Conservative Management of Placenta Percreta: Tunisian Prospective Study

Ouerdiane, Nadia; W, Daaloul; Othmani, Kaouther; A, Masmoudi; Hamouda, S.; Bouguerra, Badreddine

doi:10.21767/2471-8165.1000024

Cited by 1 publication

(1 citation statement)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ouerdiane et al ( 15 ) in their prospective study on conservative management of placenta percreta, where no additional therapy was used, reported that almost 31% of cases were complicated by massive obstetric hemorrhage or infection and required an emergency hysterectomy. In such a scenario, the role of a conservative approach with additional procedures such as injection methotrexate and UAE to decrease vascularity may be considered as a safe management option.…”

Section: Discussionmentioning

confidence: 99%

Placenta percreta - a management dilemma: an institutional experience and review of the literature

Khoiwal

Gaurav

Kapur

et al. 2020

J Turkish German Gynecol Assoc

View full text Add to dashboard Cite

Objective: Placenta percreta is an extremely high-risk obstetric condition often associated with significant maternal morbidity and mortality. To date, there is no consensus on its management. This article aimed to identify an optimum management option to improve maternal outcomes in patients with placenta percreta. Material and Methods: This was an observational study conducted at a tertiary care institute from October 2019 to June 2020. A well-defined plan of preoperative, bilateral, uterine artery catheter placement, cesarean delivery (CD) of the baby followed by uterine artery embolization (UAE), and elective delayed hysterectomy after 2-4 weeks, was made by a multidisciplinary team. Demographic variables such as age, parity, period of gestation, presenting complaints, imaging findings, mode of management, intraoperative findings, blood loss, the requirement for blood and blood products, and complications were noted. Results: We encountered seven cases of placenta percreta over a period of nine months. UAE was performed in 6/7 patients. UAE was not performed in one patient as she presented to the emergency department in shock. Elective delayed hysterectomy was performed after 2-4 weeks in three patients, three patients required emergency hysterectomy (two during CD and one on the seventh postoperative day) and one patient was managed conservatively by leaving the placenta in situ after CD and UAE. Patients who underwent UAE had notably less intraoperative blood loss and requirement of blood and blood products than the patient who could not receive UAE. During cesarean hysterectomy, blood loss was 1,700 mL in embolized (case 4) vs 3,000 mL in unembolized patient (case 7). In embolized patients, the median blood loss during CD (case 1,2,3,5,6) was 200 mL (interquartile range: 165-200 mL) and during delayed elective hysterectomy (case 1,3,5) was 150 mL (range: 125-225 mL). Blood loss in case 2 was 1,000 mL during emergency hysterectomy on the 7 th day of CD and UAE. The blood loss was appreciably higher in patients who underwent immediate cesarean hysterectomy rather than elective delayed hysterectomy. Conclusion: Placenta percreta, if not managed in a preplanned manner, may lead to disastrous maternal outcomes. Prophylactic devascularization during CD and leaving the placenta in situ followed by elective delayed hysterectomy, might be a reasonable management option in most severe cases of placenta percreta.

show abstract

Section: Discussionmentioning

confidence: 99%