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.

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.

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 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.

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