scholarly journals Cateterismo percutaneo a palloncino delle arterie uterine nei casi placenta accreta: misure pratiche di riduzione della dose durante l’angiografia

2019 ◽  
Author(s):  
Bartolini Susanna
Keyword(s):  
Placenta Accreta ◽  
Post Partum ◽  
Radiologia Interventistica ◽  
Terapia Intensiva

Il cateterismo tramite palloni vascolari delle arterie uterine nei casi elettivi di parto con taglio cesareo, a seguito di diagnosi di placenta accreta, è una procedura di radiologia interventistica. Questa semplice procedura richiede una buona conoscenza delle varie strategie attuabili per la riduzione della dose al paziente e in questo caso un’attenzione in più rivolta a quei piccoli pazienti presenti nel grembo materno. Queste strategie di riduzione e di gestione della dose vengono attuate attraverso fattori propri delle apparecchiature e, attraverso corrette tecniche che sono dipendenti dall’operatore e dalla procedura stessa. Nel complesso la procedura, condotta da team multidisciplinare (radiologia interventistica, ginecologia ed ostetricia, neonatologia, anestesiologia area materno-infantile, terapia intensiva…) può essere suddivisa in: • fase angiografica: posizionamento pre-chirurgico dei cateteri a palloncino per limitare l’afflusso ematico arterioso diretto all’utero durante le fasi immediatamente successive al parto; • fase chirurgica: estrazione del neonato e della placenta, controllo del sanguinamento associato alla procedura chirurgica; • fase angiografica: con eventuale intervento di embolizzazione finalizzata ad occlusione selettiva delle arterie uterine, cercando di limitare il ricorso all’isterectomia nei casi non responsivi al trattamento mini-invasivo. Avere una familiarità elevata con questa tecnica diventa evidente poiché la procedura può essere convertita, secondo esigenze cliniche, da chirurgica ad angiografica e viceversa, e se si pensa che la condizione di placenta accreta è la terza causa di emorragia post-partum, emorragia che è prima causa di mortalità materna.

scholarly journals SUN-007 Elevated Levothyroxine Requirements Post-Partum as Initial Presentation of Placenta Accreta

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ginny W Bao ◽  
Melissa E Weinberg ◽  
Christina Kwan
Keyword(s):  
Breast Milk ◽  
Placenta Accreta ◽  
Post Partum ◽  
Normal Vaginal Delivery ◽  
Temporal Association ◽  
Hypothyroid Patient ◽  
Dilation And Curettage ◽  
Pregnancy And Postpartum ◽  
History Of ◽  
Tsh Levels

Abstract Introduction: It is well known that estrogen plays an important role in thyroid regulation. We report an unusual case of post-partum placenta accreta causing pathologic estrogen secretion leading to increased levothyroxine (LT4) requirements and inability to lactate. Case: A 36-year-old woman with history of Hashimoto’s hypothyroidism presented post-partum day 11 after a normal vaginal delivery with inability to produce breast milk and mildly elevated TSH levels. Prior to her pregnancy, she required an equivalent dose of 142 mcg of LT4 supplementation daily, which increased appropriately to 171 mcg during pregnancy. After delivery, LT4 was decreased to 150mcg in anticipation of normalization of levothyroxine requirements to pre-pregnancy level. However, she had difficulty lactating and was found to have elevated prolactin, estradiol, and TSH levels. The following day, she presented to her obstetrician for persistent vaginal bleeding and was found to have placenta accreta requiring dilation and curettage (D&C). Her LT4 requirements eventually dropped to 125 mcg with decreasing beta-HCG and estrogen levels after successful D&C treatment. She was also then able to produce sufficient breast milk for lactation. Discussion: This case highlights the effect of estrogen on LT4 requirements during physiologic pregnancy and postpartum with placenta accreta. It is expected that hypothyroid patients have approximately 25-50% increased thyroid replacement requirements during pregnancy, which normalizes soon after delivery.1 Estrogen increases thyroxine-binding globulin and lowers circulating free thyroxine2,, which causes higher thyroid replacement requirements. Estrogen is also known to inhibit lactation. Our patient demonstrates that this holds true even in a pathologically high estrogen state from placenta accreta. Our case uniquely demonstrates a temporal association between estrogen levels and LT4 requirements in the post-partum hypothyroid patient. Patients with inappropriately high TSH levels after delivery should prompt investigation into pathologic causes of elevated estrogen-states, as levothyroxine requirements are expected to normalize immediately post-partum. References: 1. Bungard TJ, Hurlburt M. Management of hypothyroidism during pregnancy. CMAJ. 2007;176(8):1077-8. 2. Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004 Jul 15;351(3):241-9.

