Outcome of Patients with Placenta Accreta at El Shatby Maternity University Hospital (original) (raw)
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Placenta Accreta: Five-Year Experience at a Tertiary-Care Center
Objective: The goals of this analysis were (1) to evaluate the demographic profiles, high risk factors, fetomaternal outcomes, and management options for patients with placenta accreta, and (2) to plan future strategies for managing this condition. Materials and Methods: This retrospective analysis involved a review of 17 case records of women with placenta accreta from January 2007 to December 2011. Results: The mean age of the patients was 27.2 -3.8 years, and 7.6% of these women were grandmultiparous. Fourteen women (82.35%) had previous caesarean section scars and 11 women (64.7%) had scarred uteri with placenta previa. Twelve women (70.5%) presented antenatally with antepartum hemorrhage. Fourteen women have operative procedures performed on an emergency basis, and the remaining 3 women were scheduled for elective surgery. Seven of 17 women (41.7%) underwent hysterectomy. The remaining 10 patients (58.82%) were managed conservatively. Bladder injury during dissection occurred in 5 patients (29.4%). Massive blood loss was a prominent feature of this condition, with a mean blood loss of 2.8 L. There was 1 (5.8%) maternal mortality. The average gestational age was 35.4 weeks. Sixty percent of the neonates were preterm, with an average birth weight of 2.1 kg. Perinatal mortality was 35%. Conclusions: Cesarean section and placenta previa are significant risk factors for placenta accreta. This condition is associated with high fetomaternal morbidity and mortality. ( J GYNECOL SURG 30:91)
2020
Background: Every year, 140 000 women are estimated to die of postpartum hemorrhage. Placenta accreta has since become a statistically relevant etiology for maternal morbidity and mortality. There has been a 10-fold increase in the occurrence of placenta accreta since 1970, due to the rising rate of cesarean delivery. Objective: This work aims to determine the occurrence and complications of placenta accreta in instances of prior cesarean sections with placenta previa anterior and outcome of management of these complications at Al Hussein University Hospital. Patients and Methods: The study is a prospective cohort study including all cases admitted to Al Hussein university Hospital diagnosed as placenta previa anterior plus one or more previous cesarean sections during the period from January 2020 to June 2020. The number of cases was 64 cases. 40 cases (63%) of them were found as placenta previa accreta. Results: Our findings indicate that the occurrence, risk factors and feto-mate...
International journal of reproduction, contraception, obstetrics and gynecology, 2018
Placenta previa (PP) is an obstetric complication that occurs in the second and third trimesters of pregnancy. It may cause serious morbidity and mortality to both the fetus and the mother. It is one of the leading causes of vaginal bleeding in the second and third trimesters. 1 Placenta previa complicates approximately 0.4 % pregnant women and has a mortality rate of 0.0 3%. 2,3 Placenta previa may be associated with placenta accreta (PA) or one of its more advanced forms as (placenta increta and percreta). Clinically, PA becomes problematic during delivery when the placenta does not completely separate from the uterus and is followed by massive obstetric hemorrhage, leading to disseminated intravascular coagulopathy; the need for hysterectomy; surgical injury to the ureters, bladder, bowel, or neurovascular structures; adult respiratory distress syndrome; acute transfusion reaction; electrolyte imbalance; and renal failure. 4 In the period of 1982-2002, researchers have reported the incidence of PA as 1 in 533 deliveries. 5 The marked increase in the incidence has been attributed to the ABSTRACT Background: The aim of the current study was to estimate the incidence of placenta previa (PP) and accreta (PA) in the period from January 2015 to December 2016 at Women's Health Hospital, Assiut University, Egypt and to evaluate the maternal and neonatal outcomes. Methods: The study included all cases of PP with or without suspicion of accreta who were diagnosed preoperatively by ultrasound at Women's Health Hospital, Assiut University. Maternal and neonatal outcomes were evaluated. All intraoperative and postoperative data were reported. The obtained data was analyzed by means of SPSS software (version 22.0) and p<0.05 was taken as the significant level. Results: Total number of deliveries was 29027 cases. The number of cases of PP was 494 cases making an incidence of 1.7%, among them 95 cases were confirmed during surgery to be accreta (0.33%). Uterine artery ligation was carried out 300 cases (60.7%) of cases while cesarean hysterectomy was performed in 56 cases (11.3%). Bladder injury occurred in 58 cases (11.7%), ureteric injury occurred in 6 cases (1.2%), colon injury occurred in 1case (0.2%) and vascular injury occurred in 2 cases (0.4%). Maternal mortality was 4 cases (0.8%). The mean gestational age was 34.73 ± 2.8 weeks. Also, over the two years there were 148 neonatal cases (29.9%) needed assisted ventilation in the form of ambu bag or endotracheal intubation gestation. NICU admission needed in 109 neonatal cases (22.06%) and neonatal mortality reported in 18 neonates (3.6%). Conclusions: The incidence of both PP and PA is very high in our locality due to increase CS rate.
