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.

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.

scholarly journals Cesarean Hysterectomy in Abnormally Invasive Placenta: The Role of Prenatal Diagnosis

Diseases ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 56
Author(s):  
Ana Maria Cubo ◽  
Ana Villalba Yarza ◽  
Irene Gastaca ◽  
María Victoria Lapresa-Alcalde ◽  
Maria José Doyague ◽  
...  
Keyword(s):  
Decisive Role ◽  
Massive Bleeding ◽  
High Rate ◽  
Severe Bleeding ◽  
Cesarean Hysterectomy ◽  
Invasive Placenta ◽  
Postsurgical Recovery ◽  
Dangerous Condition ◽  
Abnormally Invasive Placenta

An abnormally invasive placenta (AIP) is a placenta that cannot be removed spontaneously or manually without causing severe bleeding. It is a dangerous condition associated with a high rate of maternal and perinatal morbidity and mortality due to the high rate of massive bleeding and visceral injuries. The standardized ultrasound diagnostic criteria have helped improve its early diagnosis, which is essential to plan coordinated actions to reduce associated morbimortality. We present a case report in which ultrasound diagnosis played a decisive role, enabling the coordination of a multidisciplinary team and improving the immediate care of both mother and newborn. Cesarean hysterectomy was performed with minimal blood loss and a good postsurgical recovery.

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

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.

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.

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