Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique

Palacios‐Jaraquemada, José Miguel; Fiorillo, Angel; Hamer, Jorge; Martínez, M.; Bruno, Claudio

doi:10.1080/14767058.2020.1716715

Cited by 111 publications

(114 citation statements)

References 41 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…Additionally, the rate of bladder injury was higher in patients who underwent hysterectomy, although this did not reach statistically significant difference. Our findings are consistent with the results of publications related to conservative PAS surgery ( 18 , 24 , 28 , 29 , 30 ) . In many studies, it is reported that bleeding and bladder injuries occur during vesicouterine space dissection, which is a common step in both local resection and hysterectomy ( 24 , 27 ) .…”

Section: Discussionsupporting

confidence: 93%

“…However, many patients are young and with low parity, and uterine conservative approaches should be considered in these patients with a further fertility desire. Palacios-Jaraquemada et al ( 18 ) reported that the uterus could be preserved in 80% of patients without causing additional morbidity in the study where they examined 248 PAS cases. In a prospective study involving 20 PAS cases, only 1 (5%) patient required hysterectomy when performing the triple-P procedure, which includes removal of the fetus through a separate incision over the placental site, ligation of bilateral uterine artery, and excision of the relevant myometrial region without separating the placenta ( 19 ) .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Local uterine resection with Bakri balloon placement in placenta accreta spectrum disorders

Üstünyurt¹

2020

tjod

View full text Add to dashboard Cite

Objective: Placenta accreta spectrum (PAS) is a potentially life-threatening condition characterized by the abnormal adherence of the placenta to the implantation site. We sought to evaluate the efficacy, surgical feasibility, risks, and advantages of local uterine resection in cases complicated with PAS. Materials and Methods: This study included 97 patients with PAS, which was confirmed during surgery and by histopathological examination between January 2013 and December 2019. The patients were divided into two groups based on operative approach. The study population (local resection group) consisted of 30 cases in whom total resection of adherent placenta and myometrium was performed, whereas the control group (hysterectomy group) of 67 cesarean hysterectomy cases. Results: Patients who underwent hysterectomy had significantly more bleeding than the local resection group (1180±160 mL vs 877±484 mL; p=0.002). The mean number of transfused packed red blood cells (pRBCs) was greater in the hysterectomy group (4.5±2.3) than in the local resection group (2.6±3.1; p=0.001). Transfusion rate of four and/or more pRBCs was 67.2% in the hysterectomy group and 33.3% in the local resection group, which indicated a statistically significant difference (p=0.002). Of patients, 29.6% required intensive care unit in the hysterectomy group and 6.7% in the local resection group (p=0.023). Conclusion: Local resection can be performed safely in selected PAS cases. In these cases, using a standardized protocol in terms of patient selection and surgical procedure will reduce morbidity and mortality.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Local uterine resection with Bakri balloon placement in placenta accreta spectrum disorders

Üstünyurt¹

2020

tjod

View full text Add to dashboard Cite

show abstract

“…Notably, conservative management was inconsistent among respondents (1). Sixty-one articles were retrieved from our CON-PAS registry on conservative management using UAE (23 studies) , prophylactic balloon placement (15 studies) (49-63), compression sutures (10 studies) (64-73), leaving placenta in situ (7 studies) (74)(75)(76)(77)(78)(79)(80), and uterine wall excision and reconstruction (6 studies) (81)(82)(83)(84)(85)(86). Despite the number of conducted studies (61 studies, 1,979 patients), they have not yielded robust evidence-based recommendations.…”

