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

Shamshirsaz, Alireza A.; Fox, Karin A.; Salmanian, Bahram; Diaz-Arrastia, Concepcion; Lee, Wesley; Baker, B. Wycke; Ballas, Jerasimos; Chen, Qian; Veen, Teelkien R. van; Javadian, Pouya; Sangi‐Haghpeykar, Haleh; Zacharias, Nikolaos; Welty, Stephen E.; Cassady, Christopher I.; Moaddab, Amirhossein; Popek, Edwina J.; Hui, Shiu‐Ki Rocky; Teruya, Jun; Bandi, Venkata; Coburn, Michael; Cunningham, Thomas J.; Martin, Stéphanie; Belfort, Michael A.

doi:10.1016/j.ajog.2014.08.019

Cited by 387 publications

(350 citation statements)

References 25 publications

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“…These results are consistent with previously published reports regarding surgical management of placental invasion abnormalities [3,15]. However, reduction of emergency surgery by antenatal diagnosis can play important role to decrease potential morbidity and mortality rates [11,16,17]. Similarly, Eller et al [16] reported that scheduled surgery associated with reduced maternal morbidity in women with suspected placenta accreta.…”

Section: J Clin Exp Invest Wwwjceionlineorg Vol 7 No 1 March 2016supporting

confidence: 82%

A Single Center Experience on the Management of Placental Invasion Abnormalities

Ekin

Biler²,

Gezer³

et al. 2016

J Clin Exp Invest

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Objective: The aim of this study is to investigate our management of placental invasion abnormalities. Methods:A retrospective study was conducted on patients admitted to a tertiary referral center with a diagnosis of placental invasion abnormalities between 2011 and 2015. Risk factors and perinatal outcomes associated with placental invasion abnormalities were identified. Results:The overall incidence of placental invasion abnormalities during the 5-year period was 8.3/10000 deliveries, which showed an increasing trend. Ultrasonography and magnetic resonance imaging correctly identified placental invasion abnormality in 36.7% and 68.7% cases, respectively. Majority of patients (55.1%) with adherent placenta were diagnosed at the time of delivery. Of these patients, 22.4% underwent hysterectomy, 83.8% required at least one of the additional surgical procedures and 55% were transfused at least four units of packed red blood cell. Conclusion:Since placental invasion abnormalities are associated with significant morbidity, delivery should be scheduled in a tertiary center with appropriate expertise and facilities.

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Section: J Clin Exp Invest Wwwjceionlineorg Vol 7 No 1 March 2016supporting

confidence: 82%

A Single Center Experience on the Management of Placental Invasion Abnormalities

Ekin

Biler²,

Gezer³

et al. 2016

J Clin Exp Invest

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“…Acil PH 23 hastaya uygulanmış ve 1000 doğumda 1,7 olarak tespit edildi. Peripartum histerektomi yapılan hastaların ortanca yaşı 30 (27)(28)(29)(30)(31)(32)(33), gravidası 3 (2-4), doğumdaki ortalama gebelik haftaları 36,37 (±4,47) ve ortalama doğum ağırlıkları ise 2825g (±1273,2g) idi. Peripartum histerektomi 7 (% 30,4) hastaya vajinal doğum sonrası 16 (% 69,6) hastaya ise sezaryen sonrasında uygulanmıştı (Tablo I).…”

Section: Bulgularunclassified

“…Plasenta akreata şüphesi olan olguların multidisipliner bir şekilde yönetilmesi morbidite ve mortalite oranlarını azaltmaktadır (26)(27)(28). Bu hazırlıkların yapılabilmesi için de plasental anomalilerin tanısının antenatal olarak konması gerekmektedir.…”

