Urinary tract injuries during surgery for placenta accreta spectrum disorders

Colella, Giuseppe; Salvatore, Polito; Federica, Calò; Francesco, Lucia Di; D’Antonio, F.; Alessandro, Lucio; Calagna, Gloria

doi:10.1016/j.ejogrb.2023.05.036

Cited by 6 publications

(1 citation statement)

References 28 publications

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“…This abnormal adherence is associated with an increased risk of bladder injury even outside the context of PAS which usually occurs during peritoneal entry or while creating the bladder ap [29][30][31] . This nding was also observed in a large retrospective cohort of PAS cases in Italy 32 . However, the complexity arising from high-grade PAS lies in the co-existing presence of adhesions with extensive serosal hypervascularity and anastomotic neovascular channels.…”

Section: Discussionsupporting

confidence: 77%

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

Valentina,

Ariani,

Priangga

et al. 2024

Preprint

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Background: The presence of differences between the clinical and histological classification of PAS hinders an accurate depiction of the extent of the maternal condition. None of the existing histological classification criteria are based on and correlate with surgical difficulty, morbidity risk, or maternal outcome. Methods: We conducted a case-control study of data of all PAS cases between January 2017 and December 2021 at Dr. Soetomo General Hospital, Surabaya, Indonesia. Uterine dehiscence and any cases with incomplete data were excluded from the study. After surgery, the area of abnormal adherence was marked using small pins for histological analysis. The histopathology specimens were immersed in using Hematoxylin Eosin (HE). PAS cases were divided into three groups depending on the depth of villi: accreta, increta and percreta. Primary outcome was the vesicouterine adherence. Secondary outcomes were intraoperative topography, and surgical outcome. Results: Three hundred sixty-three cases were included for analyses. Our cohort comprised of 99 accreta cases, 246 increta cases and 18 percreta cases. Estimated blood loss was significantly higher in the high-grade PAS (increta and percreta) groups than in the low-grade PAS (accreta) group (2851.0 + 2437.7 mL vs 1970.8 + 1315.8 mL; p < 0.001). Sixty-five (17.9%) cases of vesicouterine adherence were observed. This was associated with higher odds of caesarean hysterectomy (adjusted odds ratio [Adj OR] 30.77 (95% CI 12.52–75.62; p < 0.001) and bladder injury (Adj OR 7.19; 95% CI 1.94–26.64; p = 0.003) but not estimated blood loss (> 2500 mL) (Adj OR 1.06; 95% CI 0.52–2.16; p = 0.87). Cases with bladder injury had a higher estimated blood loss (p = 0.012) and concomitant caesarean hysterectomy (p < 0.001) compared to those without bladder injury. The depth of villi implantation was associated with higher blood loss (> 2500 mL) (p = 0.046) but not bladder injury (p = 0.442) and vesicouterine adherence (p = 0.503). Conclusions: Vesicouterine adherence is not associated with the depth of villi implantation, but rather with the presence of fibrosis between the bladder and uterus. These adhesions also correlated to iatrogenic bladder injuries.

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Section: Discussionsupporting

confidence: 77%

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

Valentina,

Ariani,

Priangga

et al. 2024

Preprint

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Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum

Munoz,

Cheng,

McCann

et al. 2024

Intl J Gynecology & Obste

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ObjectivePlacenta accreta spectrum (PAS) is a complex disorder of uterine wall disruption with significant morbidity and mortality, particularly at time of delivery. Both physician and physical hospital resource allocation/utilization remains a challenge in PAS cases including intensive care unit (ICU) beds. The primary objective of the present study was to identify preoperative risk factors for ICU admission and create an ICU admission prediction model for patient counseling and resource utilization decision making in an evidence‐based manner.MethodsThis was a case–control study of 145 patients at our PAS referral center undergoing cesarean hysterectomy for PAS. Final confirmation by histopathology was required for inclusion. Patient disposition after surgery (ICU vs post‐anesthesia care unit) was our primary outcome and pre‐/intra‐/postoperative variables were obtained via electronic medical records with an emphasis on the predictive capabilities of the preoperative variables. Uni‐ and multivariate analysis was performed to identify independent predictive factors for ICU admission.ResultsIn this large cohort of 145 patients who underwent cesarean hysterectomy for PAS, with histopathologic confirmation, 63 (43%) were admitted to the ICU following delivery. These patients were more likely to be delivered at an earlier gestational age (34 vs 35 weeks, P < 0.001), have had >2 episodes of vaginal bleeding and emergent delivery compared to patients admitted to patients with routine recovery care (44% vs 18.3%, P = 0.009). Uni‐ and multivariate logistic regression showed an area under the curve of 0.73 (95% CI: [0.63, 0.81], P < 0.001) for prediction of ICU admission with these three variables. Patients with all three predictors had 100% ICU admission rate.ConclusionResource prediction, utilization and allocation remains a challenge in PAS management. By identifying patients with preoperative risk factors for ICU admission, not only can patients be counseled but this resource can be requested preoperatively for staffing and utilization purposes.

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Abnorme Plazentainvasion: Harnwegskomplikationen nach Sectio-Hysterektomie

2023

Geburtshilfe Frauenheilkd

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Urinary tract injuries during surgery for placenta accreta spectrum disorders

Cited by 6 publications

References 28 publications

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

Risk factors for intensive care unit admission after cesarean hysterectomy for placenta accreta spectrum

Abnorme Plazentainvasion: Harnwegskomplikationen nach Sectio-Hysterektomie

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