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The Journal of Maternal-fetal &... Aug 2019The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.
OBJECTIVE
The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.
MATERIALS AND METHODS
We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings.
RESULTS
The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p = .003), blood transfusion (86.2% versus 46.5%, p < .001), hysterectomy (43.3% versus 11.2%, p < .001), preterm birth (65.7% versus 49.9%, p < .001), and the need for neonatal intensive care unit (NICU) admission (54.5% versus 36.7%, p < .001).
CONCLUSION
The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.
Topics: Adult; China; Female; Humans; Hysterectomy; Incidence; Intensive Care Units, Neonatal; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Severity of Illness Index
PubMed: 29514533
DOI: 10.1080/14767058.2018.1442429 -
Obstetrics and Gynecology Sep 1991The pregnancy of a patient with placenta membranacea associated with placenta increta and a live-born infant is described, and the literature covering placenta... (Review)
Review
The pregnancy of a patient with placenta membranacea associated with placenta increta and a live-born infant is described, and the literature covering placenta membranacea is reviewed. A total of 26 cases of placenta membranacea in the second and third trimesters have been reported. The condition appears to have an incidence of 1:20,000-40,000, and there have been 14 reported live births associated with this rare placental anomaly. Antepartum and postpartum hemorrhage were reported to complicate 83 and 50% of the cases, respectively. Approximately 30% of the cases involved some form of abnormal placental adherence.
Topics: Adult; Cesarean Section; Female; Humans; Hysterectomy; Infant, Newborn; Male; Placenta Accreta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Uterine Hemorrhage
PubMed: 1870811
DOI: No ID Found -
The Journal of the Kentucky Medical... Nov 1961
Topics: Female; Humans; Obstetric Labor Complications; Placenta; Placenta Accreta; Placenta Diseases; Pregnancy
PubMed: 13862040
DOI: No ID Found -
AJR. American Journal of Roentgenology Jan 2017The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and...
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. Reader accuracy and confidence require adherence to examination performance, image interpretation criteria, and awareness of common pitfalls.
Topics: Algorithms; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Patient Positioning; Placenta Accreta; Pregnancy; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27762597
DOI: 10.2214/AJR.16.16281 -
International Journal of Hyperthermia :... 2021To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
OBJECTIVE
To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
MATERIALS AND METHODS
Thirty-four patients with placenta accreta, placenta increta, or placenta percreta were treated with USgHIFU from January 2016 to December 2019 and were retrospectively reviewed. The patients were classified into three categories according to the relationship between the trophoblastic villi and the myometrium, based on magnetic resonance imaging (MRI). Fifteen patients were classified as placenta accreta, 17 patients were classified as placenta increta, and 2 were classified as placenta percreta. All patients completed follow-up. Treatment efficacy and safety were evaluated.
RESULTS
No significant differences in baseline characteristics and results of HIFU ablation were observed between the patients with placenta accreta and those with placenta increta. The return of HCG levels to normal was longer in patients with placenta accreta compared with patients with placenta increta, while no significant difference was observed in the amount of intraoperative blood loss, the return of normal menstruation and the length of hospital stay.
CONCLUSIONS
HIFU treatment followed by hysteroscopic resection is safe and effective in the treatment of patients with placenta accreta and placenta increta.
Topics: Blood Loss, Surgical; Cesarean Section; Female; High-Intensity Focused Ultrasound Ablation; Humans; Placenta Accreta; Pregnancy; Retrospective Studies
PubMed: 33827369
DOI: 10.1080/02656736.2021.1909149 -
Pediatric and Developmental Pathology :... 2017Exaggerated placental site (EPS) is usually an incidental finding seen in curettings after an abortion. Placenta increta is, by definition, a disease that damages and...
Exaggerated placental site (EPS) is usually an incidental finding seen in curettings after an abortion. Placenta increta is, by definition, a disease that damages and destroys myometrium; however, prior literature has not paid sufficient attention to the role of myometrium in its pathogenesis and diagnosis. We present an unusual case of placenta increta in a hysterectomy performed for uterine perforation after curettage for the termination of pregnancy at 18 weeks. The initial histologic section of the implantation site suggested EPS. Actin stains showed degenerated inflamed muscle at the EPS-like site, keratin stains showed interstitial trophoblast in the zone of myometrial damage, and the wall of the corpus was grossly thinned under the placenta. The myometrial damage may have softened the wall, predisposing to uterine perforation by the curettage procedure.
Topics: Adult; Female; Humans; Placenta; Placenta Accreta; Pregnancy
PubMed: 28326953
DOI: 10.1177/1093526616681939 -
Obstetrics and Gynecology Sep 2015Uterine arteriovenous malformations are rare and have been reported to occur after uterine trauma (eg, surgery, gestational trophoblastic disease, malignancy). (Review)
Review
BACKGROUND
Uterine arteriovenous malformations are rare and have been reported to occur after uterine trauma (eg, surgery, gestational trophoblastic disease, malignancy).