Section: Sonuçunclassified

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

Velipaşaoğlu¹,

Şentürk²,

Tanir³

2017

Akd Med J

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ÖZAmaç: Peripartum histerektomi sıklığı tüm dünyada giderek artmakta olan, obstetrik kanamaların tedavisinde son basamak olarak uygulanan hayat kurtarıcı bir cerrahi müdahaledir. Özellikle artan sezaryen hızları ile birlikte gelişen plasental anomaliler (plasenta previa ve invazyon anomalileri) peripartum histerektominin önemini artırmaktadır.Çalışmanın amacı, peripartum histerektominin bir üniversite kliniğindeki risk faktörlerini, insidansını endikasyonlarını, yönetim stratejilerini ve komplikasyonlarını incelemektir. Gereç ve Yöntemler:Bu retrospektif çalışmaya Mart 1997 ile Mart 2017 tarihleri arasında kliniğimizde doğum sonrası ilk 24 saat içinde peripartum histerektomi yapılan olguları dahil edilmiştir. Olguların demografik verileri, plasental anomali varlığı, histerektomi endikasyonları, yapıldı ise histerektomiye ek cerrahi müdahaleler, intraoperatif komplikasyonlar, transfüzyon ihtiyacı, verilen kan ürünü tipleri ve miktarları ile maternal ve perinatal mortaliteleri incelenmiştir. Bulgular:Kliniğimizde 20 yıl içinde 23 peripartum histerektomi yapılmış olup bu müdahale ‰ 1,7 sıklıkla uygulanmıştır. Peripartum histerektomi endikasyonları arasında en sık olarak plasenta invazyon anomalileri (n=8; %34,8), ikinci en sık olarak ise uterin atoni (n=7; %30,4) olarak yer almaktaydı. Plasental anomalilerin (plasenta previa ve invazyon anomalileri) toplam oranı %52,17 olarak tespit edilmişti. Hastaların tamamına eritrosit süspansiyonu verilmiş olup verilen ortalama eritrosit süspan-siyonu miktarı 11,52 (± 9,27) ünitedir. Perinatal mortalite hızı ‰ 120 iken maternal mortalite hızı ‰ 4,3 (n=1) olarak tespit edilmiştir.Sonuç: Çalışma plasental anomalilere (plasenta previa ve invazyon anomalileri) bağlı peripartum histerektomi sıklığının giderek artığını göstermektedir. Bu nedenle bu problemlerin antenatal dönemde tanısının konması ve bu hastaların doğum yönetiminin tecrübeli bir ekip tarafından multidisipliner yaklaşımla yapılması gerekmektedir.Anahtar Sözcükler: Peripartum histerektomi, Obstetrik kanama, Plasenta akreata, Uterin atoni, Plasenta previa ABSTRACT Objective: Peripartum hysterectomy is a lifesaving procedure that is performed as the last step in the management of massive obstetric hemorrhage. Its incidence is increasing worldwide. Placental abnormalities that are associated with high cesarean rates are of utmost importance in the concept of peripartum hysterectomy.The purpose of this study was to elucidate the risk factors, incidence indications, management strategies and complications of peripartum hysterectomy in a university setting. Material and Methods:This retrospective study included the patients who gave birth and underwent hysterectomy in the 24h after delivery at our clinic between March 1997 and March 2017. Demographic characteristics, the presence of placental abnormalities, indications of hysterectomy, surgical interventions other than hysterectomy, intraoperative complications, need of transfusion, types and amount of transfused blood products, and perinatal and maternal mortality were exam...

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“…2,8 Research evidence supports that maternal outcomes may be improved at centers that perform peripartum hysterectomy more frequently 9 and use a multidisciplinary approach in planning and delivery. 10 …”

Section: Introductionmentioning

confidence: 99%

Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations

Friedman

Wright

Ananth

et al. 2016

American Journal of Obstetrics and Gynecology

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BACKGROUND Postpartum hysterectomy is an obstetric procedure that carries significant maternal risk that is not well characterized by hospital volume. OBJECTIVE The objective of this study was to determine risk for peripartum hysterectomy for women at low and moderate risk for the procedure. STUDY DESIGN This population-based study used data from the Nationwide Inpatient Sample to characterize risk for peripartum hysterectomy. Women with a diagnosis of placenta accreta or prior cesarean and placenta previa were excluded. Obstetrical risk factors along with demographic and hospital factors were evaluated. Multivariable mixed-effects log-linear regression models were developed to determine adjusted risk. Based on these models receiver operating characteristic curves were plotted, and the area under the curve was determined to assess discrimination. RESULTS Cesarean hysterectomy occurred in 1 in 1913 deliveries. Risk factors associated with significant risk for hysterectomy included mode of delivery, stillbirth, placental abruption, fibroids, and antepartum hemorrhage. These factors retained their significance in adjusted models: The risk ratio for stillbirth was 3.44 (95% confidence interval (CI) 2.94–4.02), abruption 2.98 (95% CI 2.52–3.20), fibroids 3.63 (95% CI 3.22–4.08), and antepartum hemorrhage 7.15 (95% CI 6.16–8.32). The area under the curve (AUC) for the model was 0.833. CONCLUSION Cesarean hysterectomy is a relatively common event that hospitals providing routine obstetric care should be prepared to manage. That specific risk factors are highly associated with risk for hysterectomy supports routine use of hemorrhage risk-assessment tools. However, given that a significant proportion of hysterectomies will be unpredictable, the availability of rapid transfusion protocols may be necessary for hospitals to safely manage these cases.

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

Cited by 387 publications

References 25 publications

A Single Center Experience on the Management of Placental Invasion Abnormalities

A Single Center Experience on the Management of Placental Invasion Abnormalities

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations

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