scholarly journals Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Helena C. Bartels ◽  
James D. Postle ◽  
Paul Downey ◽  
Donal J. Brennan
Keyword(s):  
Molecular Biology ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Protein A ◽  
Serum Biomarkers ◽  
Chorionic Villi ◽  
Complex Process ◽  
Maternal Morbidity And Mortality ◽  
Placenta Accreta Spectrum ◽  
Disease Stratification

Background. Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.

scholarly journals PLACENTA ACCRETA SPECTRUM - A CASE SERIES

2020 ◽  
pp. 1-4
Author(s):  
Medha Dadaji Davile ◽  
Anil Charandas Humane ◽  
Ashwini Kuchnur
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Obstetric Hemorrhage ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
Placenta Accreta Spectrum

Morbidly adherent placenta is a major cause for massive obstetric hemorrhage, which leads to maternal morbidity and mortality. Most accepted hypothesis for etiology of placenta accreta spectrum is defect in the endometrial–myometrial interface which leads to failure of normal decidualization in the uterine scar, which allows abnormal deep infiltration of placental anchoring villi and trophoblast. Maternal morbidity and mortality can occur as a result of massive and sometimes life-threatening obstetric hemorrhage which often requires blood transfusion. It becomes exponential and life threatening when placenta previa is associated with placenta accreta spectrum. There are several risk factors for placenta accreta spectrum, most common being previous caesarian section. Antenatal diagnosis of placenta accreta is highly desirable as outcomes are optimized when timely delivery occurs at a tertiary care facility accustomed to handle such cases. Here we are reporting six cases of placenta accreta spectrum managed by conventional and expectant way at our tertiary care hospital. Methods: Study was carried out in Government Medical College & Hospital, Nagpur. Case records of patients with placenta accreta syndrome between December 2019 and March 2020 were reviewed and analysed. Results: Six cases of placenta accreta syndrome were studied.100% patients had history of previous caesarean section, 5 patients had associated placenta previa. One out of six patients one had history of dilatation and evacuation for missed abortion.4 out of six underwent caesarean hysterectomy and 2 underwent conservative management with uterine preservation. Average blood loss was 2500 ml. Conservative management was successful in two patients. There was no maternal mortality in series. Conclusion : Among many risk factors, previous caesarean section is the most common. Therefore reducing rate of caesarean deliveries can reduce the prevalence of placenta accreta syndromes. Adherent placenta should be suspected in cases of previous caesarean with placenta previa, high parity, uterine curettage, and uterine surgeries.Conservative management should be reserved for selected patients. MRI is not mandatory for diagnosis of the condition.

Clinical outcomes of a false positive antenatal diagnosis of placenta accreta spectrum

2021 ◽  
Author(s):  
Bahram Salmanian ◽  
Amir A. Shamshirsaz ◽  
Karin Fox ◽  
nazlisadat meshinchi asl ◽  
Hadi Erfani ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Resource Utilization ◽  
False Positive ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Antenatal Diagnosis ◽  
Estimated Blood Loss ◽  
Management Protocol ◽  
Significant Difference ◽  
Placenta Accreta Spectrum

Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is critical to reduce maternal morbidity. While clinical outcomes of women with PAS have been extensively described, little information is available regarding the women who undergo cesarean delivery with a presumptive PAS diagnosis which is not confirmed by histopathologic examination. We sought to examine resource utilization and clinical outcomes of this group of women with a false-positive diagnosis of PAS. Study design: Retrospective analysis of patients with prenatally diagnosed PAS cared for between 2015 and 2020 by our multidisciplinary PAS team. Maternal outcomes were examined. Univariate analysis was performed and a multivariate model was employed to compare outcomes between women with and without histopathologically confirmed PAS. Results: A total of 162 patients delivered with the pre-operative diagnosis of PAS. Of these, 146 (90%) underwent hysterectomy and had histopathologic confirmation of PAS. Thirteen women did not undergo the planned hysterectomy. Three women underwent hysterectomy but pathologic examination did not confirm PAS. In comparing women with and without pathologic confirmation of PAS, the false positive PAS group delivered later in pregnancy (34 vs. 33 weeks of gestation, P=0.015) and had more planned surgery (88% vs. 47%, P = 0.002). There was no difference in skin incision type or hysterotomy placement for delivery. No significant difference in either the estimated blood loss or blood components transfused was noted between groups. Conclusion: Careful intraoperative evaluation of women with pre-operatively presumed PAS resulted in a 3/149 (2%) retrospectively unnecessary hysterectomy. Management of women with PAS in experienced centers benefits patients both in terms of resource utilization and avoidance of unnecessary maternal morbidity, understanding that our results are produced in a center of excellence for PAS. We also propose a management protocol to assist in the avoidance of unnecessary hysterectomy in women with the pre-operative diagnosis of PAS.

