scholarly journals P09.04: Clinical profile and outcome of patients with placenta previa and abnormally invasive placenta: a study at a tertiary care referral institute in India

2018 ◽  
Vol 52 ◽  
pp. 162-162
Author(s):  
E. Jaiswal
Keyword(s):  
Placenta Previa ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Innovation of delivery of pregnant women with abnormally invasive placenta: placenta percreta (Case of practice)

2018 ◽  
pp. 19-24
Author(s):  
O.V. Golyanovskiy ◽  
◽  
V.V. Mekhedko ◽  
D.O. Goncharenko ◽  
V.M. Kucher ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Argon Plasma ◽  
Placental Tissue ◽  
Massive Bleeding ◽  
Balloon Occlusion ◽  
Depth Of Invasion ◽  
Internal Iliac ◽  
Invasive Placenta ◽  
Severe Pathology ◽  
Abnormally Invasive Placenta

The article presents a case from practice with prenatal diagnostics of abnormally invasive placenta (Рl. Percreta) with invasion into the back wall of the bladder on the background of full placenta previa and previous caesarean section. Stressed the relevance of modern diagnostic pathologists placentation using ultrasound, Doppler and MRI to determine the depth of invasion of the placental tissue into the myometrium is emphasized. An innovative algorithm for delivery of a pregnant woman with this severe pathology using the endovascular technique of temporary balloon occlusion of the abdominal aorta, performing a cesarean section with a subsequent hysterectomy without appendages, ligating of the internal iliac arteries (IIAL), and argon-plasma tissue coagulation is proposed. The proposed method significantly reduces the amount of blood loss, the likelihood of developing massive bleeding, coagulopathic disorders and possible damage to adjacent organs. Key words: abnormally invasive placenta, placenta increta/rercreta, placenta previa, massive obstetric hemorrhage, balloon occlusion of the aorta, argon-plasma tissue coagulation.

3D power Doppler in the evaluation of abnormally invasive placenta

2017 ◽  
Vol 45 (6) ◽  
Author(s):  
Giuseppe Calì ◽  
Francesca Foti ◽  
Gabriella Minneci
Keyword(s):  
Gold Standard ◽  
Placenta Previa ◽  
Power Doppler ◽  
Three Dimensional ◽  
Diagnostic Techniques ◽  
3D Power Doppler ◽  
Invasive Placenta ◽  
2D Ultrasound ◽  
Abnormally Invasive Placenta ◽  
Bladder Invasion

AbstractThe anomalies in placental insertion and invasion, such as placenta previa and the various forms of abnormally invasive placenta, are today a rising obstetric pathology. Two-dimensional (2D) ultrasonography is the gold standard in the diagnosis of abnormally invasive placenta (AIP), but the important feto-maternal impact of this pathology suggests the opportunity to employ all the available diagnostic techniques, such as three-dimensional (3D) power Doppler. This technique allows acquiring multiplanar images on coronal, axial and sagittal planes and with a rotational technique, it permits visualizing the placenta-bladder interface more accurately. Consequently, it allows a better study of the degree of bladder invasion, which is information that has a great impact on the subsequent counseling and management. Thus, 3D power Doppler represents an important technique complementary to 2D ultrasound in the diagnosis of AIP. The aim of this paper is to illustrate the possible applications of this procedure, referring to the main literature data.

scholarly journals Clinical profile and outcome of patients with placenta previa: a study at a tertiary care referral institute in Northern India

2018 ◽  
Vol 7 (7) ◽  
pp. 2559
Author(s):  
Ekta Jaiswal ◽  
Neelam Aggarwal ◽  
Vanita Suri ◽  
Rashmi Bagga ◽  
Jasvinder Kalra ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Neonatal Outcome ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Expectant Management ◽  
Clinical Profile ◽  
Northern India ◽  
Emergency Cesarean ◽  
Intraoperative Management