Section: Discussionmentioning

confidence: 99%

High intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

Elazeem¹,

Saad²,

Ahmed³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: High intensity focused ultrasound (HIFU) is a non-invasive procedure that has been recently studied in management of placenta accreta spectrum (PAS). Objective: To appraise efficacy and safety of HIFU in management of PAS and to highlight restrictions of transitioning uterus-preserving studies to clinical practice. Search Strategy: A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of database inception to January 31st, 2020. Selection Criteria: Studies on use of HIFU in management of PAS were eligible. Review articles, conference papers, animal studies, and case reports were excluded. Data Collection and Analysis: A standardized data collection sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities of management of PAS. Results: Out of 30 studies, four were eligible (399 patients). Average residual placental volume was 61.74 cm3 (6.01-339). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150). Average time for normalization of β-HCG was 16.5 (1-82) days. No major complications were encountered. Sixty-one studies were retrieved from CON-PAS registry; uterine artery embolization (23 studies), Prophylactic balloon placement (15), compression sutures (10), leaving placenta in situ (7), and uterine wall excision (6) were successful in 83.7% 92.9% 87.9%, 85.2%, and 79.3% of patients, respectively. Conclusions: HIFU yields promising success and safety profile in management of PAS in certain clinical situations. A global research strategy is recommended to incorporate conservative approaches in selected patients within a comprehensive protocol to manage PAS.

show abstract

“…Despite artery embolization (23 studies), prophylactic balloon placement (15 studies), 2,50-63 compression sutures (10 studies), 8,[64][65][66][67][68][69][70][71][72] leaving the placenta in situ (7 studies), 10,[73][74][75][76][77][78] and uterine wall excision and reconstruction (6 studies). [79][80][81][82][83][84] Despite the number of conducted studies (61 studies, 1979 patients), they have not yielded robust evidence-based recommendations. Fifty-four percent and 89% of these studies recruited 20 patients or fewer and 50 patients or fewer, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, conservative management was inconsistent among respondents 1 . Sixty‐one articles were retrieved from our CON‐PAS registry on conservative management using uterine artery embolization (23 studies), 27‐49 prophylactic balloon placement (15 studies), 2,50‐63 compression sutures (10 studies), 8,64‐72 leaving the placenta in situ (7 studies), 10,73‐78 and uterine wall excision and reconstruction (6 studies) 79‐84 . Despite the number of conducted studies (61 studies, 1979 patients), they have not yielded robust evidence‐based recommendations.…”

Section: Discussionmentioning

confidence: 99%

High‐intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

Elazeem

Saad

Ahmed

et al. 2020

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Background: High-intensity focused ultrasound (HIFU) is a non-invasive procedure that has been studied in the management of placenta accreta spectrum (PAS). Objective: To appraise HIFU in the management of PAS and highlight the restrictions on converting uterus-preserving studies into evidence-based practice. Search strategy: A search on Scopus, Cochrane, PubMed and Web of Science was conducted from date of inception to January 2020. Selection criteria: Studies on using HIFU in the management of PAS were eligible. Review articles, conference papers, and case reports were excluded. Data collection: A standardized sheet was used to abstract data from eligible studies. CON-PAS registry was used to include studies on other conservative modalities. Results: Four studies were eligible (399 patients). Average residual placental volume was 61.74 cm 3 (6.01-339 cm 3). Treatment was successful in all patients. Normal menstruation recovered after 48.8 days (15-150 days). No major complications were encountered. Sixty-one studies were retrieved from the CON-PAS registry; uterine artery embolization (23 studies), balloon placement (15 studies), compression sutures (10 studies), placenta in situ (7 studies), and uterine resection (6 studies) were successful in 83.7%, 92.9%, 87.9%, 85.2%, and 79.3% of cases, respectively. Conclusions: HIFU may fit certain clinical situations in the management of PAS. A global research strategy is recommended to incorporate conservative approaches within a comprehensive management protocol.

show abstract

Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique

Cited by 111 publications

References 41 publications

Local uterine resection with Bakri balloon placement in placenta accreta spectrum disorders

Local uterine resection with Bakri balloon placement in placenta accreta spectrum disorders

High intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

High‐intensity focused ultrasound in management of placenta accreta spectrum: A systematic review

Contact Info

Product

Resources

About