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Placenta percreta

Aoife Kilcoyne, Anuradha S Shenoy-Bhangle, Drucilla J Roberts, Rachel Clark Sisodia, Debra A Gervais, Susanna I Lee
OBJECTIVE: The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and diagnostic pitfalls. Appropriate examination indications and recommendations for optimizing image acquisition and interpretation are summarized. CONCLUSION: MRI increases the accuracy of the workup of high-risk patients and aids in multidisciplinary delivery planning to improve maternal outcome...
October 20, 2016: AJR. American Journal of Roentgenology
Shigeki Matsubara
Conservative management (leaving the placenta in situ) for abnormally invasive placenta (AIP: accreta, increta, percreta) has been repeatedly discussed in AOGS (1, 2). Delayed hemorrhage and infection are important adverse events. Especially, delayed hemorrhage required hysterectomy 3-9 months post-cesarean section in 22-58% of cases (1, 3), often performed as an emergency surgery (1, 3). Although delayed hysterectomy is not always associated with massive bleeding, a magnetic resonance imaging (MRI) showed marked gadolinium enhancement (marked blood flow) in the placental-bed-myometrium on post-cesarean day 34 (4), suggesting that hemorrhage may be serious during delayed hysterectomy at least up to one month post-cesarean...
October 14, 2016: Acta Obstetricia et Gynecologica Scandinavica
Heather Miller, Matthew L Anderson, Christopher P Smith, Alireza A Shamshirsaz, Karin A Fox
BACKGROUND: Chylous ascites is defined as the pathologic accumulation of lymphatic fluid within the peritoneal cavity and has been reported to complicate gynecologic surgeries, with an incidence of 0.17-2%. We report a case of chylous ascites after complex surgery for placenta percreta. CASE: A 26-year-old woman underwent cesarean delivery followed by bilateral uterine artery embolization and modified radical hysterectomy at 26 5/7 weeks of gestation for placenta percreta invading the urinary bladder...
October 6, 2016: Obstetrics and Gynecology
Rory Windrim, John Kingdom, Hyun-Jung Jang, Peter N Burns
BACKGROUND: Morbidly adherent placentation now complicates approximately 1 in 500 pregnancies. Our group and others have demonstrated that antenatal diagnosis of invasive placentation and team-based delivery reduce severe morbidity. Ultrasound and magnetic resonance imaging (MRI) are both employed in the antenatal evaluation of pregnancies with suspected placenta increta/percreta. Accurate diagnosis in this context is essential to direct resources appropriately. Ultrasound methods, including colour and power Doppler, are the mainstays of screening at-risk women, whereas MRI is reserved for diagnostic purposes because of its cost and limited accessibility...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Manisha Vernekar, Roy Rajib
INTRODUCTION: Uterine rupture is a catastrophic obstetrical emergency associated with a significant feto-maternal morbidity and mortality. Many risk factors for uterine rupture, as well as a wide range of clinical presentations, have been identified. OBJECTIVES: To analyze the frequency, predisposing factors, and maternal and fetal outcomes of uterine rupture. METHODS: A retrospective analysis of cases of unscarred uterine rupture was conducted at the Department of Obstetrics and Gynecology, RIMS, Imphal from June 1, 2010 to June 30, 2012...
October 2016: Journal of Obstetrics and Gynaecology of India
Shanigarn Thiravit, Sukanya Lapatikarn, Kobkun Muangsomboon, Voraparee Suvannarerg, Phakphoom Thiravit, Pornpim Korpraphong
OBJECTIVES: To retrospectively review the MRI findings of placenta percreta and identify those helpful for differentiation from non-placenta percreta. MATERIALS AND METHODS: The MRI images of 21 patients with a preliminary diagnosis of placental adhesive disorder scanned between 2005 and 2014 were evaluated. Radiologists blinded to the final diagnosis evaluated six previously described MRI findings of placenta adhesive disorder. The sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV) of MRI for the diagnosis of placenta percreta were also calculated...
