Morbidity associated with nonemergent hysterectomy for placenta accreta

Predicting factors for emergency peripartum hysterectomy in women with placenta previa

“…In particular, women may strongly beneWt from a multidisciplinary team consisting of obstetricians, gynecologic surgeons, anaesthesiologists, urologists, vascular surgeons and interventional radiologists. Before beginning the procedure, multiple units of red blood cells, fresh frozen plasma and platelets should be made available and women should undergo a preoperative cystoscopy with the placement of ureteric stents to prevent urinary tract injury [1,12,13,16,17]. The possibility to identify women at substantial increased risk of hysterectomy also consents to plan alternative management strategies such as, for instance, preliminary uterine artery embolization [16,17].…”

Placenta accreta treated with planned caesarean hysterectomy

“…The most methodologically sound studies have only recently been published. 3,4,15,16 One of the most interesting is the study of Eller et al, who found, in a series of 76 cases of cesarean hysterectomy for placenta accreta a 42.1% transfusion rate (≥ 4 red blood cells), 28.9% cystotomy rate, ureteral injury in 6.6% of the women, while infectious complications occurred in 33.3% and in all major morbidity among 59% of the women. In spite of some methodological flaws 17 , it appears that maternal morbidity is significantly reduced when no attempt is performed to remove the placenta.…”

Hemorragia obstétrica masiva en una paciente con placenta pércreta

“…Por ello, la American College of Obstetricians and Gynecologists recomienda una planificación adecuada de las pacientes diagnosticadas o de alto riesgo, para reducir la morbilidad: centro especializado, equipo quirúrgico y anestesiológico experimentado, unidad neonatológica, banco de sangre capacitado, equipo de radiología intervencionista, identificación de los casos de mayor gravedad y el planteamiento de posibles medidas profilácticas como la implantación de catetéteres con balón en las arterias hipogástricas o catéteres ureterales 9 . La ultrasonografía es fundamental para el diagnóstico, a partir de la semana 18-20 de gestación, ya que identifica del 50 al 80% de los casos.…”