Surgical management of placenta accreta: to leave or remove the placenta?

Perez-Delboy, Annette; Wright, Jason D.

doi:10.1111/1471-0528.12524

Cited by 66 publications

(63 citation statements)

References 91 publications

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“…[1,2] Retained placenta accreta is usually a rare condition, but its prevalence is increasing due to the rise in the rate of deliveries by Cesarean section. [1–4] …”

Section: Introductionmentioning

confidence: 99%

Management of patients with placenta accreta in association with fever following vaginal delivery

Zhong

Chen

Zhong³

et al. 2017

Medicine

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This study aims to analyze the clinical characteristics and to manage patients with retained placenta left in situ accompanied by fever following vaginal delivery.Twenty-one patients with retained placenta in association with fever following vaginal delivery were enrolled and managed at the maternity department of our university hospital between 2012 and 2014.All patients had risk factors for development of placenta accreta: previous cesarean sections (4/21), previous curettage (15/21), or uterine malformations (7/21). Placenta accreta was diagnosed following vaginal delivery in all patients, and manual removal of the placenta was attempted in 20 of 21 patients. The placenta left in situ was partial in 19 patients and was complete in 2 patients. All patients were managed with a multidisciplinary approach. Mifepristone was administrated to 16 patients. Fourteen patients received uterine artery embolization. Eleven patients were treated with ultrasound-guided curettage within 24 hours following delivery. Seven patients needed delayed-hysterectomy due to development of complications.Intrauterine operations during labor are not recommended if placenta accreta occurs in the fundus and/or in the cornual region of the uterus. Antibiotic treatment, interventional therapy, and ultrasound-guided curettage within 24 hours following vaginal delivery are the recommended conservative management strategies.

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“…[1,2] Retained placenta accreta is usually a rare condition, but its prevalence is increasing due to the rise in the rate of deliveries by Cesarean section. [1–4] …”

Section: Introductionmentioning

confidence: 99%

Management of patients with placenta accreta in association with fever following vaginal delivery

Zhong

Chen

Zhong³

et al. 2017

Medicine

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“…10 The urinary bladder is the most frequently involved extrauterine organ, when there is a placenta percreta. 11 In the present study, 5 patients had urinary bladder injury constituting about 23% requiring repair during hysterectomy. When there is an extension of the placenta to the parametrium, there may be significant risk to the ureteric injury; in those cases, preoperative ureteric stenting may be helpful to identify the ureter.…”

Section: Discussionmentioning

confidence: 54%

A Retrospective Study on Adherent Placenta- Its Management, Maternal and Perinatal Outcome

Dandapat¹,

Pande²,

Dora³

et al. 2017

jemds

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BACKGROUNDMorbidly adherent placenta is on rise due to the increasing incidence of caesarean section and other uterine surgery. The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and its management, maternal and perinatal outcome of these patients. MATERIALS AND METHODSThis was a retrospective observational study conducted in the Department of Obstetrics and Gynaecology, VIMSAR, Burla, India from March 2015 to February 2017. RESULTSIn the present study, there was a total of 21 patients diagnosed of morbidly adherent placenta with the incidence of 1.14 per 1000 pregnancies. Previous caesarean along with placenta previa constitutes 13 (61.90%), which is the main risk factor for the development of morbidly adherent placenta. Out of 21 patients 17 (80.95%) require hysterectomy, 2 (9.52%) managed with subtotal hysterectomy and 2 (9.52%) managed conservatively. Five (23.80%) patients had bladder injury. The mean blood loss during surgery was 2.1 ± 0.312 litre. One case of placenta percreta who later on developed disseminated intravascular coagulation died of the disease. Seventeen (80.95%) of the patients had live birth and 4 (19.05%) had fresh still birth. Six (28.57%) babies admitted in a neonatal ICU for better care. Out of 21 babies, 6 (28.57%) required neonatal intensive care for neonatal complications. CONCLUSIONPatients with previous caesarean with placenta previa always should be referred to the nearest tertiary care centre keeping adherent placenta as a possibility. It is always preferable to take the help of a senior obstetrician in such cases to reduce the morbidity and mortality. KEYWORDSPlacenta Accreta, Increta and Percreta; Previous Caesarean Section; Peripartum Hysterectomy; Internal Iliac Artery Ligation. HOW TO CITE THIS ARTICLE: Dandapat AB, Pande B, Dora SK, et al. A retrospective study on adherent placenta-its management, maternal and perinatal outcome. J. Evolution Med. Dent. Sci. 2017;6(34):2785-2788, DOI: 10.14260/Jemds/2017/600 BACKGROUND Morbidly Adherent Placenta (MAP) includes placenta accreta, placenta increta and placenta percreta. Detachment is delayed in MAP, because the placenta is unusually adhered to the implantation site. In this case, the decidua is scanty or absent, and the physiological line of cleavage through the decidual spongy layer is lacking. Incidence of MAP is on rise due to increasing trend in caesarean section rate. 1,2 The incidence of MAP in USA 3,4 is 1 in 2500, that of in Canada 5 is 14.4 per 10,000 and in UK 6 it is 1.7 per 10,000. Besides caesarean section surgery involving uterus like myomectomy, dilatation and curettage, previous hysterotomy all lead to abnormality in placental implantation and defective Nitabuch layer formation. All this also predisposes the women to have placenta previa and more ominously MAP. 7Financial or Other, Competing Interest: None. Submission 06-04-2017, Peer Review 19-04-2017, Acceptance 21-04-2017, Published 27-04-2017. Corresponding Author: Atal Bihari Dandapat, Department ...

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“…Early identification of abnormal placentation allows for close follow-up, arrangement for transfer to tertiary care center, and early multidisciplinary planning and has been shown to lead to improved outcomes [4,5]. With increasing utilization of first trimester screening ultrasonography, detection of abnormal placentation early in pregnancy has increased.…”

Section: Discussionmentioning

confidence: 99%

Placenta Percreta with Occult Uterine Rupture in the First Trimester

Singh¹,

Jodicke²,

Reynolds³

et al. 2016

JCR

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Abstract:Placenta percreta is a rare finding in the first trimester and is often associated with severe maternal morbidity. Herein we describe a case of placenta percreta with occult uterine rupture in the first trimester in a patient with a history of two previous cesarean deliveries. Imaging was concerning for placenta accreta. Following onset of acute abdominal pain, she underwent exploratory laparoscopy, which was negative for overt uterine scar dehiscence. She ultimately underwent total abdominal hysterectomy at 14 weeks following severe bleeding, with intraoperative and histologic findings consistent with placenta percreta with dehiscence of the anterior lower uterine segment below the level of, and obscured by the vesicouterine peritoneum.Bleeding and severe abdominal pain in the first trimester in the context of prior uterine instrumentation should always prompt evaluation of the scar, by imaging in a stable patient, and by direct visualization if necessitated. However, maintenance of clinical suspicion for uterine scar dehiscence is warranted in patients at high risk even in the absence of direct visualization intra-operatively.

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Surgical management of placenta accreta: to leave or remove the placenta?

Cited by 66 publications

References 91 publications

Management of patients with placenta accreta in association with fever following vaginal delivery

Management of patients with placenta accreta in association with fever following vaginal delivery

A Retrospective Study on Adherent Placenta- Its Management, Maternal and Perinatal Outcome

Placenta Percreta with Occult Uterine Rupture in the First Trimester

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