scholarly journals When is the ideal time to remove cerclage in cases requiring cesarean hysterectomy for placenta accreta spectrum?

2019 ◽  
Vol 8 (4) ◽  
pp. 1668
Author(s):  
Futa Ito ◽  
Shinya Matsuzaki ◽  
Masayuki Endo ◽  
Tadashi Kimura
Keyword(s):  
Preterm Birth ◽  
Maternal Morbidity ◽  
Birth Rate ◽  
Placenta Accreta ◽  
Cervical Insufficiency ◽  
Short Cervix ◽  
Cesarean Hysterectomy ◽  
Preterm Birth Rate ◽  
Placenta Accreta Spectrum ◽  
The Ideal

Placenta accreta spectrum (PAS) presents one of the highest risks to pregnancy and often requires a cesarean hysterectomy for management, but the challenges associated with this surgery often cause severe obstetric haemorrhaging and high rates of maternal morbidity. Shirodkar cerclage is usually performed in cases with cervical insufficiency, a short cervix with previous preterm birth, etc., to decrease the preterm birth rate. It is recommended that Shirodkar cerclage is removed when the patient approaches term, but the ideal timing of removal for patient for whom cesarean hysterectomy is planned is not clear. Here, authors present a case of PAS in whom Shirodkar cerclage that was difficult to remove at the timing of cesarean hysterectomy. After cesarean hysterectomy, the patient had a vaginal abscess and required antibiotic therapy for approximately two weeks. In the light of our case, authors discuss the timing of removal of cerclage in the cases of PAS.

scholarly journals ElNoury - Webster bundle: a pre-emptive surgical approach for the management of morbidly low or adherent placenta

2020 ◽  
Author(s):  
Amr Elnouri ◽  
Dr Sophia Webster ◽  
Diaa Abdelhalim
Keyword(s):  
Placenta Accreta ◽  
Case Series ◽  
Placenta Praevia ◽  
Uterine Preservation ◽  
Healthcare Settings ◽  
Adherent Placenta ◽  
Obstetric Haemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy

Placenta accreta spectrum and placenta praevia are a significant cause of obstetric haemorrhage, maternal morbidity and mortality worldwide. We report a novel surgical technique, which pre-emptively and prophylactically reduces intrapartum bleeding during caesarean sections for these conditions and hence reducing the risk for a caesarean hysterectomy. This technique is particularly useful in low resource healthcare settings where interventional radiology is not readily available and where the woman is keen on uterine preservation. In this report we present the surgical and clinical outcomes of a case series of 16 patients on whom this technique was piloted demonstrating its feasibility and safety.

Improved management of placenta accreta spectrum disorders: experience from a single institution

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kendra Sylvester-Armstrong ◽  
Callie Reeder ◽  
Kathryn Patrick ◽  
Mehmet R. Genc
Keyword(s):  
Blood Loss ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Logistic Analysis ◽  
Improved Outcomes ◽  
Estimated Blood Loss ◽  
Placenta Accreta Spectrum ◽  
T1 And T2

