Case series of outcomes of a standardized surgical approach for placenta percreta for prevention of ureteral lesions

Atallah, David; Moubarak, Malak; Nassar, M.; Kassab, Bernard; Ghossain, M.; Kassis, Nadine El

doi:10.1002/ijgo.12402

Cited by 5 publications

(6 citation statements)

References 18 publications

(30 reference statements)

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“…Fetal cardiotocography revealed regular uterine contractions. She underwent urgent delivery by cesarean section and hysterectomy under general anesthesia according to our specially developed technique [1,2]. The placenta was previa, anteriorly located and slightly lateralized to the left and reached the uterine serosa without perforating it.…”

Section: Case Presentationmentioning

confidence: 99%

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

Atallah

Zeid

Moubarak

et al. 2020

BMC Pregnancy Childbirth

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Background: Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation: This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient's death. Conclusion: This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.

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Section: Case Presentationmentioning

confidence: 99%

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

Atallah

Zeid

Moubarak

et al. 2020

BMC Pregnancy Childbirth

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“…When performing such a procedure, the major concern is to prevent ureteral lesions in a pelvis with a distorted anatomy and to reduce blood loss. A recent study has demonstrated the effectiveness and safety of a well-standardized approach for managing all cases of placenta percreta and in all circumstances [23].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Subsequently, the surgeon will be able to position his index and middle fingers through both anterior and posterior incisions, to lift the uterus and to place the clamps alongside the cervix after making sure that ureters are at distance. In case of severe adherence or bladder invasion, a cystotomy or partial bladder resection might be needed [23,24], (Figures 3 and 4). Of note, this procedure should not be performed by any surgeon; only a surgeon with appropriate expertise in pelvic surgery should operate on these critical cases [25].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Otherwise, the operating surgeon will be compromising the safety of the patient. On a similar note, the absence of ureteral injuries is guaranteed when performing a cesarean hysterectomy according to the aforementioned steps [23]. To prevent the development of vesicovaginal fistulas, an omentoplasty is recommended after bladder reparation [23].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Another technique was described in the literature based on a posterior approach but was criticized for the ligature of the anterior division of the internal iliac artery with the concomitant risk of bladder devascularization [23,26]. Also, the fact of grasping a gravid cervix, as described in the latter technique, will lead to massive bleeding and is not always feasible in case of cervical effacement.…”

Section: Surgical Techniquementioning

confidence: 99%

See 2 more Smart Citations

Placental Malformation: Accreta and Beyond

Atallah¹,

Moubarak²,

Saliba³

et al. 2018

Placenta

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Abnormal placentation is a noncommon but life-threatening obstetric condition that requires a multidisciplinary approach. It is a spectrum of disorders that seems to parallel the increasing rate of cesarean sections. Imaging findings have a crucial role in detecting this abnormality early in the pregnancy and subsequently guiding and alerting the surgeon. Between accreta and percreta, the difference is huge; thus, they are managed with a different degree of radicality. The surgeon tends to treat more radically cases of placenta percreta with cesarean hysterectomy and needs to have special expertise in pelvic surgery, inter alia, and gynecologic oncology. While extrapolation does not find its way in every case of abnormally invasive placenta, a new inspired technique from gynecologic oncology surgeries and adapted to percreta cases seems to be applied safely and effectively in all circumstances of percreta. Conservative treatment is also an alternative but is limited to selected cases of placenta accreta.

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The Lebanese percreta group: A retrospective cohort study of both radical and conservative management outcomes of abnormally invasive placenta

Seoud,

Chahine,

Arab

et al. 2024

Intl J Gynecology & Obste

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ObjectiveThe aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon.MethodsWe conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death).ResultsThe study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively.ConclusionThrough their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed.

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Case series of outcomes of a standardized surgical approach for placenta percreta for prevention of ureteral lesions

Abstract: The surgical technique developed for placenta percreta was found to be effective (operative and postoperative outcomes) and safe (prevention of ureteral lesions).

Cited by 5 publications

References 18 publications

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

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

Placental Malformation: Accreta and Beyond

The Lebanese percreta group: A retrospective cohort study of both radical and conservative management outcomes of abnormally invasive placenta

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