scholarly journals Response to “Surgical management of abnormally invasive placenta: is decreased blood loss due to participation of gynecologic oncologists?”

2015 ◽  
Vol 95 (1) ◽  
pp. 120-120
Author(s):  
Donal Brennan ◽  
Alex Crandon ◽  
Lewis Perrin
Keyword(s):  
Blood Loss ◽  
Surgical Management ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

scholarly journals Surgical management of abnormally invasive placenta: is decreased blood loss due to participation of gynecologic oncologists?

2015 ◽  
Vol 95 (1) ◽  
pp. 119-119 ◽  
Author(s):  
Shigeki Matsubara ◽  
Hiroyuki Fujiwara ◽  
Akihide Ohkuchi ◽  
Hironori Takahashi ◽  
Alan K. Lefor
Keyword(s):  
Blood Loss ◽  
Surgical Management ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

scholarly journals Factors Contributing to Massive Blood Loss on Peripartum Hysterectomy for Abnormally Invasive Placenta: Who Bleeds More?

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Hironori Takahashi ◽  
Akihide Ohkuchi ◽  
Rie Usui ◽  
Hirotada Suzuki ◽  
Yosuke Baba ◽  
...  
Keyword(s):  
Blood Loss ◽  
Balloon Catheter ◽  
Massive Bleeding ◽  
Peripartum Hysterectomy ◽  
Perinatal Center ◽  
Invasive Placenta ◽  
Primiparous Women ◽  
Emergent Surgery ◽  
Abnormally Invasive Placenta ◽  
Prior Cesarean Section

Introduction. To identify factors that determine blood loss during peripartum hysterectomy for abnormally invasive placenta (AIP-hysterectomy).Methods. We reviewed all of the medical charts of 11,919 deliveries in a single tertiary perinatal center. We examined characteristics of AIP-hysterectomy patients, with a single experienced obstetrician attending all AIP-hysterectomies and using the same technique.Results. AIP-hysterectomy was performed in 18 patients (0.15%: 18/11,919). Of the 18, 14 (78%) had a prior cesarean section (CS) history and the other 4 (22%) were primiparous women. Planned AIP-hysterectomy was performed in 12/18 (67%), with the remaining 6 (33%) undergoing emergent AIP-hysterectomy. Of the 6, 4 (4/6: 67%) patients were primiparous women. An intra-arterial balloon was inserted in 9/18 (50%). Women with the following three factors significantly bled less in AIP-hysterectomy than its counterpart: the employment of an intra-arterial balloon (4,448±1,948versus8,861±3,988 mL), planned hysterectomy (5,003±2,057versus9,957±4,485 mL), and prior CS (5,706±2,727versus9,975±5,532 mL). Patients with prior CS (−) bled more: this may be because these patients tended to undergo emergent surgery or attempted placental separation.Conclusion. Patients with intra-arterial balloon catheter insertion bled less on AIP-hysterectomy. Massive bleeding occurred in emergent AIP-hysterectomy without prior CS.

The Role of Bilateral Internal Iliac Artery Ligation in Minimizing Blood Loss Prior to Cesarean Hysterectomy Patients with Abnormally Invasive Placenta

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Magdy Mohamed kamal Yousef ◽  
Ahmed Mohamed Rateb ◽  
Ahmed Mohsen Hassan Mohamed
Keyword(s):  
Blood Loss ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Artery Ligation ◽  
Cesarean Hysterectomy ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Abstract Background Abnormally invasive placenta (AIP) is a term that describes cases in which there is complete or partial failure of separation of the placenta from the uterine wall following delivery of the fetus. Objective to detect the role of bilateral internal iliac artery ligation in minimizing blood loss, prior to performing Cesarean Hysterectomy in cases with confirmed preoperative or intraoperative diagnosis of Abnormally invasive placenta. Patients and Methods The study was carried out at Ain shams university maternity hospital in 2019. Women were recruited from the labor ward who underwent CS Hysterectomy. The total number of pregnant women enrolled in the study was 95 women. Approval from the Medical Ethics Committee were obtained. Results Our study showed that internal iliac artery ligation in CS hysterectomy cases for AIP has non significant lower blood loss than cases who did not underwent internal iliac artery ligation. In stead, it had increased the operative time. In comparison of 45 patients underwent internal iliac artery ligation and 45 without ligation blood loss was non significantly lower in the group who underwent ligation with mean 1933 ml blood loss in comparison with 2117 ml in the group who did not. Conclusion Bilateral internal iliac artery ligation, in cases of AIP undergoing caesarean hysterectomy, is not recommended for routine practice to minimize blood loss intraoperatively.

