Maternal Morbidity in Cases of Placenta Accreta Managed by a Multidisciplinary Care Team Compared With Standard Obstetric Care

Abstract

II

Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach

“…[1][2][3][4] Placenta accreta results from abnormal invasion of the myometrium by chorionic villi and attempts to separate a placenta accreta manually from the underlying uterine wall frequently precipitates significant hemorrhage. 5 Based on the depth of the invasion and the amount of morbidly adherent placenta, hysterectomy frequently is performed as a life-saving procedure. 6,7 Placenta accreta is associated strongly with the combination of placenta previa and previous cesarean delivery.…”

Revisit of risk factors for major obstetric hemorrhage: insights from a large medical center

“…As much as 30 %, and in some countries more than 50 % of maternal mortality, is due to hemorrhage, primarily in the postpartum period [2][3][4]. The challenge of identifying and reducing risk factors for major obstetric hemorrhage is also relevant in developed countries where these events are increasingly seen [5][6][7], especially because of complications of overinvasive placentation and postpartum hemorrhage (PPH) [8][9][10][11][12].Real-time assessment and/or quantification of blood loss perinatally is notoriously difficult to assess leading to underestimation of the amount of maternal blood loss [13]; therefore, for this analysis it was decided to circumscribe the study population to women with no co-morbidities (e.g., pre-existing maternal anemia) posing potentially catastrophic outcomes and to specify transfusion of C5 packed red blood cells (pRBC) units at birth.Our purpose was to identify the incidence of major obstetric hemorrhage and revisit clinical and peripartum obstetric risk factors, both modifiable and non-modifiable, for major obstetric hemorrhage, and assess related neonatal outcome. …”

“…As much as 30 %, and in some countries more than 50 % of maternal mortality, is due to hemorrhage, primarily in the postpartum period [2][3][4]. The challenge of identifying and reducing risk factors for major obstetric hemorrhage is also relevant in developed countries where these events are increasingly seen [5][6][7], especially because of complications of overinvasive placentation and postpartum hemorrhage (PPH) [8][9][10][11][12].…”

Urological Manifestations of Placenta Percreta

“…Table 3 signifies the roles of each specialty in the treatment plan. Eller et al [37] report significant reduction in morbidity and mortality with utilization of a multidisciplinary team. This signifies the importance of patient counseling and the development of a multidisciplinary team towards successive treatment of placenta percreta.…”

“…A team comprising an obstetrician experienced in pelvic surgery, a blood bank team, an anesthesiologist, a urologist skilled in pelvic reconstruction, an interventional radiologist, and an experienced neonatologist is advised [19,37]. Table 3 signifies the roles of each specialty in the treatment plan.…”