Placenta accreta : fréquence, dépistage prénatal, prise en charge

Sentilhes, Loïc; Kayem, Gilles; Ambroselli, Clémence; Grangé, G.; Boussion, F.; Descamps, Philippe

doi:10.1016/j.lpm.2010.01.005

Cited by 20 publications

(6 citation statements)

References 46 publications

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“…As for the cesarean hysterectomy, the specific modalities of conservative treatment for optimal management remain to be determined . Should manual removal of the placenta be attempted routinely in cases of prenatal suspicion of placenta accreta, by moderate traction on the umbilical cord, to avoid leaving a non‐accreta placenta in place in case of a false‐positive diagnosis from prenatal imaging, but at the risk of inducing a severe hemorrhage?…”

Section: Management Of Placenta Accreta Suspected Before Deliverymentioning

confidence: 99%

PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity

Kayem

Deneux‐Tharaux

Sentilhes

2013

Acta Obstet Gynecol Scand

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Background. No population-based study has assessed the prevalence of placenta accreta, the predictive value of prenatal diagnostic examinations, the maternal morbidity associated with its management, or its psychological effects. Moreover, the technical resources necessary for the safest delivery of women at risk have not been clearly identified. Objectives. The primary objectives are to identify individual risk factors, as well as factors associated with types of management and with the healthcare facilities for postpartum hemorrhage. Secondary objectives are to (i) determine the prevalence of placenta accreta among women at risk; (ii) assess the predictive value of ultrasound and MRI for the diagnosis of placenta accreta in this population; (iii) evaluate psychological impact and physical complications; and (iv) report maternal physical complications during the year after delivery. Design. Population-based prospective observational study of pregnant women with a placenta inserted at a uterine scar. Setting. A total of 182 centers in eight French regions, with 270 000 deliveries annually. Methods. We expect to include 620 women at risk of placenta accreta in two years, of whom approximately 120 (20%) will have placenta accreta. Main outcome measures. The primary outcome measure is severe maternal hemorrhage; secondary outcome measures are maternal morbidity and deaths, predictive value of ultrasound and MRI, and psychological evaluations at 6 and 12 months. Conclusion. This study will be the first prospective population-based study to include women at risk of placenta accreta and to investigate incidence, prenatal detection, type of management, morbidity and maternal psychological consequences.

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Section: Management Of Placenta Accreta Suspected Before Deliverymentioning

confidence: 99%

PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity

Kayem

Deneux‐Tharaux

Sentilhes

2013

Acta Obstet Gynecol Scand

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“…Le placenta accreta doit être é voqué en pré sence d'au moins un anté cé dent de cé sarienne associé à un placenta bas insé ré [57,58]. Les risques d'hé morragie massive et de morbidité maternelle sé vè re sont trè s significativement augmenté s lors de l'accouchement en l'absence de diagnostic pré natal pré alable ayant permis une organisation optimale des soins ou lors de tentative de dé livrance manuelle forcé e [59,60].…”

Section: Pathologies Placentaires : Anomalies D'insertion Placentaireunclassified

“…Les risques d'hé morragie massive et de morbidité maternelle sé vè re sont trè s significativement augmenté s lors de l'accouchement en l'absence de diagnostic pré natal pré alable ayant permis une organisation optimale des soins ou lors de tentative de dé livrance manuelle forcé e [59,60]. En fonction de la situation clinique, la prise en charge d'un placenta accreta fait appel aux mesures thé rapeutiques habituellement dé crites en pré sence d'une hé morragie du post-partum sé vè re et fait discuter un traitement conservateur ou radical [2,58,59].…”

Section: Pathologies Placentaires : Anomalies D'insertion Placentaireunclassified

Mort fœtale in utero au-delà de 14SA : induction du travail et obtention de la vacuité utérine

Beucher¹,

Dolley²,

Stewart

et al. 2015

Gynécologie Obstétrique & Fertilité

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“…Studies comparing conserving management with one-step surgery have shown different results and have been controversially discussed (11)(12)(13)(14)(15)(16)(17). Recommendations vary between different guidelines between planned caesarean hysterectomy and leaving the placenta in situ with delayed removal as an option for women who desire to preserve their fertility (7,11).…”

Section: Introductionmentioning

confidence: 99%

A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach

Weydandt,

Lia,

Schöne

et al. 2023

Preprint

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Background Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimize blood loss. Methods We conducted a monocentric retrospective cohort study including all patients operated for PAS between 2006 and 2023. During this period, one-step surgery was abandoned and a two-step surgical approach was adopted. The number of units of red blood cells (RBC) needed during surgery were the primary outcomes used to compare these two approaches. Results A total of 43 cases were included in this analysis. Median blood loss during surgery was 2000 ml and 2800 ml for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBC was 0.28 (95%-CI: 0.063 ‒ 1.15, p = 0.067). Longer interval between the caesarean section and the second operation showed a trend to lower blood loss (p = 0.065) and were associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusion Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction of blood transfusion. Leaving the placenta in situ and delay final operation represents a possible alternative to traditional cesarean hysterectomy (one-step surgery).

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Placenta accreta : fréquence, dépistage prénatal, prise en charge

Cited by 20 publications

References 46 publications

PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity

PACCRETA: Clinical situations at high risk of Placenta ACCRETA/Percreta: impact of diagnostic methods and management on maternal morbidity

Mort fœtale in utero au-delà de 14SA : induction du travail et obtention de la vacuité utérine

A single-centre analysis of pregnancies with placenta accreta spectrum (PAS): from one-step surgery towards two-step surgical approach

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