Surgical Management of Abnormally Invasive Placenta

2016 ◽  
Vol 36 (4) ◽  
pp. 203-204
Author(s):  
D.J. Brennan ◽  
B. Schulze ◽  
N. Chetty ◽  
A. Crandon ◽  
S.G. Petersen ◽  
...  
Keyword(s):  
Surgical Management ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

scholarly journals Conservative management of abnormally invasive placenta complicated by local hyperfibrinolysis and beginning disseminated intravascular coagulation

2020 ◽  
Author(s):  
C. Biele ◽  
L. Kaufner ◽  
A. Schwickert ◽  
A. Nonnenmacher ◽  
K. von Weizsäcker ◽  
...  
Keyword(s):  
Blood Loss ◽  
Disseminated Intravascular Coagulation ◽  
Conservative Management ◽  
Maternal Blood ◽  
Oral Dosage ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Pubmed Database ◽  
Invasive Placenta ◽  
Abnormally Invasive Placenta

Abstract Introduction Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead to high perioperative maternal blood loss. A conservative treatment by leaving the placenta in utero after caesarean delivery of the baby is an option to preserve fertility and to reduce peripartum hysterectomy-related morbidity. Nevertheless, due to increased placental coagulation activity as well as consumption of clotting factors, a disseminated intravascular coagulation (DIC)-like state with secondary late postpartum bleeding can occur. Purpose Systematic review after the presentation of a case of conservative management of placenta percreta with secondary partial uterine wall resection due to vaginal bleeding, complicated by local hyperfibrinolysis and consecutive systemic decrease in fibrinogen levels. Methods Systematic PubMed database search was done until August 2019 without any restriction of publication date or journal Results Among 58 publications, a total of 11 reported on DIC-like symptoms in the conservative management of AIP, in the median on day 59 postpartum. In most cases, emergency hysterectomy was performed, which led to an almost immediate normalization of coagulation status but was accompanied with high maternal blood loss. In two cases, fertility-preserving conservative management could be continued after successful medical therapy. Conclusion Based on these results, we suggest routinely monitoring of the coagulation parameters next to signs of infection in the postpartum check-ups during conservative management of AIP. Postpartum tranexamic acid oral dosage should be discussed when fibrinogen levels are decreasing and D-Dimers are increasing.

scholarly journals Management of Abnormally Invasive Placenta: One-center Experience

2017 ◽  
Vol 11 (3) ◽  
pp. 184-188
Author(s):  
Grigoriy Penzhoyan ◽  
Vladislava Novikova
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Placenta Previa ◽  
Combined Treatment ◽  
Total Blood ◽  
Multiparous Women ◽  
Perinatal Center ◽  
Invasive Placenta ◽  
Magnetic Resonance Imaging Mri ◽  
Abnormally Invasive Placenta