September 20, 2016: La Radiologia Medica
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
August 31, 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Hon C Cheng, Anita Pelecanos, Renuka Sekar
BACKGROUND: Peripartum hysterectomy is commonly performed for catastrophic postpartum haemorrhage uncontrolled by conservative medical and surgical therapies. Currently, information about the incidence and indications for peripartum hysterectomy are not well defined in Australia. AIMS: Evaluate the incidence and indications of peripartum hysterectomy in the Royal Brisbane and Women's Hospital (RBWH) between 2000 and 2014. MATERIALS AND METHODS: A 15-year retrospective cohort study of peripartum hysterectomies at RBWH was conducted...
August 17, 2016: Australian & New Zealand Journal of Obstetrics & Gynaecology
Masaaki Sawada, Shinya Matsuzaki, Kazuya Mimura, Keiichi Kumasawa, Masayuki Endo, Tadashi Kimura
Placenta percreta is a rare condition that presents a risk of massive intraoperative hemorrhage. To decrease maternal morbidity in such cases, conservative management was recently adopted as an option. Nevertheless, severe morbidity occurs in 42% of cases. In addition, the clinical course of conservative management remains unclear. We encountered a case of placenta percreta that was successfully treated by conservative management without complications or other clinical interventions. Serial magnetic resonance imaging (MRI) was performed to investigate the natural course of conservative management of placenta percreta...
August 16, 2016: Journal of Obstetrics and Gynaecology Research
Kerry L O'Brien, Lynne Uhl
Obstetric hemorrhage remains a leading cause of maternal mortality with more than 140,000 deaths annually worldwide. Abnormal placentation has increased to become the most common diagnosis requiring massive blood transfusion in obstetrics, with uterine atony a close second. At our institution, as well as nationwide, there has been a steady increase in pregnancies complicated by abnormal placentation, including accreta, increta, and percreta. Providers at our facility created the New England Center for Placental Disorders in May 2015 to address these complex patients...
September 2016: Transfusion
Eric Jauniaux, Sally L Collins, Davor Jurkovic, Graham J Burton
OBJECTIVE: Determining the depth of villous invasiveness before delivery is pivotal in planning individual management of placenta accreta (PA). We have evaluate the value of the various ultrasound signs described in the literature for the diagnosis of PA and in the assessment of the depth of villous invasiveness. DATA SOURCES: We undertook a PubMed and MEDLINE search of the relevant studies published between the first prenatal ultrasound description of PA in 1982 and 30 March 2016 using key words "placenta accreta", "placenta increta", "placenta percreta", "abnormally invasive placenta", "morbidly adherent placenta" and "placenta adhesive disorder" as related to "sonography", "ultrasound diagnosis", "prenatal diagnosis", "grey-scale imaging", three-dimensional (3D) ultrasound and "colour Doppler imaging"...
July 26, 2016: American Journal of Obstetrics and Gynecology
Yasutaka Konishi, Satoshi Yamamoto, Kei Sugiki, Hidetoshi Sakamoto, Shigehito Sawamura
Cesarean deliveries in patients with placenta accreta often are accompanied by life-threatening bleeding and sometimes death. A novel, multidisciplinary approach that uses uterine embolization after cesarean delivery recently has been advocated; however, embolization in the radiology department requires transfer of postoperative patients, which could increase maternal mortality and morbidity. In a case of severe placenta accreta, we planned a stepwise treatment, including cesarean delivery without separation of the placenta followed by intraoperative uterine arterial embolization in a hybrid operating room, followed by hysterectomy a few weeks after cesarean delivery...
September 15, 2016: A & A Case Reports
R C Ortiz-Villalobos, A Bañuelos-Franco, R F Serrano-Enriquez, M L Mejía-Mendoza, J Laureano-Eugenio
OBJECTIVE: To analyze the maternal-fetal surgical complications techniques utilizing two obstetric hysterectomy in patients with placenta accreta, increta or percreta, in the Hospital General de Occidente, Jalisco, Mexico during the period 2011 to 2014. MATERIAL AND METHODS: observational, descriptive, cross-sectional study, analyzing maternal and fetal complications in all patients diagnosed with placenta accreta, increta or percreta, intervened with two surgical techniques obstetric hysterectomy, during the period January 2011 to December 2014, using clinical records to identify the study variables...
