The morbidly adherent placenta

Hayes, E; Ayida, Gubby; Crocker, Alison

doi:10.1097/gco.0b013e32834cef7a

Cited by 36 publications

(4 citation statements)

References 34 publications

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“…Attempt to remove the placenta leads to disruption of the infiltrated bed and is associated with increased maternal morbidity. It has been suggested that it may be sensible to complete the delivery of the infant and proceed to an intended hysterectomy with the placenta left in situ 13,29,38,41,42. A total rather than subtotal hysterectomy is advocated because of the risk of hemorrhage from lower-segment invasions.…”

Section: Obstetric Management Strategiesmentioning

confidence: 99%

The sonographic appearance and obstetric management of placenta accreta

Cheung¹,

Chan²

2012

IJWH

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Placenta accreta is a condition of abnormal placental implantation in which the placental tissue invades beyond the decidua basalis. It may invade into or even through the myometrium and adjacent organs, such as the urinary bladder. The incidence has been rising in recent years. It is one of the important obstetric complications nowadays, leading to significant maternal morbidity and mortality. In the past, this condition was often diagnosed at the time of delivery when massive and unexpected hemorrhage occurred. Hysterectomy, associated with significant physical and psychological consequences, was usually the only management option. As more obstetricians have become aware of this condition, early identification with antenatal imaging diagnostic technology has become possible. Ultrasound scan plays an important role in the antenatal diagnosis. Various sonographic features with different specificity and sensitivity have been described in the literature. In equivocal cases, magnetic resonance imaging may be helpful. With such information, more accurate counseling can be offered to the mothers and their families before delivery. The delivery can also be arranged at a favorable time and in an institution where multidisciplinary support is available. Input from a hematologist, interventional radiologist, intensive care physician, urology surgeon, and/or other specialist are desirable. Apart from hysterectomy, various forms of conservative management can also be considered when the diagnosis is made prior to delivery. Fertility can therefore be preserved. After delivery, with or without hysterectomy performed, psychological support to the mothers and their families is essential.

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Section: Obstetric Management Strategiesmentioning

confidence: 99%

The sonographic appearance and obstetric management of placenta accreta

Cheung¹,

Chan²

2012

IJWH

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“…During pregnancy, the vascular resistance in the uteroplacental circulation decreases, and; therefore, a persistently low PI after delivery would theoretically reflect the persistence of the placenta. 52,53 The PI on the side of the placental retention is also found to be lower than on the contralateral side. 53 The evidence regarding the efficacy of PI in the conservative management is perplexing.…”

Section: Ultrasound and Doppler Examinationmentioning

confidence: 80%

“…The measurement of the PI in uterine arteries has also been proposed. During pregnancy, the vascular resistance in the uteroplacental circulation decreases, and; therefore, a persistently low PI after delivery would theoretically reflect the persistence of the placenta 52,53 . The PI on the side of the placental retention is also found to be lower than on the contralateral side 53 .…”

Section: Conservative Management Of Pasmentioning

confidence: 94%

Placenta Accreta Spectrum: Conservative Management and Its Impact on Future Fertility

Abbas

Nassar

2020

Maternal-Fetal Medicine

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Placenta accreta spectrum is a complication of pregnancy, which poses a great risk on maternal health. Historically, hysterectomy was the modality of treatment of such condition, but an approach towards a more conservative management has been in the light recently. This includes several methods with varying rates of success and complications. Expectant management is effective in up to 78%-80% of the cases. The extirpative method is associated with a high risk of postpartum hemorrhage. The success of the onestep conservative procedure depends on the degree of placental invasion, and the triple-P procedure appears to be successful but requires and interdisciplinary approach. Adjuvant treatment options can be tailored according to individual cases, and these include methotrexate injection, uterine devascularization and hysteroscopic resection of retained placental tissues. Follow up after conservative management is crucial to detect complications early, and it can be done by ultrasound, Doppler examination, and trending b human chorionic gonadotropin levels. Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications. In the future, more research should be directed to achieve clear guidelines regarding this topic.

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“…Recent studies have reported that pelvic artery catheterization and embolization are safe and effective to prevent HE in women with PAS [25,26]. A study by Munoz et al in 2023 demonstrates that UAE increases perioperative outcome and reduces maternal morbidity.…”

Section: Discussionmentioning

confidence: 99%

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

Neef,

Flinspach,

Eichler

et al. 2024

JCM

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Background: Placenta accreta spectrum (PAS) disorders are a continuum of placental pathologies with increased risk for hemorrhage, blood transfusion and maternal morbidity. Uterine artery embolization (UAE) is a safe approach to the standardization of complex PAS cases. The aim of this study is to analyze anemia and transfusion rate, outcome and anesthesiological management of women who underwent caesarean delivery with subsequent UAE for the management of PAS. Material and Methods: This retrospective observational study included all pregnant women admitted to the University Hospital Frankfurt between January 2012 and September 2023, with a diagnosis of PAS who underwent a two-step surgical approach for delivery and placenta removal. Primary procedure included cesarean delivery with subsequent UAE, secondary procedure included placenta removal after a minim of five weeks via curettage or HE. Maternal characteristics, anesthesiological management, complications, anemia rate, blood loss and administration of blood products were analyzed. Results: In total, 17 women with PAS were included in this study. Of these, 5.9% had placenta increta and 94.1% had placenta percreta. Median blood loss was 300 (200–600) mL during primary procedure and 3600 (450–5500) mL during secondary procedure. In total, 11.8% and 62.5% of women received red blood cell transfusion during the primary and secondary procedures, respectively. After primary procedure, postpartum anemia rate was 76.5%. The HE rate was 64.7%. Regional anesthesia was used in 88.2% during primary procedure. Conclusion: The embolization of the uterine artery for women diagnosed with PAS is safe. Anemia management and the implementation of blood conservation strategies are crucial in women undergoing UAE for the management of PAS.

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The morbidly adherent placenta

Cited by 36 publications

References 34 publications

The sonographic appearance and obstetric management of placenta accreta

The sonographic appearance and obstetric management of placenta accreta

Placenta Accreta Spectrum: Conservative Management and Its Impact on Future Fertility

Management and Outcome of Women with Placenta Accreta Spectrum and Treatment with Uterine Artery Embolization

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