Background: The aim of this study was to determine clinical profile, evaluate our antenatal and intraoperative management and see the maternal and perinatal outcome in patients with placenta previa.Methods: A prospective study was carried out in 130 women with placenta previa in the Department of Gynecology, PGIMER, Chandigarh, India between Jan 2015–April 2016. The profile of these patients was recorded in a predesigned proforma and maternal and perinatal outcome analyzed in detail.Results: One third (46/130) of the patients with placenta previa had a history of previous caesarian section, 27% had previous uterine curettage and 82% were multiparous.18% were asymptomatic placenta previa whereas 82% had one or more bleeding episodes. Expectant management was given to 67% patients after first bleeding episode. Majority (92/130) of patients required emergency cesarean section. Due to invasive placentation, 25 patients required cesarean hysterectomy. Ninety percent patients required delivery at ≤37 weeks and neonatal outcome improved with increasing gestation as expected.Conclusions: Reduction in cesarean rate is the major key factor for decreasing the incidence of placenta previa as, as well as placenta accreta and other associated complications as there were no patients diagnosed to have placenta accreta when placenta previa was present without any previous cesarean scar. In cases of invasive placenta, performing a classical CS, not trying to remove the placenta and proceeding directly to hysterectomy resulted in reduced blood loss. Neonatal outcome as well as maternal outcome is best when cesarean is done between 36-37 weeks.

scholarly journals Abnormally invasive placenta: an overview of diagnosis and management options

2017 ◽  
Vol 6 (11) ◽  
pp. 5013
Author(s):  
Parveen Rajora ◽  
Amanjot Singh
Keyword(s):  
Placenta Previa ◽  
Management Options ◽  
Diagnosis And Management ◽  
Medical College ◽  
Uterine Surgery ◽  
Broad Term ◽  
Invasive Placenta ◽  
Life Threatening ◽  
Foetal Outcome ◽  
Abnormally Invasive Placenta

Background: Abnormally invasive placenta, also known as morbidly adherent placenta, is a broad term that describes abnormal adherence of placenta to the underlying myometrium. Clinical risk factors include placenta previa and prior uterine surgery, including caesarean delivery. The diagnosis and management of women at risk is not only based on clinical parameters, but also driven by imaging, namely ultrasound and more recently magnetic resonance (MRI) imaging.Methods: This is a retrospective analysis of 10 cases of abnormally invasive placenta undertaken at Guru Gobind Singh Medical College and Hospital, Faridkot.Results: Hysterectomy done in six cases and uterus was preserved in four cases. Foetal outcome was on average side. Four foetal losses noted two because of prematurity and two due to excessive blood loss admitted with intra uterine foetal death. Two babies needed NICU care but successfully discharged.Conclusions: Newer approaches should be considered investigational until larger prospective series to become available, until then hysterectomy should remain the stay of treatment specially when the family is complete and there is life threatening Haemorrhage.

scholarly journals Obstetric complications of placenta previa percreta

2014 ◽  
Vol 71 (12) ◽  
pp. 1163-1166 ◽  
Author(s):  
Radmila Sparic ◽  
Ljiljana Mirkovic ◽  
Uros Ravilic ◽  
Tijana Janjic
Keyword(s):  
Uterine Rupture ◽  
Maternal Morbidity ◽  
Vaginal Bleeding ◽  
Placenta Previa ◽  
Bladder Wall ◽  
Fistula Formation ◽  
Ureteral Stricture ◽  
Uterine Incision ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Introduction. Placenta previa is related to severe maternal and fetal morbidity. The increasing incidence of cesarean delivery rate causes a marked increase in abnormally invasive placenta over the past decades. The abnormally invasive placenta is becoming the foremost cause of obstetric hemorrhage and postpartum hysterectomy, causing a significant maternal and fetal morbidity and even mortality. Maternal morbidity in such cases also comprise politransfusion, development of disseminated intravascular coagulation, uterine rupture, cystostomy, fistula formation, ureteral stricture, intensive care unit admission, infection, and prolonged hospitalization, adult respiratory distress syndrome, renal failure, septicemia and even death. Case report. A 38-year-old gravida 3, para 2, was admitted to our hospital at 27 weeks of gestation as an emergency due to vaginal bleeding, previously diagnosed with an anterior placenta previa. Following tocolytic therapy, bleeding stopped. The patient was informed on the diagnosis and the possibility of lifethreatening hemorrhage necessitating preterm delivery. She was given corticosteroids to enhance fetal lung maturity. At 28 weeks of gestation, she experienced massive vaginal bleeding, and a decision was made to perform emergency cesarean section. We made a corporeal transverse uterine incision well above the uterovesical fold and tortuous vessels, at the same time avoiding the superior edge of the placenta. The placenta was found to be densely adherent to the lower uterine segment, penetrating through it and infiltrating the posterior wall of the urinary bladder. An attempt to remove the placenta resulted in injury to the bladder wall and the uterine rupture at a previous cesarean scar. The decision was made to perform total abdominal hysterectomy with placenta left in situ. At present, both mother and the baby are well. Conclusion. Anticipation and the surgeon's judgment are leading factors for surgery, from the choice of uterine incision type to the decision to proceeding to hysterectomy in order to reduce maternal morbidity.