Abstract Objectives To assess the applicability of a standardized multidisciplinary protocol for managing placenta accreta spectrum (PAS) disorders and its impact on the outcomes. Methods We compared patients with PAS manage by a standardized multidisciplinary protocol (T2) to historic controls managed on a case-by-case basis by individual physicians between (T1). The primary outcome is composite maternal morbidity. Secondary outcomes were the rates of surgical complications, estimated blood loss, number of blood products transfused, intensive care unit admissions, ventilator use, and birth weight. Multivariate logistic analysis was used to identify independent predictors of composite maternal morbidity. Results During T1 and T2, we managed 39 and 36 patients with confirmed PAS, respectively. During T2, the protocol could be implemented in 21 cases (58%). Compared to T1, patients managed during T2 had 70% less composite maternal morbidity (95% CI: 0.11–0.82) and lower blood loss (median, 2,000 vs. 1,100 mL, p=0.008). Also, they were 68% less likely to require transfusion of blood products (95% CI: 0.12–0.81; p=0.01), including fewer units of packed red blood cells (median, 2 vs. 0, p=0.02). Management following the protocol was the only independent factor associated with lower composite maternal morbidity (OR: 0.22; 95% CI: 0.05–0.95; p=0.04). Selected maternal and neonatal outcomes were not different among 12 and 15 patients with suspected but unconfirmed PAS disorders managed during T1 and T2, respectively. Conclusions Most patients can be managed under a standardized multidisciplinary protocol for PAS disorders, leading to improved outcomes.

MORBID ADHERENT PLACENTA: PREDICTION, DIAGNOSIS AND MANAGEMENT

2007 ◽  
Vol 18 (4) ◽  
pp. 357-381 ◽  
Author(s):  
JM PALACIOS JARAQUEMADA ◽  
CH BRUNO ◽  
WA CLAVELLI
Keyword(s):  
Caesarean Section ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Close Relation ◽  
Morbidity And Mortality ◽  
Vital Importance ◽  
Diagnosis And Management ◽  
On Demand ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality

Morbid adherent placenta (MAP), also known as placenta accreta, increta or percreta, is one of the main causes of maternal morbidity and mortality. Its incidence has noticeably increased in the last few decades, a fact directly related to the increase in caesarean sections. There is a close relation between iterative caesarean sections and MAP. This connection is of vital importance, since caesarean rates have risen worldwide, especially in the countries where there is the possibility of caesarean section on demand.

scholarly journals Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 111
Author(s):  
Nicolae Gică ◽  
Carina Ragea ◽  
Radu Botezatu ◽  
Gheorghe Peltecu ◽  
Corina Gică ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Morbidity Rate ◽  
Maternal Outcomes ◽  
Peripartum Hysterectomy ◽  
Cesarean Deliveries ◽  
Life Saving ◽  
Emergency Peripartum Hysterectomy ◽  
Placenta Accreta Spectrum

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

Resurgence of classical caesarean section in current obstetric practice- A case series

2021 ◽  
Vol 8 (4) ◽  
pp. 592-594
Author(s):  
Priyanka Mathe ◽  
Sanjana Narula Wadhwa ◽  
Taru Gupta
Keyword(s):  
Multidisciplinary Approach ◽  
Placenta Accreta ◽  
Case Series ◽  
Cesarean Sections ◽  
Obstetric Hemorrhage ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
Placenta Accreta Spectrum ◽  
High Index Of Suspicion ◽  
Lower Segment Uterine

Although, the incidence of placenta accreta spectrum (PAS) and large fibroids is rare but still these cases contributes to a large number of maternal morbidity and mortality. Major obstetric hemorrhage is one the dreadful complication of these types of cases and thus early diagnosis and intervention in such cases helps the physician to minimize the risk to mother and the fetus. Also, current widespread use of ultrasound has helped us to manage these cases judiciously, predict and prevent life threatening obstetric hemorrhage. Here we present three complicated obstetric cases of placenta accreta, large lower segment uterine fibroid and large cervical fibroid which necessitated classical cesarean sections (CCS) thus emphasizing prowess in CCS in modern obstetric era. High index of suspicion, Multidisciplinary approach alongwith expert surgical personnel should be available in high risks cases like placenta accreta syndrome and large fibroids in pregnancy.

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