A prior placenta accreta is an independent risk factor for post-partum hemorrhage in subsequent gestations

2015 ◽  
Vol 187 ◽  
pp. 20-24 ◽  
Author(s):  
Adi Vinograd ◽  
Tamar Wainstock ◽  
Moshe Mazor ◽  
Salvatore Andrea Mastrolia ◽  
Ruthy Beer-Weisel ◽  
...  
Keyword(s):  
Risk Factor ◽  
Independent Risk Factor ◽  
Placenta Accreta ◽  
Post Partum ◽  
Post Partum Hemorrhage

scholarly journals MAGNETIC RESONANCE EVALUATION OF INVASIVE PLACENTA – OUR EXPERIENCE

2020 ◽  
pp. 1-3
Author(s):  
Prajwaljeet Gour ◽  
Deoyani Sarjare ◽  
Kalyani Wani ◽  
Sandhya Yeshwante
Keyword(s):  
Magnetic Resonance ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Post Partum ◽  
Treatment Options ◽  
Cross Sectional Study ◽  
Treatment Modalities ◽  
Mri Findings ◽  
Cross Sectional ◽  
Obstetric Management

Introduction: Placenta accreta (PA) includes various types of abnormal placentation in which chorionic villi attach directly to or invade he myometrium. There is a rising trend of placenta accreta owing to increased number of primary and repeat Caesarean sections. Accurate and timely identification of affected pregnancies allows optimal obstetric management to reduce maternal morbidity and mortality. The availability of conservative treatment modalities for the management of post partum hemorrhage arising from the same mandates the use of magnetic resonance imaging (MRI) to precisely evaluate the degree of placental invasion so as to further guide the treatment options. Materials and Methods: In two years observational cross sectional study, 18 pregnant females between age group 15-40 years were subjected to MRI pelvis and MRI findings were noted. Result : Placenta accrete vera was the most common type found in our study. Patients with placenta previa and previous Caesarean section were at highest risk. Intraplacental bands, heterogenous placenta, lumpy placental contour were the most commonly observed findings. Conclusion: MRI is very useful for accurate evaluation of placenta accreta particularly when USG findings are ambiguous or when there is a posterior placenta. There is increased incidence of placenta accreta with multiparity, placenta previa and history of previous Caesarean sections.

scholarly journals A case series on conservative management in pregnancies with abnormal placentation in obstetrics: placenta accrete, increta and percreta

2018 ◽  
Vol 7 (12) ◽  
pp. 5193
Author(s):  
Fasiha Tasneem ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Post Partum ◽  
Case Series ◽  
Chemotherapeutic Agents ◽  
Morbidly Adherent Placenta ◽  
Decidua Basalis ◽  
Adherent Placenta ◽  
Caesarean Delivery Rate

Adherent placenta is one of the important causes of post- partum hemorrhage. Placenta accreta-related pathologies are an increasing contributor to maternal death from hemorrhage. With the rising caesarean delivery rate the incidence of placenta accreta has significantly increased. Morbidly adherent placenta (MAP) occurs when there is a defect in the decidua basalis, resulting in an abnormal invasion of the placenta into the substance of the uterus. A multidisciplinary approach is relevant in managing these patients in order to reduce morbidity and mortality associated with morbidly adherent placenta. A non-surgical conservative method is to leave the placenta in situ to reabsorb and institute treatment with chemotherapeutic agents, such as methotrexate. With improvement in the medical services conservative management for adherent placenta has gained significance.