scholarly journals Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Foetal Demise

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
A. MacGibbon ◽  
Y. M. Ius
Keyword(s):  
Fertility Preservation ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Placenta Previa ◽  
Placenta Increta ◽  
Significant Complication ◽  
Obstetric Haemorrhage ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

We present the case of a midtrimester intrauterine foetal demise (IUFD) in the context of abnormally invasive placentation. This was a grade 4 placenta previa with placenta increta in a patient requesting fertility conservation and was managed conservatively without immediate surgical intervention. The patient spontaneously delivered the fetus after 33 days, followed by a large obstetric haemorrhage requiring immediate laparotomy and hysterotomy. Her uterus was preserved and she went on to recover without further significant complication. While conservative management of morbidly adherent placentas has been well documented, there are no published cases of this strategy in the context of IUFD and fertility preservation.

scholarly journals The role of prenatal diagnosis of abnormally invasive placenta in pregnancy outcome

2020 ◽  
Vol 14 (3) ◽  
pp. 384-394
Author(s):  
J. Yu. Ungiadze ◽  
I. V. Nikuradze ◽  
N. D. Zamtaradze
Keyword(s):  
Prenatal Diagnosis ◽  
Cesarean Section ◽  
Past History ◽  
Placenta Previa ◽  
Placenta Praevia ◽  
Artery Ligation ◽  
Total Blood ◽  
Invasive Placenta ◽  
Placental Invasion ◽  
Abnormally Invasive Placenta

Aim: to demonstrate the role and importance of prenatal diagnosis of abnormally invasive placenta.Materials and methods. Retrospective analysis of 3 clinical cases of the delivery in Health Center Medina. All women were diagnosed with the complete placenta praevia and invasion of chorion in the myometrium, the last was confirmed by the results of histological examination. Anamnesis data, extragenital pathology and results of examination during pregnancy were analyzed. In the prenatal period the diagnosis was confirmed by the results of ultrasound examination and MRI in two women.Results. All women were diagnosed with the different degree of placenta praevia, 2 women had a cesarean section in the past history. All patients had unifetal pregnancy without complications and no extragenital pathology was noted. 2 women were diagnosed with the placenta praevia using ultrasound scan and MRI, were estimated the degree and topography of placental invasion. Both women had planned caesarean section. During operation was performed autohemotransfusion using a Cell Saver system. In one of the cases urgent c-section was performed due to the massive bleeding, presence of placental invasion was diagnosed intraoperatively. Hysterectomy was performed in all 3 cases, total blood loss was 950–1450 ml in patients with the prenatally diagnosed invasive placentation. Iliac artery ligation was performed to the third patient, due to excessive bleeding and development of coagulopathy, 1200 ml of fresh frozen plasma has been transfused for correction of coagulopathy, as well as transfusion of donor erythrocyte mass.Conclusion. Probably the development of placental invasion abnormalities along with other factors is mostly affected by presence of placenta previa and cesarean section in the patient’s past history. Prenatal assessment of presence and degree of the abnormal placental invasion is important factor for planning of delivery: gestational age, method and the hospital level.

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