Placenta previa-accreta: Risk factors and complications

Usta, Ihab M.; Hobeika, Elie; Musa, Antoine Abu; Gabriel, G.; Nassar, Anwar H.

doi:10.1016/j.ajog.2004.10.166

Cited by 90 publications

(142 citation statements)

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“…after uterine curettage or termination of pregnancy. [1][2][3] In the case described, three of these were noted in the history. The risk for placenta accreta in women with one caesarean section is eight-fold higher than in those with an unscarred uterus and is increased a further four-fold following two or more caesarean sections.…”

Section: Discussionmentioning

confidence: 99%

Using the cervix to stop bleeding in a woman with placenta accreta: a case report

Dawlatly¹,

Wong²,

Khan³

et al. 2007

BJOG

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A 41-year-old lawyer of black African origin booked at 26 weeks of gestation at our antenatal clinic. Her early antenatal care had been undertaken in Nigeria. A cervical stitch had been inserted at 20 completed weeks of gestation after the ultrasound finding of a shortened cervix. Her gravidity was 21 and parity 0. She had undergone 20 surgical terminations of pregnancy at gestations ranging from 3 to 4 months, carried out in Nigeria and the USA. In addition, it was noted on ultrasound scan that she had multiple uterine fibroids, the largest of which was fundal, measuring 5 cm. Her first obstetric ultrasound scan in our unit was at 29 weeks of gestation. The placental site was reported to be posterior and high, and fetal growth measurements were within normal limits.Apart from the cervical cerclage, the antenatal course was uneventful, and at 36 weeks of gestation, the cervical stitch was removed. She presented to the labour ward at 39 weeks of gestation with spontaneous labour. She made slow progress, and the labour was augmented with oxytocics. The decision was made to proceed to emergency caesarean section under spinal anaesthesia at 5-cm dilatation as the cardiotocograph was suboptimal and there was now fresh meconium.Initially, the caesarean section was straightforward. A 2.375 kg male infant was delivered, with Apgar scores of 9 at 1 minute and 10 at 5 minutes. The surgeon did not anticipate any problems with the third stage and hence proceeded to deliver the placenta. This could only be partially removed; the placenta was found to be morbidly adherent to the posterior wall of the uterus and there was no clear plane of separation between the placenta and the uterus and accreta was diagnosed. At this point, she had begun to bleed heavily. The consultant was informed and attended immediately. He removed the remaining placenta. Five international units of syntocinon was administered intravenously, followed by an infusion of 40 iu syntocinon in 500 ml of normal saline in accordance with the labour ward guidelines. The uterus was well contracted, but she continued to bleed from the placental bed. Haemostatic sutures, interrupted figure of eight sutures, were placed at the bleeding points, with no effect. The placental bed was very friable and the bleeding uncontrolled. Compression methods were attempted using packs, with no success, as bleeding continued through the packs. The large fundal fibroid precluded the use of a B-Lynch suture.At this point, the consultant opted to try a technique he had successfully used to stop life-threatening bleeding in two cases of placenta praevia in the Sudan (unpublished; personal communication). He inserted his hand through the uterine incision into the cervix, which he then grasped, pulled through and inverted into the uterine cavity. The posterior lip of the cervix was then sutured onto the posterior wall of the uterus over the bleeding areas of the placental bed. In all, three interrupted stitches with a 2/0 vicryl, taper, curved bodied 30-mm needle were placed deep into th...

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Section: Discussionmentioning

confidence: 99%

Using the cervix to stop bleeding in a woman with placenta accreta: a case report

Dawlatly¹,

Wong²,

Khan³

et al. 2007

BJOG

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“…A past history of cesarean delivery and placenta previa are the two risks for MAP, and the incidence of MAP is increased concomitantly with increased cesarean section rates (3,(25)(26)(27). Antenatal diagnosis of MAP is crucial for proper counseling for possible surgical complications, multidisciplinary team care, and recruitment (3).…”

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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“…The MAP remains the greatest challenge in modern obstetrics 11 . Maternal risk is the greatest on attempt to separate the placenta, resulting torrential haemorrhage, DIC, massive blood transfusion, hysterectomy, bladder and uterine trauma, ARDS, acute tubular necrosis, need to intensive care and even death.…”

Section: Discussionmentioning

confidence: 99%

Morbidly Adherent Placenta in Mid Trimester Abortion - A Case Report

Nahar

Farhad

Apsara³

et al. 2017

Bangladesh J Obstet Gynaecol

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Morbidly adherent placenta (MAP) occurs when there is abnormally firm attachment of placental villi to the uterine wall with the absence of the normal intervening decidua basalis and nitabuchs layer. There are several risk factors of this condition including previous uterine surgery like myomectomy, dilatation and curettage operation, placenta praevia following previous caesarean section, advanced maternal age, multiparity and tobacco use. A diagnosis of MAP can be confirmed with tissue histology; however, medical imaging can be effective diagnostic tool. USG can detect the presence of accreta (80% sensitivity) and absence of accreta (95% specificity). This condition is presented here as a 20 weeks pregnancy with missed abortion with morbid adherent placenta (MAP).Bangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 50-53

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Placenta previa-accreta: Risk factors and complications

Cited by 90 publications

References 0 publications

Using the cervix to stop bleeding in a woman with placenta accreta: a case report

Using the cervix to stop bleeding in a woman with placenta accreta: a case report

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

Morbidly Adherent Placenta in Mid Trimester Abortion - A Case Report

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