Placenta accreta spectrum-a catastrophic situation in obstetrics

Pegu, Bhabani; Thiagaraju, Chitra; Nayak, Deepthi; Subbaiah, Murali

doi:10.5468/ogs.20345

Cited by 17 publications

(19 citation statements)

References 54 publications

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“…The same authors underline that the association between placenta praevia and placenta accreta simultaneously grow with the number of Cesarean deliveries from 3% for first Cesarean delivery to 67% for fifth Cesarean delivery [ 5 ]. Thinking like our approach other published data are underscoring that PAS disorders diagnosis must be thoroughly checked in circumstances such as need for manual removal of focal or total adherent placenta, suggestive US images for PAS disorders, expressive gross exam and finally confirmed by HP exam [ 47 ]. Published data reveal that in situation characterized by suspicion of PAS disorders that is not confirmed by HE microscopic exam, it is recommended to perform IHC exam with markers for trophoblast, such as CK7 and HLA-G, which are the most indicated immunomarkers to detect AIP.…”

Section: Methodsmentioning

confidence: 99%

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam – literature review and authors’ experience

Stănculescu¹,

Brătilă²,

Socolov³

et al. 2022

Rom J Morphol Embryol

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The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.

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Section: Methodsmentioning

confidence: 99%

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam – literature review and authors’ experience

Stănculescu¹,

Brătilă²,

Socolov³

et al. 2022

Rom J Morphol Embryol

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“…Massive hemorrhage is the leading cause of death in a variety of clinical settings, such as trauma in military, civilian settings, or high-risk surgery. [1][2][3] Management for severe hemorrhage consists of both acute bleeding control and supplementation for intravascular volume and blood component deficiencies, usually with blood product transfusion. Therefore, both hemorrhage control and massive transfusion are important components in the management of uncontrolled massive hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

Lee

Kim

et al. 2022

JAMA Netw Open

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ImportanceMassive transfusion is essential to prevent complications during uncontrolled intraoperative hemorrhage. As massive transfusion requires time for blood product preparation and additional medical personnel for a team-based approach, early prediction of massive transfusion is crucial for appropriate management.ObjectiveTo evaluate a real-time prediction model for massive transfusion during surgery based on the incorporation of preoperative data and intraoperative hemodynamic monitoring data.Design, Setting, and ParticipantsThis prognostic study used data sets from patients who underwent surgery with invasive blood pressure monitoring at Seoul National University Hospital (SNUH) from 2016 to 2019 and Boramae Medical Center (BMC) from 2020 to 2021. SNUH represented the development and internal validation data sets (n = 17 986 patients), and BMC represented the external validation data sets (n = 494 patients). Data were analyzed from November 2020 to December 2021.ExposuresA deep learning–based real-time prediction model for massive transfusion.Main Outcomes and MeasuresMassive transfusion was defined as a transfusion of 3 or more units of red blood cells over an hour. A preoperative prediction model for massive transfusion was developed using preoperative variables. Subsequently, a real-time prediction model using preoperative and intraoperative parameters was constructed to predict massive transfusion 10 minutes in advance. A prediction model, the massive transfusion index, calculated the risk of massive transfusion in real time.ResultsAmong 17 986 patients at SNUH (mean [SD] age, 58.65 [14.81] years; 9036 [50.2%] female), 416 patients (2.3%) underwent massive transfusion during the operation (mean [SD] duration of operation, 170.99 [105.03] minutes). The real-time prediction model constructed with the use of preoperative and intraoperative parameters significantly outperformed the preoperative prediction model (area under the receiver characteristic curve [AUROC], 0.972; 95% CI, 0.968-0.976 vs AUROC, 0.824; 95% CI, 0.813-0.834 in the SNUH internal validation data set; P &lt; .001). Patients with the highest massive transfusion index (ie, &gt;90th percentile) had a 47.5-fold increased risk for a massive transfusion compared with those with a lower massive transfusion index (ie, &lt;80th percentile). The real-time prediction model also showed excellent performance in the external validation data set (AUROC of 0.943 [95% CI, 0.919-0.961] in BMC).Conclusions and RelevanceThe findings of this prognostic study suggest that the real-time prediction model for massive transfusion showed high accuracy of prediction performance, enabling early intervention for high-risk patients. It suggests strong confidence in artificial intelligence-assisted clinical decision support systems in the operating field.

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“…The second major complication is massive intraoperative or postpartum bleeding due to placenta previa or placenta accreta spectrum, including placenta accreta, increta, and percreta [ 14 ]. In all cases, we secured the A-line and C-line by consulting the anesthesiologist and preparing for mass transfusion, hysterectomy, and ICU care before surgery.…”

Section: Discussionmentioning

confidence: 99%

New paradigm for cervico-isthmic pregnancy: conservative management of cervico-isthmic pregnancy leading to successful deliveries

Bae

2023

Obstet Gynecol Sci

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To establish a new treatment option for cervico-isthmic pregnancy (CIP) other than termination by maintaining pregnancy from diagnosis to delivery. MethodsThis retrospective observational study included women diagnosed with CIP at Dongsan Medical Center, Daegu, Korea, from January 2014 to December 2019. Eight patients were diagnosed with CIP using transvaginal ultrasound and met the following inclusion criteria: (1) preserved and closed cervical canal; and (2) more than half of the uterine cavity above the sac was not involved in sac implantation. Five of the eight mothers decided to maintain their pregnancy after an adequate explanation of the possible risks. The same sonographer assessed fetal and maternal status every 1-2 weeks. Intra-and postoperative indicators, delivery information, and neonatal outcomes were also recorded. ResultsThe mean patient age was 36 years. In all cases, placenta accreta spectrum and placenta previa were detected using preoperative ultrasonography. A hysterectomy was performed in three cases, and all patients required intensive care unit (ICU) care. The mean operative time was 156 minutes. The rate of postpartum hemorrhage was 40%. Four viable fetuses were delivered. Birth preceding 34 weeks occurred in one patient, who required neonatal ICU hospitalization for 19 days. ConclusionConservative treatment with careful diagnosis, management, and sufficient consultation could be an alternative treatment option in women with CIP, particularly older mothers, those with subfertility, and those who expect to have limited future opportunities for a successful pregnancy. Therefore, CIP should be treated as a separate disease entity.

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Placenta accreta spectrum-a catastrophic situation in obstetrics

Cited by 17 publications

References 54 publications

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam – literature review and authors’ experience

Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam – literature review and authors’ experience

Development and Validation of a Prediction Model for Need for Massive Transfusion During Surgery Using Intraoperative Hemodynamic Monitoring Data

New paradigm for cervico-isthmic pregnancy: conservative management of cervico-isthmic pregnancy leading to successful deliveries

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