scholarly journals Huge Post-Partum Intra-Myometrial Hematoma (Couvelaire Uterus) in A Preserved Uterus in A Case of Placenta Accreta: Case Report

2021 ◽  
Vol 84 (1) ◽  
pp. 2173-2175
Author(s):  
Ahmed A. Khalifa ◽  
Elsemary M.A ◽  
Mahmoud Mousa Ahmed ◽  
Mariam M. Elshamandy
Keyword(s):  
Case Report ◽  
Placenta Accreta ◽  
Post Partum

scholarly journals Placenta accreta scoring system (PASS)—assessment of a simplified clinico-radiological scoring system for antenatal diagnosis of placenta accreta

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Harsha Vardhan Mahalingam ◽  
Rajeswaran Rangasami ◽  
J. Premkumar ◽  
Anupama Chandrasekar
Keyword(s):  
Scoring System ◽  
High Probability ◽  
Placenta Accreta ◽  
Antenatal Diagnosis ◽  
Post Partum ◽  
Diagnostic Feature ◽  
Mri Findings ◽  
Multiple Imaging ◽  
Wide Range ◽  
Significant Difference

Abstract Background Placenta accreta spectrum (PAS) of disorders is an important cause of post-partum hemorrhage and resultant maternal morbidity and mortality. Imaging plays an indispensable role in antenatal diagnosis of PAS. However, diagnosis of PAS on both ultrasonography and magnetic resonance imaging (MRI) is reliant on recognition of multiple imaging signs each of which have a wide range of sensitivity and specificity. There is no single pathognomonic diagnostic feature. This results in interobserver variability. In our study, we aim to assess the accuracy of a combined clinico-radiological scoring system in predicting placenta accreta. Results This retrospective study included 60 MRI examinations done for suspected placenta accreta (PA). MRI findings were assessed by two radiologists in consensus. Clinical details of the patients were obtained from the hospital information system. Two clinical and six imaging criteria were assessed and a total score was calculated for each patient. Patients were stratified into three groups—low, moderate or high probability for placenta accreta based on the total score. The presence of any statistically significant difference in prevalence of PA among these groups was assessed. Intra-operative findings/histopathology were considered the gold standard. The prevalence of PA was 3% (1/33), 28.5% (2/7) and 90% (18/20) in the low-, moderate- and high-risk groups respectively. There was a statistically significant difference in the prevalence between the three groups (chi-square statistic = 41.54, p value < 0.0001). A score of greater than or equal to 6 provided sensitivity, specificity and accuracy of 85.71, 94.87 and 92.5% respectively in diagnosing placenta accreta. Conclusion PASS provides a simple, objective and accurate way to stratify patients into low, intermediate and high probability categories for PA.

scholarly journals Placenta Accreta: Obstetrician's Nightmare; A Case Series of Seven Patients

2013 ◽  
Vol 7 (1) ◽  
pp. 56-58
Author(s):  
Deepti Choudhary ◽  
A Nigam ◽  
R Yadav ◽  
S Choudhary ◽  
C Raghunandan
Keyword(s):  
Maternal Age ◽  
Placenta Accreta ◽  
Post Partum ◽  
Case Series ◽  
Bladder Injury ◽  
Complication Rates ◽  
Cesarean Sections ◽  
Peripartum Hysterectomy ◽  
Obstetrics And Gynaecology ◽  
Short Span

The incidence of placenta accreta is increasing as a consequence of rising number of cesarean sections and advancing maternal age. A series of seven cases of placenta accreta observed in a short span of four months is being presented. Complication rates in the present series are post partum hemorrhage and major transfusion support (100%), peripartum hysterectomy (100%), ICU admission in four (57%), fever (14%) and bladder injury in one case (14%). Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 56-58 DOI: http://dx.doi.org/10.3126/njog.v7i1.8839

Sign in / Sign up

Export Citation Format

Share Document