Multidisciplinary approach in management of placenta accreta

World Journal of Current Medical and Pharmaceutical Research, 2020

The incidence of placenta accreta spectrum (PAS) disorders has increased over the last decades due to increase in cesarean deliveries, resulting in increase in Cesarean hysterectomies,maternal mortality and morbidity but since last few years there has been a gradual shift towards the idea of conservative management. Conservative management of PAS is known to reduce major obstetric hemorrhage and salvage hysterectomy.We present a case of placenta accreta diagnosed by ultrasound where management of post-partum hemorrhage was accomplished by conservative surgery. The concise steps taken in management of placenta accreta before and during cesarean section were: Availability of 4 donors with cross match; Stark cesarean section; atraumatic clamps around uterine arteries; ureterotonic drugs; external (B-Lynch suture); and application of diathermy where required. This experience indicates that few selected cases of PAS could be managed conservatively who are at risk of intra-partum hemorrhage and post-partum hemorrhage.

Background : The morbidly adherent placenta (MAP), once a rare occurrence, is now an increasingly common complication of pregnancy secondary to the increase in cesarean delivery rates. The massive haemorrhage associated with this condition leads to severe maternal morbidity and mortality.There are various surgical methods in use to control bleeding from the placental bed,but MAP has replaced atonic post partum haemorrhage as the leading cause of Cesarean hysterectomy. Aim : to analyse the surgical management of the morbidly adherent placenta with the objective of reducing maternal morbidity and mortality ,by studying the various surgical methods used to achieve haemostasis. Results : 36 cases of MAP managed between January to December 2017 were analysed.The average age of the cases was 24 years,with average gravidity 2.All patients had undergone previous cesaerean delivery with average of 2 previous LSCS.22 cases were diagnosed in the antenatal period and the rest during cesaerean section. 17 cases were delivered between 32 to 38 weeks of gestation. 3 cases were managed by hysterectomy with placenta insitu. In the18 cases where uterine sparing surgery was undertaken 10 cases had to undergo hysterectomy and bilateral hypogastric artery ligation for control of bleeding.Average blood and component therapy was 6 and 8 units.Ionotropic support was required in 13 cases and ventilator support in 9 cases.Bladder injury occurred in 6 cases and ureteric injury in 2.There was maternal mortality in 3 cases-8.3%. Conclusion: Patients diagnosed in the antenatal period undergoing planned surgery had better outcomes with fewer blood transfusions and shorter hospital stay. Uterine sparing surgery was associated with significant maternal morbidity and was not successful in 54 % of cases.Compression sutures ,with bilateral hypogatic artery ligation was the most common surgical technique used to control bleeding from the placental bed.

American Journal of Obstetrics and Gynecology, 2010

The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, classic cesarean section delivery, and uterine and placental embolization before hysterectomy for placenta accreta. We conducted a cohort study of retrospective and prospective data from cases of histologically identified placenta accreta at a tertiary teaching hospital with access to interventional radiology. Twenty-six cases of placenta accreta were identified histologically (7 accretas, 5 incretas, and 14 percretas); 8 cases were successful staged embolization procedures. These cases had significant reductions in blood loss (553 vs 4517 mL; P = .0001), need for transfusion (2 vs 16; P = .001), and units of blood transfused (0.5 vs 7.9; P = .0013). The total operation time was no different between the 2 groups, but there was a longer length of anesthesia (2.7 vs 6.6 hours; P = .0001). There were nonsignificant reductions in admission to the intensive care unit and length of hospital stay. We found that the successful use of a staged embolization hysterectomy procedure for placenta accreta is associated with decreased maternal morbidity.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019

Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome. Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded. Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series. Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.

Adherent placenta is a serious pregnancy condition, where placenta invades into uterine wall up to varying depth. Rising rate of cesarean section and increasing maternal age are the major causes. There were 8 cases reported in 1 year (2018-2019) study. All were undiagnosed cases of adherent placenta. Maternal morbidity and mortality is caused by life threatening hemorrhage and massive blood transfusion. In our study blood transfusion rate was (100%), hysterectomy (84%), major artery ligation rate (56%) and mortality rate was (14%). Antenatal imaging and high index of suspicion help in the diagnosis.

American Journal of Obstetrics and Gynecology, 2015

Over the last century, the incidence of placenta accreta, increta, and percreta, collectively referred to as morbidly adherent placenta, has risen dramatically. Planned cesarean hysterectomy at the time of cesarean delivery is the standard recommended treatment in the United States. Recently, interest in conservative management has resurged, especially in Europe. The aims of this review are the following: (1) to provide an overview of methods used for conservative management, (2) to discuss clinical implications for both clinicians and patients, and (3) to identify areas in need of further research.

Pakistan Journal of Medical and Health Sciences

Aim: To determine the fetomaternal outcome in morbidly adherent placenta Study design: Cross-sectional study. Place and duration of study: Department of Obstetrics & Gynecology, Liaquat University Hospital Hyderabad from 1st January 2022 to 30th June 2022. Methodology: Forty five females of adherent placenta were enrolled. The consent was taken from every relevant patient having low lying placenta with previous scar/surgery the following details were collected. The operative events were recorded. Results: The mean age was 30.77 years and mean gestational age was 34.15 weeks. Majority of the cases 53.3% had history of three previous C-sections, 64.4% cases had placenta accreta, 20% had placenta percreta and 15.6% had p Placenta increta. Antepartum haemorrhage was seen in 68.9% of the cases. 55.6% females underwent C-sections, 22.2% were admitted in ICU, rate of the hysterectomy was high, 46.7% one patient was died. Considering the fetal outcome, 22.2% of the cases had fetal growth re...

International Journal of Gynecology & Obstetrics, 2014

Bangladesh Journal of Obstetrics & Gynaecology

Objective:The study is aimed to describe the grave maternal outcomes encountered inpatients having morbidly adherent placenta along with history of previous caesarean section. Materials and Methods: This was a cross-sectional study from September 2014 to August2015. All the patients attended in the in-patient department of obstetrics & gynaecology inDMCH during the study period having morbid adhesion of placenta (diagnosed antenatallyby USG or diagnosed preoperatively) along with history of previous caesarean section. Result: Total 10,805 obstetric patients delivered during the study period, of which 6,337patients had caesarean sections. Out of them 37 pregnant patients were found to havemorbid adhesion of placenta along with history of previous C/S. The incidence is 1 in 292deliveries. All of the 37 patients needed hysterectomy for intractable per operativehaemorrhage. All the patients needed transfusion of more than 04 units of blood. Nineteenpatients needed ICU supports Ten (27%)...

Journal of South Asian Federation of Obstetrics and Gynaecology, 2016

Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication often requiring peripartum hysterectomy. We report a series of cases of placenta accreta in patients desiring future fertility who were managed conservatively. How to cite this article Kaur B, Mohi MK, Singh B, Gupta R. Morbidly Adherent Placenta managed conservatively: A Case Series. J South Asian Feder Obst Gynae 2016;8(4):327-330.