Maternal Outcome After Conservative Treatment of Placenta Accreta

Sentilhes, Loïc; Ambroselli, Clémence; Kayem, Gilles; Provansal, Magali; Fernandez, H.; Perrotin, F.; Winer, Norbert; Pierre, Fabrice H.F.; Benachi, Alexandra; Dreyfus, Michel; Bauville, Estelle; Michelet, Dominique; Marpeau, L.; Descamps, Philippe; Goffinet, François; Bretelle, Florence

doi:10.1097/aog.0b013e3181d066d4

Cited by 430 publications

(364 citation statements)

References 26 publications

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“…The doses to be administered are not standardized [7,9,18] , and no studies have yet elucidated the risks or benefi ts of this treatment [18] . Dramatic complications, including maternal death, were reported after injecting MTX into the umbilical cord [20] . Among our four patients treated with MTX, two developed infectious complications, which might be attributable to the immunosuppressive action of MTX.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of massive hemorrhaging during forced delivery or hysterectomy without classical anatomical reference points is very high. Severe placenta percreta with invasion of adjacent organs or parametrium remains a very dangerous situation for patients, given its associated non-negligible morbidity and even mortality [17,20] . In such instances, delayed hysterectomy can be performed 4 -6 weeks after cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

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Individual decisions in placenta increta and percreta: a case series

Chantraine

Nisolle

Petit

et al. 2012

Jpme

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Objective: Placenta increta or percreta is an uncommon pathology, sometimes associated with high maternal morbidity. Its prevalence increases proportionally to the number of cesarean sections. This study analyzed the changes of our management strategy to devise treatment guidelines for this uncommon disorder. Materials and methodology: Between 2005 and 2011, 10 cases of placenta increta or percreta were managed at our university hospital maternity department. Results: Among the 10 cases, seven were diagnosed prenatally. Two patients were diagnosed early, at 14 and 17 weeks of gestational age, and their pregnancies were terminated. Five had hysterectomies during the intrapartum period, and despite attempted conservative treatment for the two others, hysterectomy proved necessary 2 months postpartum because of intrauterine infections. Seven of the 10 women had hysterectomies. Conclusion: Prenatal diagnosis of placenta increta or percreta is essential to plan the delivery in a competent tertiary care center. The decision to perform a cesarean hysterectomy or leave the placenta in situ for spontaneous delivery is based on the extent of infi ltration, the patient ' s hemodynamic status, and her desire to remain fertile. The high-risk of infection and severe hemorrhage must not be overlooked should conservative treatment be chosen. This situation requires prolonged close monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Individual decisions in placenta increta and percreta: a case series

Chantraine

Nisolle

Petit

et al. 2012

Jpme

View full text Add to dashboard Cite

show abstract

“…Sentilhes et al [5] studied 167 cases of placenta accreta treated conservatively at 40 hospitals which reported maternal morbidity rate of 6 % and one maternal death due to septic shock. The median time required for complete spontaneous resorption of placenta was 13.5 weeks (4-60 weeks).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of Uterus in a Primigravida at 26 weeks of Gestation with Placenta Previa and Percreta

Rr¹,

Vs²,

Sewlikar³

et al. 2016

J Obstet Gynecol India

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“…Plasentası uterusta bırakılan kadınlarda plasental rezorpsiyon ortalama 13.5 haftada olmuştur (4-60 hafta arası) [49]. Kanda hCG seviyelerinin tespit edilemez seviyede olması yerinde bırakılan plasental dokunun komplet rezorpsiyonunu garanti etmez.…”

Section: İntraoperatif Yaklaşımunclassified

Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

Çelen¹,

Kahyaoğlu²,

Mollamahmutoğlu³

et al. 2013

CMJ

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ÖzetÖnceki sezaryan doğumları takibeden gebeliklerde obstetrik riskler artmıştır. Anormal plasentasyon oluşumları olarak plasenta akreta ve sezaryan skar gebelikleri iki önemli klinik durumdur. Plasenta akreta; plasentanın uterin kaviteye desidua bazalisin yokluğu nedeni ile anormal bir şekilde yapışması ve fibrinoid tabakanın inkomplet gelişimi ile karakterize bir tanıdır. Plasenta previa ile komplike olan gebeliklerin %5-10'unda plasenta akreta olur. Plasental implantasyonun daha ciddi anormallikleri, koryonik villusların myometriyum içine kadar invaze olduğu plasenta inkreta ve koryonik villusların uterus serozasını penetre ettiği plasenta perkretadır. 1950'li yıllarda yaklaşık 30.000 doğumda bir görülen plasenta akretanın insidansı son yıllarda artan sezaryan ile doğumların prevelansındaki artışa paralel olarak 553 ile 2510 doğumda bir görülmeye başlamıştır. Plasenta akretanın en önemli risk faktörü önceki geçirilmiş uterus cerrahisidir. Alt uterin segmentin skarlı alanındaki ince, kötü oluşan veya olmayan desidua bazalis tabakasının trofoblastların derin penetrasyonuna direnç gösterememez ve plasenta önceki uterin cerrahiye bağlı olarak travmatize olan uterusun patolojik bir bölgesini invaze eder. Anormal plasental implantasyon doğumu takiben plasentanın normal ayrılmasına engel olur. Plasenta akretanın ilk klinik bulgusu manuel plasenta ayrılması girişimi sırasında meydana gelen aşırı ve hayatı tehdit eden kanamadır. Plasenta akretaya renkli dopler modalitelerini de içeren prenatal ultrason muayenesindeki karakteristik bulguların varlığı ile tanı konur. Şüpheli vakalarda manyetik rezonans görüntüleme yararlı olur. Masif kanama ve bunun sonucunda gelişebilen dissemine intravasküler koagülasyon, erişkin respiratuar distres sendromu, böbrek yetmezliği, planlanmamış cerrahi ve ölüm plasenta akretanın en ciddi komplikasyonlarıdır. Plasenta akretanın preoperatif ve intraoperatif yönetim stratejileri bu derlemede detaylı olarak ele alınmıştır. Anahtar sözcükler: Plasenta akreta, yönetim, klinik yaklaşım, tedavi stratejileri AbstractObstetric risks have increased among pregnancies following previous cesarean section deliveries. Placenta accreta and cesarean scar pregnancies, as abnormal placentation entities, represent two important clinical manifestations. Placenta accreta is characterised with a placenta that is abnormally adherent to uterine cavity because of the absence of decidua basalis and presence of incompletely developed fibrinoid layer. Placenta accreta occurs in 5-10% of pregnancies complicated with placenta previa. Placenta increta and percreta are the other serious abnormalities of placental implantation that demonstrates invasion of chorionic villi into the myometrium and uterine serosa respectively. Placenta accreta has been seen rarely as 1 in 30.000 births in 1950's but the incidence of placenta accreta has increased recently to 1 in 553 and 2510 deliveries in parallel with increased cesarean sectio deliveries. Previous uterine surgery is the most important risk factor for placenta accreta. Thin,...

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Maternal Outcome After Conservative Treatment of Placenta Accreta

Abstract: Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.

Cited by 430 publications

References 26 publications

Individual decisions in placenta increta and percreta: a case series

Individual decisions in placenta increta and percreta: a case series

Spontaneous Rupture of Uterus in a Primigravida at 26 weeks of Gestation with Placenta Previa and Percreta

Plasenta yapışma anomalileri: Klinik yaklaşım ve yönetim

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