Trends, characteristics, and outcomes of conservative management for placenta percreta

Youssefzadeh, Ariane C.; Matsuzaki, Shinya; Mandelbaum, Rachel S.; Sangara, Rauvynne N.; Bainvoll, Liat; Matsushima, Kazuhide; Ouzounian, Joseph G.; Matsuo, Koji

doi:10.1007/s00404-021-06384-1

Cited by 8 publications

(2 citation statements)

References 31 publications

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“…PAS is a challenging problem worldwide, with a high maternal morbidity [ 1 , 2 , 7 ]. Although conservative management for PAS is associated with lower surgical morbidity at CS, CS-HE is still the gold standard of treatment [ 41 ]. Antenatal diagnosis and centralized management are associated with lower maternal and fetal morbidity [ 20 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

Ayub,

Strizek,

Poetzsch

et al. 2023

JCM

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Background: To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS). Methods: This is a monocentric retrospective study of women with PAS presenting at our hospital between 2005 and 2021. All data were retrospectively collected through the departmental database. Results: 35 patients with PAS were included. EM was planned in 25 patients prior to delivery. Complete absorption of the retained placenta was seen in two patients (8%). Curettage was performed in 14 patients (56%). A hysterectomy (HE) was needed in seven (28%) patients; 18 patients (72%) underwent uterus-preserving treatment without severe complications. The mean duration of EM was 107 days. The mean day of onset of hyperfibrinolysis and beginning of TXA treatment was day 45. The mean nadir of fibrinogen level before TXA was 242.4 mg/dL, with a mean drop of 29.7% in fibrinogen level. Conclusions: Our data support EM as a safe treatment option in PAS. Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. To our knowledge, this is the first cohort of patients with EM of PAS in whom coagulation monitoring and use of TXA have been shown to successfully treat hyperfibrinolysis.

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Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

Ayub,

Strizek,

Poetzsch

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…In a study based on the National Inpatient Sample from 2015 to 2017, 53% of U.S. deliveries complicated by PAS and 75% of deliveries complicated by placenta percreta underwent hysterectomy during the delivery hospitalization. 9 10 In New South Wales, Australia, from 2003 to 2012, 12% of deliveries complicated by PAS underwent hysterectomy up to 6 months after the delivery. Despite the predominance of hysterectomy, conservative management appears to be practiced in the United States as well.…”

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confidence: 99%

Leaving the Placenta In Situ in Placenta Accreta Spectrum Disorders: A Single-Center Case Series

et al. 2022

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The most common treatment for placenta accreta spectrum disorders (PAS) is planned primary cesarean-hysterectomy. However, other management strategies may improve outcomes and/or allow fertility preservation. This is a series of 11 patients with PAS managed by leaving the placenta in situ at a single academic center in the U.S. from 2015-2022. The approach described involves delivery of the fetus via cesarean, no attempt at placental removal, closure of the hysterotomy, prophylactic intravenous antibiotics for up to one week, and close outpatient follow up until the uterus is empty. The uterus was successfully preserved in 6 (55%), minimally invasive hysterectomy was performed in 4 (36%), and abdominal hysterectomy was performed in 1 (9%). During cesarean delivery, the median estimated blood loss was 650mL (range 200 – 1,000 mL). The majority of patients had no vaginal discharge for several weeks after delivery, followed by brown or bloody discharge, and intermittent mild-moderate cramping. The median time to resolution of PAS was 18 weeks in patients with successful uterine preservation (range 5 – 25 weeks). Indications for hysterectomy included hemorrhage (n=1), coagulopathy (n=1), endomyometritis (n=2), and pain (n=1), and these occurred at a median of 5 weeks postpartum (range 1 – 25 weeks). Four patients had subsequent pregnancies, of whom three were live births at or near term, and one was a spontaneous abortion at 19 weeks.

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The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder

Yuan

Liu

et al. 2022

Arch Gynecol Obstet

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Trends, characteristics, and outcomes of conservative management for placenta percreta

Cited by 8 publications

References 31 publications

Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

Placenta Accreta Spectrum Prophylactic Therapy for Hyperfibrinolysis with Tranexamic Acid

Leaving the Placenta In Situ in Placenta Accreta Spectrum Disorders: A Single-Center Case Series

The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder

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