First-trimester abortion complicated with placenta accreta: A systematic review

Wang, Yeou-Lih; Weng, Shih-Shien; Huang, Wen‐Chen

doi:10.1016/j.tjog.2018.11.032

Cited by 23 publications

(33 citation statements)

References 25 publications

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“…The early diagnosis of accreta is crucial for a patient to be given the option to continue with their pregnancy, but, typically, patients choose hysterectomy or to terminate the pregnancy with a high chance of uterine preservation. Most of the literature describes a clinical diagnosis of placenta accreta during or after suction dilatation and curettage due to first-trimester miscarriage [7]. In most cases, the procedure was complicated with profuse bleeding, and most end up with emergency hysterectomy [7].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the literature describes a clinical diagnosis of placenta accreta during or after suction dilatation and curettage due to first-trimester miscarriage [7]. In most cases, the procedure was complicated with profuse bleeding, and most end up with emergency hysterectomy [7].…”

Section: Discussionmentioning

confidence: 99%

“…Most diagnoses are made during the second and third trimesters of pregnancy [5]. A firsttrimester diagnosis of PAS is considered rare and challenging [6,7]. The classical signs or clinical diagnosis of placenta accreta such as demonstration of placental lacunae, loss of the clear zone, bladder wall interruption, and uterovesical hypervascularity can be identified via ultrasound starting at 11-14 weeks of pregnancy [8].…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2021

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“…Although early diagnosis of PAS is desirable to avoid associated adverse outcome [8][9][10][11][12][13][14][15] , it is challenging, and the diagnosis is often missed even in high-risk populations 16 . Among women with anterior placenta previa and previous CS, 1 in 3 is at risk of PAS 17 .…”

Section: Introductionmentioning

confidence: 99%

Lower uterine segment scar assessment at 11–14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery

Bhatia

Palacio

Wright

et al. 2022

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?In pregnant women with previous Cesarean section, assessment of the lower uterine segment scar on transvaginal ultrasound at the time of first-trimester aneuploidy screening is accurate and feasible. This screening strategy can identify reliably women at high risk of subsequent development of placenta accreta spectrum disorder. What are the clinical implications of this work?Routine first-trimester assessment of the location of the lower uterine segment scar in women with prior Cesarean section may become part of early risk assessment for placenta accreta spectrum disorder. Implementation of such a scanning protocol should help plan optimal multidisciplinary management of high-risk pregnancies while reassuring the vast majority of women with previous Cesarean section.

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“…Pelvic artery embolization can be used in patients with acute hemorrhage during pregnancy, especially in those who present with placenta accrete and previa [ 3 , 4 ]. Because of vascular collaterals formation during pregnancy, the uterine artery alone might not be the only source of bleeding.…”

Section: Introductionmentioning

confidence: 99%

Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology

et al. 2022

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(1) Background: A quarter of maternal deaths are caused by post-partum hemorrhage; hence obstetric bleeding is a significant cause of morbidity and mortality among women. Pelvic artery embolization (PAE) represents a minimally invasive interventional procedure which plays an important role in conservative management of significant bleeding in Obstetrics and Gynecology. The aim of this study was to evaluate the effect and the complications of PAE in patients with significant vaginal bleeding with different obstetrical and gynecological pathologies. (2) Methods: We conducted an observational, retrospective study on 1135 patients who presented to the University Emergency Hospital of Bucharest with vaginal bleeding of various etiology treated with endovascular therapy. All the patients included in the study presented vaginal hemorrhage that was caused by: uterine leiomyomas, genital tract malignancies, ectopic pregnancy, arterio-venous mal-formations and other obstetrical causes. We excluded patients with uncontrolled high blood pressure, severe hepatic impairment, congestive heart failure, renal failure or ventricular arrhythmias. (3) Results: Bleeding was caused in 88.19% of cases by uterine leiomyomas (n = 1001), 7.84% (n = 89) by cervical cancer, 2.29% by ectopic pregnancy (n = 26), 1.23% by arteriovenous malformation (n = 14) and 0.52% by major hemorrhage of obstetrical causes. Endovascular procedures were used in all the cases. In patients with uterine leiomyomas, supra-selective uterine arteries embolization was used. In 97% (n = 1101) of patients, bleeding was stopped after the first attempt of PAE. 3% (n = 34) needed a second embolization. In 12 of 14 cases of AVM, PAE was successful, two other cases needed reintervention; (4) Conclusions: Endovascular procedures represent a major therapy method for both acute and chronic hemorrhage in Obstetrics and Gynecology. It can be used in post-partum or post-traumatic causes of vaginal bleeding, but also in patients with chronic hemorrhage from uterine leiomyomas or inoperable genital malignancies or even as a preoperative adjuvant in cases of voluminous uterine fibroids or invasive malignant tumors, aiming to reduce intraoperative hemorrhage.

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First-trimester abortion complicated with placenta accreta: A systematic review

Cited by 23 publications

References 25 publications

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

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

Lower uterine segment scar assessment at 11–14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery

Our Experience in Using the Endovascular Therapy in the Management of Hemorrhages in Obstetrics and Gynecology

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