Comparison between emergent and elective delivery in women with placenta accreta

Pri-Paz, Shai; Fuchs, Karin; Gaddipati, Sreedhar; Lu, Yu-Shiang; Wright, Jason D.; Devine, Philip E.

doi:10.3109/14767058.2013.766711

Cited by 28 publications

(20 citation statements)

References 23 publications

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“…Interestingly, the 2010 decision analysis showed that when a low rate of emergency hemorrhage was assumed (2–8%), the preferred timing strategy would be a 37‐week delivery . Other tertiary centers have shown similarly low rates of morbidity with scheduled and unscheduled accreta deliveries, likely reflecting the ability of an individual institution to assemble a surgical team on short notice . We acknowledge that the low morbidity rates in these retrospective studies likely reflect patient selection, and we offer initial guidance for triaging suspected accreta patients at a tertiary medical center.…”

Section: Discussionmentioning

confidence: 91%

“…The ACOG and NICHD recommendations for previa‐accreta delivery at 34 or 35 weeks’ gestation arose from the assumption that maternal morbidity, including but not limited to massive hemorrhage and ICU admission, increases with GA . Here we describe a cohort of patients with previa and suspected accreta in which more than half were delivered at 36 weeks or later.…”

Section: Discussionmentioning

confidence: 99%

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Patient selection for later delivery timing with suspected previa‐accreta

Perlman

Little

Thomas

et al. 2017

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Patient selection for later delivery timing with suspected previa‐accreta

Perlman

Little

Thomas

et al. 2017

Acta Obstet Gynecol Scand

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“…The mean blood loss in a pregnancy complicated with PA is usually 2.5-3 liters. [16,17] The massive hemorrhage (≥5000 ml estimated blood loss) and massive transfusion (≥10 units erythrocyte transfusion) were observed more in PPA cases. [18] The presence of PP alone even in the patients not within placenta accreta spectrum is an independent factor increasing erythrocyte transfusion and hysterectomy risks.…”

Section: Discussionmentioning

confidence: 99%

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

Gezer¹,

Ture²,

Balcı³

et al. 2020

Perinatal J

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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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“…Interestingly, the 2010 decision analysis showed that when a low rate of emergency hemorrhage was assumed (2-8%), the preferred timing strategy would be a 37-week delivery (4). Other tertiary centers have shown similarly low rates of morbidity with scheduled and unscheduled accreta deliveries, likely reflecting the ability of an individual institution to assemble a surgical team on short notice (17,19). We acknowledge that the low morbidity rates in these retrospective studies likely reflect patient selection, and we offer initial guidance for triaging suspected accreta patients at a tertiary medical center.…”

Section: Discussionmentioning

confidence: 99%

Patient Selection for Later Delivery Timing With Suspected Previa-accreta

Perlman¹,

Little²,

Thomas³

et al. 2018

Obstetric Anesthesia Digest

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Purpose: We identified patients with previa and suspected accreta who are at lowest risk of unscheduled delivery or major morbidity with planned delivery beyond 34 weeks' gestation. Methods: This was a retrospective cohort study of patients who had reached 34.0 weeks' gestational age with a suspected previa-accreta. We evaluated rates of unscheduled and emergent delivery based on known risk factors for premature birth. In a second analysis, we stratified patients based on level of preoperative morbidity concern and evaluated rates of major transfusion and Intensive Care Unit admission by delivery week (34 weeks, 35 weeks or 36 weeks and beyond). Results: Of 84 available patients, we classified 31 patients as low risk for unscheduled delivery and 52 as high risk. The low risk group was scheduled later (36.6 vs. 36.0 weeks; p < 0.01), but demonstrated lower rates of unscheduled delivery prior to 36 weeks (3% vs. 19%, p = 0.05). Of the patients with no prior cesarean section, only one (7%) experienced massive blood loss even though 36% had unscheduled deliveries. We observed no significant increase in major transfusion or massive blood loss with advancing gestational age, likely due to selection of the most concerning patients for early, scheduled delivery. Conclusions: Patients with suspected previa-accreta and no risk factors for preterm birth are at low risk for an unscheduled delivery prior to 36 weeks. Those with no concern for percreta or increta or no prior cesarean section may also be candidates for later delivery.

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Comparison between emergent and elective delivery in women with placenta accreta

Cited by 28 publications

References 23 publications

Patient selection for later delivery timing with suspected previa‐accreta

Patient selection for later delivery timing with suspected previa‐accreta

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

Patient Selection for Later Delivery Timing With Suspected Previa-accreta

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