New insights in the diagnosis of placenta accreta (original) (raw)
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Placenta accreta not previa: a rare case report of placenta accreta in an unscarred uterus
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Placenta accreta spectrum disorders are usually associated with direct surgical scar such as caesarean delivery, surgical termination of pregnancy, Dilatation and curettage, Myomectomy, Endometrial resection and Asherman’s syndrome. It can also be associated with non-surgical scar and uterine anomalies. Rarely it can be encountered in unscarred uterus. Mrs X, 35-year female, unbooked patient, G7P2L2A4 with nine months of amenorrhoea reported in emergency of RML Hospital on 30/07/2019 with history of labour pains since 2 days. Patient gave history of four dilatation and curettage for incomplete abortion. On examination patient was found to be severely anaemic (Hb -6 gm). 2 Packed RBC were transfused preoperatively. There was no progress in labour beyond 6 cm for 4 hours. Patient was thus taken for LSCS for NPOL, with blood on flow. Intraoperatively, after delivery of the baby placenta which was fundo-posterior did not separate. In view of parity and morbidly adherent placenta (clinic...
Case report on placenta accreta presenting obstetric emergency
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017
Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. As the incidence of Caesarean have increased, Placenta accreta also has increased and considered as an important cause of maternal and fetal/neonatal morbidity and mortality. Although multiple caesarean deliveries are at the largest risk factor for the placenta accreta, increasing maternal age and parity, as well as other uterine surgeries are also important. In Patient at risk for accreta, obstetrical ultrasonography performed by an experienced provider should be obtained. A multidisciplinary team in a centre with expertise in managing placenta accreta should care for case of suspected accreta.
Placenta Accreta: A Review of the Etiology, Diagnosis, and Management
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2016
The incidence of placenta accreta is rising, primarily due to the increase in cesarean section rates. The prenatal diagnosis of placenta accretas has been shown to decrease the amount of blood loss and complications. Real-time ultrasound is helpful for diagnosing placenta accreta, and magnetic resonance imaging (MRI) can increase the sensitivity of prenatal diagnosis. Postpartum hysterectomy for placenta accreta has been the standard of therapy for placenta accreta, but conservative management including uterine artery embolization, and leaving the placenta in situ may be considered in patients who want to preserve their fertility. The etiology of placenta accreta is due to a deficiency of maternal decidua, resulting in placenta invasion into the uterine myometrium. The molecular basis is yet to be elucidated, but it probably involves abnormal paracrine or autocrine signaling between the deficient maternal decidua and the invading placenta trophoblastic tissue. How to cite this artic...
Placenta accreta spectrum-a catastrophic situation in obstetrics
Obstetrics & Gynecology Science, 2021
Placenta accreta is a significant obstetric complication in which the placenta is completely or focally adherent to the myometrium. The worldwide incidence of placenta accreta spectrum (PAS) is increasing day by day, mostly due to the increasing trends in cesarean section rates. The accurate and timely diagnosis of placenta accreta is important to improve the feto-maternal outcome. Although standard ultrasound is a reliable and primary tool for the diagnosis of placenta accreta, the absence of ultrasound findings does not preclude the diagnosis of placenta accreta. Therefore, clinical evaluation of risk factors is equally essential for the prediction of abnormal placental invasion. Pregnant women with a high impression or established diagnosis of placenta accreta should be managed by a multidisciplinary team in a specialist center. Traditionally, PAS has been managed by an emergency obstetric hysterectomy. Previously, few studies suggested a satisfactory success rate of conservative...
Placenta Accreta Spectrum in Unscarred Uterus: A Case Report in a Tertiary Facility
EAS journal of medicine and surgery, 2023
Background: Placenta accreta spectrum (PAS) is a broad term that includes placenta accreta, placenta increta, and placenta percreta. The major risk factor is a scarred uterus commonly as a result of prior cesarean delivery, myomectomy, or uterine instrumentation. We report a case of placenta increta in the absence of identifiable risk factors. Case presentation: A 22-year-old, para 2 living 2, presented with postpartum hemorrhage due to retained placenta post vaginal delivery at a gestational age of 38 weeks and 4 days, manual removal of placenta was attempted general anesthesia without success; necessitating explorative laparotomy where the placenta was found deeply invading into the myometrium. Intractable bleeding necessitated supracervical hysterectomy. Histopathological results later revealed placenta increta. Conclusion: PAS in an unscarred uterus in the absence of other identifiable risk factors is quite uncommon; however, carries high maternal morbidity and mortality. This case serves as an eye opener on the need to evaluate for radiological features of PAS during antenatal visits even in low-risk group.
