scholarly journals A Quality Improvement Initiative to Decrease Maternal Morbidity in Placenta Accreta Spectrum with a Standardized Approach: A Single Institution Experience

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Lersten Ivy L ◽  
Rodriguez Christina E ◽  
Gilroy Jamie R ◽  
Fink Dina M ◽  
Guntupalli Saketh R
Keyword(s):  
Quality Improvement ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Quality Improvement Initiative ◽  
Single Institution ◽  
Placenta Accreta Spectrum

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.

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.

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.

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 767: Improvements in the management of placenta accreta Spectrum (PAS): Experience from a single institution

2020 ◽  
Vol 222 (1) ◽  
pp. S485-S486
Author(s):  
Kendra Sylvester-Armstrong ◽  
Kathryn Patrick ◽  
Erika Wert ◽  
Lauren Silva ◽  
Elif Esra Gultekin-Elbir ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Single Institution ◽  
Placenta Accreta Spectrum

Planned versus Unplanned Delivery for Placenta Accreta Spectrum

2020 ◽  
Author(s):  
Michal Fishel Bartal ◽  
Ramesha Papanna ◽  
Nikolaos M. Zacharias ◽  
Neomary Soriano-Calderon ◽  
Maria Limas ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Primary Outcome ◽  
Placenta Accreta ◽  
Statistical Significance ◽  
Neonatal Morbidity ◽  
Adverse Outcomes ◽  
Severe Maternal Morbidity ◽  
Cesarean Hysterectomy ◽  
Significant Difference ◽  
Placenta Accreta Spectrum

Objective Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. Study Design Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal morbidity which defined as any of the following: transfusion of ≥4 RBC units or ureter/bowel injury. Neonatal outcome was a composite neonatal morbidity defined as any of the following: Apgar score's < 5 at 5 minutes, mechanical ventilation, or respiratory distress syndrome. Maternal demographic, clinical, and sonographic characteristics were compared between the two groups (planned vs. unplanned). Descriptive statistics were used as appropriate, and a statistical significance was established if p-value was < 0.05. Results Of 109 women who underwent cesarean hysterectomy for PAS, 41 (37.6%) had an unplanned delivery. There was no significant difference in the number of previous cesarean deliveries or ultrasound findings between the two groups. Women with an unplanned delivery were more likely to bleed during pregnancy than those that had a planned delivery (p = 0.04). Women with unplanned delivery had lower gestational age at delivery (30.3 vs. 33.8 weeks, p = 0.001) had a 75% higher rate of the primary outcome (63 vs. 36%, p = 0.007) and had a higher rate of intensive care unit admissions (39 vs. 17.7%, p = 0.01) compared with women with a planned delivery. The neonatal morbidity did not differ between the two groups. Conclusion Since unplanned cesarean hysterectomy among women with PAS occurs in 40% and is associated with significantly higher morbidity, interventions are needed to mitigate the rate of adverse outcomes. Key Points

scholarly journals Examining disparities in severe maternal morbidity among pregnant people with placenta accreta spectrum

2022 ◽  
Vol 226 (1) ◽  
pp. S538
Author(s):  
Alison N. Goulding ◽  
Karin A. Fox ◽  
Christina C. Reed ◽  
Bahram Salmanian ◽  
Kjersti M. Aagaard ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Severe Maternal Morbidity ◽  
Placenta Accreta Spectrum
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