Antenatal diagnosis of placenta accreta leads to reduced blood loss

Tikkanen, Minna; Paavonen, Jorma; Loukovaara, Mikko; Stefanović, Vedran

doi:10.1111/j.1600-0412.2011.01147.x

Cited by 194 publications

(170 citation statements)

References 26 publications

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“…Morbidly adherent placenta is one of the most devastating complications in pregnancy [10]. It is characterized by the attachment of placental villi directly to the myometrium, sometimes invading deeper into the uterine wall or surrounding organs.…”

Section: Discussionmentioning

confidence: 99%

Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome

Chaudhari

Shah

D’Souza

2016

J Obstet Gynecol India

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Objectives The aim of the study was to identify the risk factors predisposing to morbidly adherent placenta and to study the different modes of management and the obstetric and neonatal outcome of these patients. Methods This was a retrospective cum prospective observational study conducted in the Department of Obstetrics and Gynaecology in a tertiary care referral hospital in Mumbai from January 2012 to November 2014. Results The incidence of morbidly adherent placenta was 1.32 per 1000 pregnancies with patient profile comprising second gravida in the age group 26-28 years; 90 % of the patients in this study had previous Caesarean section and co-existing placenta praevia was diagnosed in 63 %. Fiftythree per cent of the women delivered between 35 and 38 weeks and 40 % had elective deliveries. Caesarean section was the mode of delivery in 90 % of the patients. 123Prophylactic balloon placement in the internal iliac artery followed by classical Caesarean section, uterine artery embolization and post-operative methotrexate was done in 27 % which preserved the uterus and was associated the blood loss of 1000-2000 mL. Conclusion Antenatal diagnosis of morbidly adherent placenta allows for multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Morbidly Adherent Placenta: Its Management and Maternal and Perinatal Outcome

Chaudhari

Shah

D’Souza

2016

J Obstet Gynecol India

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“…In this study, parity and the number of previous cesarean sections were significantly high among women who had difficult placental delivery, considerable intraoperative blood loss, who required emergency hysterectomy to control bleeding. Wright et al (29) found that 41.7% of women with a known placenta accreta had a blood loss of ≥5000 mL, and, although Wright et al (29) concluded that there was no significant relation between parity, number of previous cesarean deliveries, degree of placental invasion, and massive blood loss, Tikkanen et al (30) found that the risk factors of placenta accreta included parity, cesarean section, and placenta previa. In addition, Guleria et al (31) concluded that the risk factors of abnormal invasive placentation (AIP) were placenta previa and a past history of cesarean delivery, and Thia et al (32) concluded that the depth of invasion in MAP is increased with multiple previous surgeries or excessive curettage or infection causing defective decidua basalis.…”

Section: Discussionmentioning

confidence: 99%

“…Warshak et al (33) concluded that antenatal detection of placenta accreta was associated with a significant decrease in maternal hemorrhage. In addition, Tikkanen et al (30) concluded that the diagnosis of placenta accreta may significantly reduce peripartum blood loss, and Chantraine et al (34) concluded that the prenatal diagnosis of AIP reduces morbidity and undiagnosed cases of AIP led to more emergency hysterectomies (33,30,34). Eller et al (35) concluded that planned cesarean hysterectomy and preoperative ureteric stents were associated with reduced maternal morbidity in MAP.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of three-dimensional multislice view Doppler in diagnosis of morbid adherent placenta

Moniem¹,

Ibrahim²,

Akl³

et al. 2015

J Turkish German Gynecol Assoc

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Placenta accreta occurs when placental trophoblasts invade the endometrium beyond the Nitabuch's layer of decidua basalis, placenta increta occurs when placental trophoblasts invade the myometrium, and placenta percreta occurs when placental trophoblasts invade the serosa (1, 2). Morbid adherent placenta (MAP) is generally associated with excess blood loss, bladder injuries and hysterectomies (3, 4). The incidence of MAP has increased significantly over the last 50 years (5, 6). A past history of a cesarean delivery, placenta previa, and damage of the Nitabuch's layer of decidua basalis following intrauterine infection or scarring are the risk factors of MAP. The incidence of MAP is increased concomitantly with increased cesarean section rates (1, 7-9). The incidence of MAP is 3.3% in pregnant women with no past history of cesarean delivery and placenta previa and is 40% in pregnant women with a history of two cesarean sections and placenta previa (4). If MAP was diagnosed or suspected before delivery, the optimum time for planned delivery is around 34-35 weeks, following a course of corticosteroids and multidisciplinary team care approach (2, 10, 11). An accurate diagnosis of MAP is essential to prepare both the patient and health providers for possible complications during delivery. Authors reported that ultrasound is a useful tool to diagnose MAP, with 77%-93% sensitivity and 71%-98% specificity (12-16). Moodley et al. (17) concluded that the color flow Doppler was more specific, with a 95% negative predictive value (NPV) in the prenatal diagnosis of MAP, than magnetic resonance imaging (MRI), and MRI should be reserved for cases with inconclusive sonographic findings (13,15,17). The sonographic markers of placenta accreta can be seen in the first trimester of pregnancy in the form of low implantation of the pregnancy sac and multiple vascular spaces within the placenta (2). Prenatal diagnosis of MAP with gray-scale and Doppler sonography allows the development of the multidisciplinary team care approach during delivery (14). This current study aimed Objective: To detect the accuracy of the three-dimensional multislice view (3D MSV) Doppler in the diagnosis of morbid adherent placenta (MAP). Material and Methods:Fifty pregnant women at ≥28 weeks gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale ultrasound scan was performed for the subjects to confirm the gestational age, placental location, and findings suggestive of MAP, followed by the 3D power Doppler and then the 3D MSV Doppler to confirm the diagnosis of MAP. Intraoperative findings and histopathology results of removed uteri in cases managed by emergency hysterectomy were compared with preoperative sonographic findings to detect the accuracy of the 3D MSV Doppler in the diagnosis of MAP. Results:The 3D MSV Doppler increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 3D power Doppler. The sensitivity and negative predictive value (NPV) (79.6%...

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“…[27,28] Como lo documentado en los reportes de caso revisados [2,4,10,14-16,18-19,22] la sospecha diagnostica de esta patología se tiene por medio de la ecografía, pudiendo coexistir en una misma paciente distintos grados de acretismo. [29] El uso de ecografía transabdominal puede encontrar solución de continuidad en el miometrio en el 35% de las mujeres con espesor <2,0 mm.…”

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