Placenta Accreta - a Management Enigma
GLOBAL JOURNAL FOR RESEARCH ANALYSIS, 2019
Abnormal placentation (accreta, increta, percreta) has emerged over uterine atony as leading indication for 2 peripartum hysterectomy. Placenta accrete syndrome is a general term used to describe the clinical condition when part of the placenta ,or the entire placenta, invades and is 3 inseparable from the uterine wall. These placental abnormalities rarely get detected before delivery. Antenatal diagnosis is crucial in planning its management and has shown to reduce maternal morbidity and mortality. (RCOG 2018) Accurate prenatal identication allows optimal obstetric management, because timing and site of delivery, availability of blood products, and recruitment of a skilled anaesthesia and surgical team can be organized in advance .The clinical consequence of placenta accreta is massive haemorrhage at the time of manual placental separation at the time of caesarean section.At times the haemorrhage is difcult to control and may even result in death on OT table. Mainstay of prenatal diagnosis remains USG, with MRI being 4 used only as an adjunct in indeterminate cases. SONOGRAPHIC CHARACTERISTICS INCLUDE: intraplacental lacunae, loss of the normal retroplacental clear space and thinning or disruption of the hyperechogenic 4 uterine serosa-bladder wall interface. SPECIFIC MRI FINDINGS ARE: uterine bulging , heterogeneous signal intensity within the placenta and dark intraplacental bands on T2-weighted images AIMS AND OBJECTIVES: The objectives of this study is to-1. To analyse maternal and foetal outcomes. 2. To analyse type of interventions. MATERIALS AND METHODS: TYPE OF STUDY:-Retrospective study. We retrospectively reviewed the medical records of all patients suspected to have placenta accreta.
Management of placenta accreta: Morbidity and outcome
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2007
Objective: The aim of the study was to evaluate our results in the management of placenta accreta. Study design: In a retrospective study we reviewed cases of placenta accreta diagnosed in two university teaching hospitals between 1993 and 2003. For a subgroup of patients a conservative approach was attempted. In this procedure placenta was left in place until spontaneous resorption. Results: Fifty cases (0.12%) of placenta accreta were observed in 41, 119 deliveries during the study period. Of the 50 cases, 24 patients (48%) were managed by the standard approach and 26 patients (52%) underwent conservative treatment. Additional surgical or medical treatment was performed in 35 of the 50 patients (70%). There was no maternal death. Overall hysterectomy rate was 40%, 10 patients were transferred to intensive care unit (20%), 7 had fever (14%), 5 had endometritis (10%) and 19 patients had blood transfusion (38%). Conservative treatment did not lead to hysterectomy in 21 cases (80.7%) and failed in 5 (19.3%). During the follow-up period, 3 women had successful pregnancy. Conclusion: Analysis of management of placenta accreta shows that for a subgroup of selected patients a conservative approach could preserve subsequent fertility without evident increase in morbidity.
Ultrasonographic Diagnosis of Placenta Accreta
Pjr, 2011
with the cesarean section rate, has increased tenfold in the past fifty years, with frequency of approximately one per thousand deliveries. 4,5 Placenta accreta is the abnormal adherence of placenta to myometrium due to defect in decidua basalis. This type of placenta could not remove manually after delivery and lead to severe hemorrhage that may result in emergency cesarean hysterectomy. Prenatal diagnosis of placenta accreta is important because it reduces the fetal and maternal morbidity and mortality as appropriate pre-operative and per operative procedures are possible. Grey scale ultrasonography along with color Doppler imaging proves to be the non invasive, real time, readily available modality with high sensitivity and high positive predictive value.
Pan African Medical Journal, 2019
Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year fro m 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta accreta spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. L eaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta accreta spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.
Case Report of Placenta Accreta: Successful Management with Conservative Surgery
World Journal of Current Medical and Pharmaceutical Research, 2020
The incidence of placenta accreta spectrum (PAS) disorders has increased over the last decades due to increase in cesarean deliveries, resulting in increase in Cesarean hysterectomies,maternal mortality and morbidity but since last few years there has been a gradual shift towards the idea of conservative management. Conservative management of PAS is known to reduce major obstetric hemorrhage and salvage hysterectomy.We present a case of placenta accreta diagnosed by ultrasound where management of post-partum hemorrhage was accomplished by conservative surgery. The concise steps taken in management of placenta accreta before and during cesarean section were: Availability of 4 donors with cross match; Stark cesarean section; atraumatic clamps around uterine arteries; ureterotonic drugs; external (B-Lynch suture); and application of diathermy where required. This experience indicates that few selected cases of PAS could be managed conservatively who are at risk of intra-partum hemorrhage and post-partum hemorrhage.