Placenta accreta and anesthesia: A multidisciplinary approach

Khokhar, RS; Baaj, Jumana; Khan, M. Z.; Dammas, FA; Rashid, Nosheen

doi:10.4103/1658-354x.174913

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…Abnormal placentation is correlated with a more adverse outcome, the most disturbing being severe obstetric hemorrhage owing to the incomplete placental separation, which usually necessitates hysterectomy 26,27 . Recently, Wang et al published a retrospective study including 31 women with PAS disorder who underwent hysterectomy; of these, 7 were treated with UAE before hysterectomy was performed and 24 controls underwent cesarean hysterectomy alone.…”

Section: Discussionmentioning

confidence: 99%

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Mohr–Sasson

Hochman

Anteby

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The aim of this study is to compare immediate and long‐term obstetrical outcomes of patients who underwent cesarean delivery with and without uterine artery embolization (UAE) for the management of placenta accreta spectrum disorder. Material and methods A retrospective case control study including all pregnant women admitted to a single tertiary medical center between December 2001 and May 2018 with a diagnosis of placenta accreta spectrum disorder, who underwent cesarean delivery with and without UAE. Groups were compared for maternal characteristics, operative management, postoperative complication rate and long‐term outcomes. Follow up on future obstetrical outcomes was conducted via telephone questionnaire. Non‐parametric statistics were used. Results During the study period, 272 women met the inclusion criteria: 64 (23.53%) and 208 (76.47%) underwent preservative cesarean section with and without UAE, respectively. UAE procedure was associated with a longer operative time (82.5 [68‐110] vs 50.5 [39‐77] minutes; P = .001), and higher blood loss (2000 (1500‐3000) vs 1000 (600‐2000) mL; P = .001). Hysterectomy rate was comparable between the groups (9 [14%] vs 35 [16.82%]; P = .88); however, multivariate logistic regression analysis found UAE to be an independent factor associated with lower hysterectomy rate (P = .02). Postoperative complications were more frequent in the UAE group. Follow up was achieved in 29 (59.18%) and 72 (51.79%) of the women with and without UAE, respectively (P = .36). No differences were found in rate of abortions, pregnancy and deliveries between the groups. Conclusions Cesarean delivery using UAE in placenta accreta spectrum disorder is associated with a higher rate of operative and postoperative complications. Nevertheless, in cases of severe adherence of the placenta, embolization reduces the need for hysterectomy, allowing future fertility.

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Section: Discussionmentioning

confidence: 99%

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Mohr–Sasson

Hochman

Anteby

et al. 2020

Acta Obstet Gynecol Scand

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“…Our study group included women with high grade of placental invasiveness–increta, in which placental villi extend into the myometrium, and percreta, where the villi penetrate through the myometrium to the uterine serosa and may invade adjacent organs, such as the bladder [14]. Abnormal placentation is correlated to worse adverse outcome, the most disturbing is severe obstetric hemorrhage owing to the incomplete placental separation, which usually necessitates hysterectomy [15,16]. Prenatal diagnosis and adequate planning, particularly in high-risk populations, is indicated for the reduction of adverse outcomes [14, 17,18].…”

Section: Discussionmentioning

confidence: 99%

Ovarian reserve after uterine artery embolization in women with morbidly adherent placenta: A cohort study

et al. 2018

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ObjectiveTo evaluate ovarian reserve in women after preservative cesarean delivery using uterine artery embolization due to morbidly adherent placenta.Study designA historical cohort study including all women admitted to a single tertiary care center, with morbidly adherent placenta that had preservative cesarean delivery with bilateral uterine artery embolization. Inclusion criteria included gestational age >24 weeks, singleton pregnancy and placenta increta / percreta. Exclusion criteria included maternal age > 43 years old and cesarean hysterectomy. Control group included women attending the infertility clinic due to male factor or single women conceiving via sperm donation, matched by age. Blood samples were collected on day 2–5 of menstruations for hormonal profile and Anti Mullarian Hormone (AMH) levels. Primary outcome was ovarian reserve evaluated by the levels of AMH.Results59 women underwent preservative cesarean delivery using uterine artery embolization during the study period. 21 women met inclusion criteria (33.9%) and were matched controls (n = 40). Circulating levels of E2 and FSH did not differ significantly between the two groups (p = 0.665, p = 0.396, respectively). AMH was lower in the study group (median 0.8 IQR 0.44–1.80) compared to the controls (median 2.08 IQR 1.68–3.71) (p = 0.001). This finding was consistent in linear multivariate regression analysis where the group of cesarean delivery using bilateral artery embolization due to placenta accrete was significantly predictive for the levels of AMH (B = -1.308, p = 0.012).ConclusionWomen post preservative cesarean delivery using uterine artery embolization due to placenta accrete have lower ovarian reserve compare to controls matched by age.

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“…A particular etiology which causes this hemorrhage is placental adhesion [2]. Patients with abnormal placentation frequently show a placenta invasion through the desidua basal layer [3]. Placenta perccreta is a spectrum in placenta accreta, which extravilli of the trophoblast invades through the myometrium and may reach other intrabdominal organs, commonly invading the urinary bladder [4].…”

Section: Introductionmentioning

confidence: 99%

Successful Anesthesia Management of Massive Haemorrhage During C-Section Indicated of Placentapercreta Multidisciplinary Approach Based Team: A Case Report

Shantikaratri,

Pankao,

Hartono

2023

Preprint

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Background Placenta perccreta accounts for 7–10% of maternal mortality. Immature preoperative management and planning could increase the risk of maternal mortality. Anesthetic management during the procedure are involved due to high risk of massive hemorrhage. A multidisciplinary team approach is important to reduce risk during the procedure. The author reports the multidisciplinary approach in a placenta perccreta patient. Case Presentation Gestating woman aged 33 years with a gestational age 30–32 weeks canceled going to RSUD dr. Saiful Anwar Malang with complaints of bleeding from the birth canal for the past 1 month. The patient had a history of caesarean section in the lower segment. In the last 1 month, the patient has received a total of 6 RRC bags with antibiotics. Caesarean section (SC) to be performed due to the abnormal estimation of placental implantation from ultrasonography and gross hematuria. The patient was consulted for anesthesia 7 days before the scheduled SC. Calculation of the Placenta Accreta Index (PAI) score obtained a total score of 5. The patient underwent a Magnetic Resonance Imaging examination and found placenta previa type III (partial placenta previa) accompanied by placenta percreta, the impression of infiltrating the superoposterior wall of the urinary bladder. Preoperative management is carried out by involving a multidisciplinary team. Conclusion Anesthetic management with a multidisciplinary team approach shows an effective and safe results in patients with placenta preccreta during a C-Section procedure. Hemodynamic monitoring is important during the procedure and need to be manage carefully.

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Placenta accreta and anesthesia: A multidisciplinary approach

Cited by 10 publications

References 11 publications

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Cesarean delivery with and without uterine artery embolization for the management of placenta accreta spectrum disorder—A comparative study

Ovarian reserve after uterine artery embolization in women with morbidly adherent placenta: A cohort study

Successful Anesthesia Management of Massive Haemorrhage During C-Section Indicated of Placentapercreta Multidisciplinary Approach Based Team: A Case Report

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