Placenta accreta: risk factors, perinatal outcomes, and consequences for subsequent births
American Journal of Obstetrics and Gynecology, 2013
We sought to evaluate risk factors and perinatal outcomes of pregnancies complicated with placenta accreta and to study perinatal outcomes in subsequent pregnancies. STUDY DESIGN: A retrospective study comparing all singleton cesarean deliveries (CD) of women with and without placenta accreta was conducted. In addition, a retrospective comparison of all subsequent singleton CD of women with a previous placenta accreta, with CD of women with no such history, was performed during the years 1988 through 2011. Stratified analysis using multiple logistic regression models was performed to control for confounders. RESULTS: During the study period, there were 34,869 CD, of which 0.4% (n ϭ 139) were complicated with placenta accreta. Using a multivariable analysis with backward elimination, year of birth (adjusted odds ratio [aOR], 1.06; 95% confidence interval [CI], 1.03-1.09; P Ͻ .001), previous CD (aOR, 5.11; 95% CI, 3.42-7.65; P Ͻ .001), and placenta previa (aOR, 50.75; 95% CI, 35.57-72.45; P Ͻ .001) were found to be independently associated with placenta accreta. There were 30 subsequent pregnancies of women with placenta accreta. Recurrent accreta occurred in 4 patients (13.3%). Previous placenta accreta was significantly associated with uterine rupture (3.3% vs 0.3%, P Ͻ .01) peripartum hysterectomy (3.3% vs 0.2%, P Ͻ .001), and the need for blood transfusions (16.7% vs 4%, P Ͻ .001). Nevertheless, increased risk for adverse perinatal outcomes such as low Apgar scores at 1 and 5 minutes and perinatal mortality was not found in these patients. CONCLUSION: Prior CD and placenta previa are independent risk factors for placenta accreta. A pregnancy following a previous placenta accreta is at increased risk for adverse maternal outcomes such as recurrent accreta, uterine rupture, and peripartum hysterectomy. However, adverse perinatal outcomes were not demonstrated.
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.
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 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.
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.
Placenta Accreta in Placenta Previa
The Professional Medical Journal, 2018
Objective: To calculate the frequency of placenta accreta in placenta previawith or without scarred uterus and compare clinico demographic features of cases with orwithout placenta accreta. Study Design: Cross sectional study. Place and Duration of Study:Department of Obst & Gynae Allied Hospital, Faisalabad from 1st June 2007 to 31st May 2008.Methodology: 200 patients of placenta previa, 100 with history of previous cesarean sectionand 100 without history of previous C-section fulfilling inclusion criteria were taken. They wereevaluated by history, examination and ultrasound noting placental location and type. Placentaaccreta was diagnosed during delivery. Results: Out of 200 patients, frequency of placentaaccreta was significantly increased with history of previous C-section. It was 20% in patientswith previous C-sections and 6% in patients without previous C-sections. Conclusions: Ourdata suggests that frequency of placenta accreta is greater in patients with previous C-sectionan...