ABSTRACT Aim To present one-center experience of the management of abnormally invasive placenta (AIP). Materials and methods This was a retrospective cohort study of clinical cases of abnormally invasive placenta (the AIP) in Perinatal Center (PC), which is part of General Hospital— Regional Clinical Hospital N2 of Krasnodar city, in the period from 2014 to August 2016. Results The total number of childbirth for the period was 24 078, and AIP was diagnosed in 0.17%. The average age of women was 31.5 ± 0.8 years. About 97.5% were multiparous women and 85% women in the previous pregnancy had childbirth by cesarean section (CS): One CS—41.18%, two—32.35%, and three—23.53%. An AIP was first diagnosed in pregnancy at 11 to 39 weeks of pregnancy by ultrasound or magnetic resonance imaging (MRI). Cesarean section performed in the conditions of the X-ray operating of the endovascular department. The relative risk (RR) for accurate diagnosis of AIP by ultrasound was 1.789 ± 0.709 [95% confidence interval (CI) 0.446–7.186], and for MRI RR was 0.944 ± 0.142 (95% CI 0.715–1.246). At CS, in 85% of women balloon dilatation of the iliac vessels was performed, in 15%, uterine artery embolization (UAE), and in 72.5%, metroplasty. In 15% of women with AIP were the cause of hysterectomy without adnexa. The total blood loss was 1152.56 ± 107.67 (4,000–35,000) mL or 15.539 ± 1.7374 (5,0000–58,330) mL/kg. Maximum blood loss was in women with placenta previa and its localization in the area of the scar on the uterus that required a hysterectomy. Conclusion Despite increasing incidence of AIP, it is possible to prevent massive blood loss during delivery by combined treatment using radiological endovascular procedures for devascularization of the lower pelvis. Early diagnosis of placental abnormalities with regionalized approach in perinatal health makes it possible not only to preserve the women's reproductive health and fertility but also to minimize postpartum hemorrhage. How to cite this article Penzhoyan G, Novikova V. Management of Abnormally Invasive Placenta: One-center Experience. Donald School J Ultrasound Obstet Gynecol 2017;11(3):184-188.

The Jellyfish Sign: A New Sonographic Cervical Marker to Predict Maternal Morbidity in Abnormally Invasive Placenta Previa

2017 ◽  
Vol 40 (01) ◽  
pp. 40-46 ◽  
Author(s):  
Emma Bertucci ◽  
Filomena Sileo ◽  
Giovanni Grandi ◽  
Valentina Fenu ◽  
Carlotta Cani ◽  
...  
Keyword(s):  
Blood Loss ◽  
Maternal Morbidity ◽  
Placenta Previa ◽  
Intraoperative Bleeding ◽  
Cesarean Hysterectomy ◽  
Postoperative Intensive Care ◽  
Invasive Placenta ◽  
Postoperative Intensive Care Unit ◽  
Caesarean Hysterectomy ◽  
Abnormally Invasive Placenta

Abstract Purpose To investigate the value of a new cervical sonographic sign, called the jellyfish sign (JS), for predicting the risk of maternal morbidity in cases of abnormally invasive placenta (AIP) previa totalis. Materials and Methods Retrospective evaluation of transvaginal (TV) and transabdominal (TA) scans performed in all singleton pregnancies with placenta previa totalis. JS, i. e. the absence of the normal linear demarcation between the placenta previa and the cervix, was evaluated by TV scans. The presence/severity of AIP and outcomes of maternal morbidity were related to this sign. Results JS was noted in 8/39 (20.5 %) patients. The two analyzed groups, i. e. with and without JS, were similar. The specificity of JS in AIP diagnosis, histological findings of accreta/increta/percreta, need for caesarean hysterectomy or blood loss > 2000 ml ranges between 92 % and 96.2 %, with the PPV and NPV ranging between 71.4 % and 85.7 % and 61.3 % and 80.6 %, respectively. The JS group had a significant increase in blood loss (ml) (p = 0.003), transfusions (%) (p = 0.016), red blood cells (p = 0.002) and plasma (p = 0.002), admission to an postoperative intensive care unit (ICU) (%) (p = 0.002), hospitalization length (p < 0.001) and the need of cesarean hysterectomy (%) (p < 0.001). JS was independently correlated to cesarean hysterectomy (OR 25.6; 95 % CI 2.0:322.3, p = 0.012) and blood loss > 2000 ml (OR 16.6; 95 % CI 1.5:180.1, p = 0.021) also in a logistic regression model. Conclusion JS is useful in predicting the increase in maternal morbidity: massive transfusion, admission to the ICU and cesarean hysterectomy related to intraoperative bleeding in patients with a previa AIP.

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