April 2016: Ginecología y Obstetricia de México
Mahreen Rasool, Imrana Masroor, Shafia Shakoor, Shama Munim
Spontaneous Uterine rupture is associated with massive intra-peritoneal bleed which can be fatal if not recognized. We report a case of 32 year old multigravida at 28 weeks of gestation with history of liver cysts, previous caesarean and uterine curettage, who presented with acute abdominal pain and tenderness; ultrasound revealed placenta percreta. CT abdomen showed haemoperitoneum. The patient underwent emergency caesarean hysterectomy due to uterine rupture at the cornual site.
July 2016: JPMA. the Journal of the Pakistan Medical Association
Giuseppe Cali, Francesco Forlani, Ilan Timor-Trisch, Jose Palacios-Jaraquemada, Gabriella Minneci, Francesco D'Antonio
OBJECTIVE: Advances in prenatal imaging techniques have led to an increase in the diagnosis of caesareans scar pregnancy (CSP). However, antenatal counselling when CSP is diagnosed is challenging and the current evidence mainly derived from small series reporting high rates of adverse maternal outcomes. The aim of this study was to ascertain the performance of prenatal ultrasound in anticipating the natural history of CSP introducing a new sonographic sign, the cross-over sign (COS). METHODS: Retrospective analysis of early first trimester (6-8 weeks of gestation) ultrasound images of women with morbidly adherent placenta (MAP) treated in the third trimester of pregnancy...
July 15, 2016: Ultrasound in Obstetrics & Gynecology
Faye Cuthbert, Mireia Teixidor Vinas, Elspeth Whitby
Placental adhesion disorder (PAD) comprises placenta accreta, increta and percreta lesions; these are classified according to the depth of uterine invasion. Although PAD is considered a rare condition, its incidence has increased 10-fold in the last 50 years. Ultrasound is the primary imaging modality for the assessment of the placenta and in the majority of cases, it is sufficient for diagnosis; however, when ultrasound findings are suspicious or inconclusive, MRI is recommended as an adjunct imaging technique...
September 2016: British Journal of Radiology
Devon M Rupley, Ana I Tergas, Katherine L Palmerola, William M Burke
BACKGROUND: The prevalence of morbidly adherent placenta has dramatically increased in the setting of the rising cesarean rate in the United States. Delayed surgical management of placenta accreta and its variants is emerging as methods that may significantly decrease bleeding and perioperative complications; however, optimal surgical approaches have not yet been determined. In this report, we present a case of robotic-assisted delayed interval hysterectomy in a patient with placenta percreta...
August 2016: Gynecologic Oncology Reports
Ali O Ersoy, Sibel Ozler, Efser Oztas, Ebru Ersoy, Ayse Kirbas, Nuri Danisman
OBJECTIVES: Despite medical advances, rising awareness, and satisfactory care facilities, placenta previa (PP) remains a challenging clinical entity due to the risk of excessive obstetric hemorrhage. Etiological concerns gave way to life-saving concerns about the prediction of maternal outcomes due to hemorrhage. Our study aimed to detect an early predictive marker of placenta previa. MATERIAL AND METHODS: Ninety-three pregnant patients diagnosed with PP and 247 controls were recruited for this retro-spective study...
2016: Ginekologia Polska
Erbil Karaman, Ali Kolusarı, Orkun Çetin, Numan Çim, İsmet Alkış, Recep Yıldızhan, Hanım Güler Şahin, Abdulaziz Gül
OBJECTIVE: To evaluate and describe a surgical approach for uterine preservation and management of postpartum hemorrhage in placenta percreta. METHODS: We analyzed the data of patients who were diagnosed with placenta percreta prenatally and subsequently underwent cesarean section in which local resection technique was used to manage postpartum hemorrhage and uterine preservation at our tertiary care center between 2013 and 2016. The technique includes local resection of placental invasion site and suturing the new uterine edges...
June 8, 2016: Journal of Maternal-fetal & Neonatal Medicine
Marie-Aimée Päivi Soro, Alban Denys, Maud de Rham, David Baud
OBJECTIVES: Arterial embolisation (AE) plays a major role in current practice in the management of postpartum haemorrhage (PPH) that fails to respond to conservative treatment. While its benefit is well known, long-term outcomes of AE have been poorly investigated. The objective of this review is to assess its potential complications and long-term effects on the patients' quality of life. METHODS: Using the terms "embolisation" and "postpartum haemorrhage", we searched the Cochrane Central Register of Controlled Trials, Medline and PubMed for published studies...
May 26, 2016: European Radiology
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