CASE
A 33-year-old woman, gravida 3 para 3, presented 4 weeks post-cesarean delivery with episodic profuse vaginal bleeding. Pelvic ultrasonography and magnetic resonance imaging revealed a left uterine arteriovenous malformation. After consideration of all treatment options, total laparoscopic hysterectomy was performed.
CONCLUSION
Acquired uterine arteriovenous malformations and placental ingrowth into the myometrium are increasingly reported after surgical uterine procedures. This case of a postpartum patient with both uterine arteriovenous malformation and retained placenta increta suggests a correlation between the two complications.
Topics: Adult; Arteriovenous Malformations; Cesarean Section; Female; Follow-Up Studies; Humans; Hysterectomy; Immunohistochemistry; Magnetic Resonance Angiography; Monitoring, Intraoperative; Placenta Accreta; Postoperative Hemorrhage; Pregnancy; Rare Diseases; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler; Uterine Hemorrhage
PubMed: 25923029
DOI: 10.1097/AOG.0000000000000812 -
American Journal of Obstetrics &... Aug 2023This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa.
DATA SOURCES
A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022.
STUDY ELIGIBILITY CRITERIA
The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. In addition, maternal age, assisted reproductive technology, previous cesarean delivery, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa.
METHODS
Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis.
RESULTS
Among 2598 studies that were initially retrieved, 5 were included in the review. With the exception of 1 study, 4 studies were included in the meta-analysis. This meta-analysis showed that placenta accreta spectrum without placenta previa was associated with less risk of invasive placenta (odds ratio, 0.24; 95% confidence interval, 0.16-0.37), blood loss (mean difference, -1.19; 95% confidence interval, -2.09 to -0.28) and hysterectomy (odds ratio, 0.11; 95% confidence interval, 0.02-0.53), and more difficult to diagnose prenatally (odds ratio, 0.13; 95% confidence interval, 0.04-0.45) than placenta accreta spectrum with placenta previa. In addition, assisted reproductive technology and a previous uterine procedure were strong risk factors for placenta accreta spectrum without placenta previa, whhereas previous cesarean delivery was a strong risk factor for placenta accreta spectrum with placenta previa.
CONCLUSION
The differences in clinical aspects of placenta accreta spectrum with and without placenta previa need to be understood.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Retrospective Studies; Placenta Previa; Hysterectomy; Risk Factors
PubMed: 37211089
DOI: 10.1016/j.ajogmf.2023.101027 -
Acta Medica Iranica 2011Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of... (Review)
Review
Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and β-hCG assessment. Serum β-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta.
Topics: Abortifacient Agents, Nonsteroidal; Adult; Biomarkers; Chorionic Gonadotropin, beta Subunit, Human; Female; Humans; Injections, Intramuscular; Methotrexate; Placenta Accreta; Pregnancy; Stillbirth; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Color
PubMed: 21874645
DOI: No ID Found -
The Journal of Maternal-fetal &... May 2022To compare conservative management and cesarean hysterectomy in patients with placenta increta or percreta.
OBJECTIVE
To compare conservative management and cesarean hysterectomy in patients with placenta increta or percreta.
MATERIALS AND METHODS
In this multicenter retrospective study, we recorded data on 2219 patients with placenta increta or percreta from 20 tertiary care centers in China from 1 January 2011 to 31 December 2015. Propensity score analysis was used to control for baseline characteristics. We divided patients into conservative management (C) and hysterectomy (H) groups. The primary outcome was operative/postoperative maternal morbidity; secondary outcomes were maternal-neonatal outcomes.
RESULTS
In total, 17.9% (398/2219) of patients had placenta increta and percreta; 82.1% (1821/2219) of the patients were in group C. After propensity score matching, 140 pairs of patients from the two groups underwent one-to-one matching. Group C showed less average blood loss within 24 h of surgery (1518 ± 1275 vs. 4309 ± 2550 ml in group H, <.001). There were more patients with blood loss >1000 ml in group H than in group C (93.6% [131/140] vs. 61.4% [86/140], <.001). More patients received blood transfusions in group H than in group C (=.014). There was no significant difference between the groups in terms of bladder injury, postoperative anemia, fever, and disseminated intravascular coagulation. Neonatal outcomes in the two groups were similar.
CONCLUSION
Either conservative management or hysterectomy should be considered after thorough evaluation and detailed discussion of risks and benefits. A balance between bleeding control and fertility can be achieved.
Topics: Conservative Treatment; Female; Humans; Hysterectomy; Infant, Newborn; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Retrospective Studies
PubMed: 32498575
DOI: 10.1080/14767058.2020.1774871