Complications

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2020.27 ◽

2019 ◽

Vol 8 (2) ◽

pp. 169-173

Author(s):

Mojgan Barati ◽

Mahvash Zargar ◽

Mahin Najafian ◽

Najmie Saadati ◽

Maryam Rekabizadeh

Keyword(s):

Cesarean Section ◽

Pregnant Women ◽

Previous History ◽

Bladder Rupture ◽

Predictive Values ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

History Of ◽

Sensitivity Specificity ◽

Previous Cesarean

Objectives: This study was conducted to evaluate the importance of different sonographic findings in the detection of the morbidly adherent placenta (MAP) among pregnant women and then to assess the correlation between delivery complications and ultrasonographic findings. Materials and Methods: This analytical and prospective study was conducted on 150 pregnant women with a previous history of a cesarean section from 2015 to 2017. The sonographic findings included the location of the placenta, retroplacental aliasing, bulging toward the bladder, lacuna, and the lack of sonolucent area behind the placenta. Finally, these patients were followed until delivery and their complications were assessed as well. Results: Of 150 previous cesarean sectioned patients, 101 (67.3%) cases had not sonographic findings of MAP. No morbidity was found in those with no sonographic findings of MAP. Fifty-nine pregnant mothers had the sonographic criteria of MAP prior to delivery, of whom 39 (80%) patients had MAP during the cesarean section. In 39 patients with confirmed MAP, 27 cases underwent a hysterectomy and 12 received special procedures for uterus reservation. In addition, 8 cases had bladder rupture, 25 cases experienced ICU hospitalization, and 33 cases needed a blood transfusion. Of these 39 confirmed MAP, 31 (79.48%) and 8 patients (20.51%) had previa and an anterior placenta without previa, respectively. Finally, no mortality was reported in the current study. Conclusions: In general, the most important sonographic factors on predicting MAP were the location of placenta, the aliasing and bulging while lacuna and the lack of sonolucent area had less value. The results demonstrated 93%, 100%, 90%, 79.59%, and 100% accuracy, sensitivity, specificity, as well as positive and negative predictive values for the prediction of MAP by ultrasonography, respectively.

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Diagnosis of Placenta Percreta after Cesarean Delivery

Acta Chirurgica Latviensis ◽

10.1515/chilat-2016-0015 ◽

2016 ◽

Vol 16 (1) ◽

pp. 37-38

Author(s):

Elizabete Pumpure ◽

Zane Grabe ◽

Maira Jansone ◽

Dace Rezeberga

Keyword(s):

Urinary Bladder ◽

Cesarean Section ◽

Ultrasound Examination ◽

Placenta Percreta ◽

Elective Cesarean Section ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Elective Cesarean ◽

Emergency Hysterectomy ◽

Uterine Scar

Summary A 30-year-old woman presented for elective cesarean section due to the suspicion of placental growth into uterine scar on ultrasound examination. At the time of the delivery morbidly adherent placenta was not detected but massive postpartum hemorrhage occurred. Patient was discharged and 13 days later emergency hysterectomy and suturing of urinary bladder was performed as a consequence of placenta percreta.

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Retrospective review of maternal deaths and maternal near misses due to major obstetric haemorrhage at a tertiary care centre in India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193582 ◽

2019 ◽

Vol 8 (8) ◽

pp. 3431 ◽

Cited By ~ 1

Author(s):

Swati Agrawal ◽

Anuradha Singh ◽

Ratna Biswas ◽

Abha Singh

Keyword(s):

Cesarean Section ◽

Maternal Death ◽

Tertiary Care ◽

Near Miss ◽

Tertiary Care Centre ◽

Maternal Deaths ◽

Near Misses ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Obstetric Haemorrhage

Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital over a period of 12 months (April 2016-March 2017), of all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was 2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH.

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Increased rates of cesarean sections and large families: a potentially dangerous combination

Journal of Perinatal Medicine ◽

10.1515/jpm-2016-0242 ◽

2017 ◽

Vol 45 (5) ◽

Cited By ~ 3

Author(s):

Ahmed M. Saleh ◽

Joachim W. Dudenhausen ◽

Badreldeen Ahmed

Keyword(s):

Immune System ◽

Cesarean Section ◽

Cesarean Delivery ◽

World Health ◽

Safe Procedure ◽

Cesarean Sections ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

The World ◽

Large Families

AbstractRates of cesarean sections have been on the rise over the past three decades all over the world, despite the ideal rate of 10–15% that had been set by the World Health Organization (WHO) in 1985, in Fortaleza, Brazil. This epidemic increase in the rate of cesarean delivery is due to many factors which include, cesarean delivery on request, advanced maternal age at first pregnancy, decrease in number of patients who are willing to try vaginal birth after cesarean delivery, virtual disappearance of vaginal breech delivery, perceived increase in the weight of the fetus and increase in the number of women with chronic medical conditions such as Diabetes Mellitus and congenital heart disease in the reproductive age. There is no doubt that cesarean delivery is a safe procedure and it is getting safer and safer for many reasons. However, like all other surgical procedures it is not without risks both to the mother and the new born. There is a substantial increase in the incidence of morbidly adherent placenta and the risk of scar pregnancy. In the Middle East and many African and Asian countries women tend to have large families. The number of previous cesarean section deliveries is directly proportional to the risk of developing morbidly adherent placenta. Morbidly adherent placenta is the most common cause of emergency postpartum hysterectomy, which is often associated with multiple surgical complications, severe maternal morbidity and mortality. The increased rates of cesarean sections lead to increased rates of scar pregnancies, which can have lethal consequences. Cesarean delivery has a negative impact on the infant immune system. This effect on the infant led to the introduction of a new concept called “Vaginal seeding”. This refers to the practice of transferring some maternal vaginal fluid to the infant born via cesarean section in an effort to enhance its immune system.

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