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Obstetrics and Gynecology May 1999
Topics: Abortion, Missed; Adult; Diagnosis, Differential; Dilatation and Curettage; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage
PubMed: 10912421
DOI: 10.1016/s0029-7844(98)00315-9 -
Annals of Palliative Medicine Jan 2022Placental increta can easily lead to secondary infections in the perinatal period. In severe cases, it can develop into sepsis and endanger the life of the mother. It is...
Placental increta can easily lead to secondary infections in the perinatal period. In severe cases, it can develop into sepsis and endanger the life of the mother. It is a difficult problem in obstetrics. The incidence of placenta increta is increasing due to the continuous increase of a number of related factors, such as cesarean section, uterine cavity surgery, and elderly pregnant women. Currently, various guidelines on the treatment of placenta increta focus recommend hysterectomy. However, with the adjustment of the fertility policy, more and more patients have a strong desire to retain the uterus, and the conservative treatment of placenta increta has become more common worldwide. We report a case study of a patient with a uterine cavity infection due to placenta increta. The report outlines the clinical manifestations, laboratory examinations, imaging examinations, pathological examinations, interventional therapy, and traditional Chinese medicine treatment. After vaginal delivery, the woman was diagnosed with placenta increta and uterine cavity infection. After active treatment, the implanted tissue could not be discharged normally, and the complicated infection could not be effectively controlled. After treatment with the Simiao Yongan decoction, the implanted tissue discharged totally. The infection index gradually decreased, the clinical manifestations returned to normal, and the prognosis was good. In this case, Chinese medicine effectively treated the uterine cavity infection caused by placenta increta after vaginal delivery. Thus, these results provide a new diagnosis and treatment choice for placental increta in clinical practice.
Topics: Aged; Cesarean Section; China; Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 35144429
DOI: 10.21037/apm-21-3794 -
Archives of Gynecology and Obstetrics May 2016Placenta accreta is an abnormal adherence of the placenta to the uterine wall. As the incidence of placenta accreta continues to rise, it has been useful to develop... (Review)
Review
PURPOSE
Placenta accreta is an abnormal adherence of the placenta to the uterine wall. As the incidence of placenta accreta continues to rise, it has been useful to develop standard protocols for the diagnosis and management of affected patients. Pathologists have the opportunity to take an active role in evaluating these resource intensive protocols.
METHODS
We describe methods of gross dissection, microscopic examination and reporting of hysterectomy specimens containing placenta accreta.
RESULTS
This protocol facilitates retrospective correlation with surgical and radiographic findings as well as standardized tissue sampling for potential research.
CONCLUSIONS
Through regular review of such quality measures pathologists can give feedback on the quality of surgical planning and use of imaging.
Topics: Female; Humans; Hysterectomy; Middle Aged; Placenta; Placenta Accreta; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 26758078
DOI: 10.1007/s00404-015-4006-5 -
Acta Obstetricia Et Gynecologica... Feb 2014Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim... (Review)
Review
Publications on abnormally invasive placenta in general report what can be considered a mixture of the conditions true accreta, increta and percreta varieties. The aim of this review was to identify all published cases of the most severe condition, placenta percreta in order to describe complications associated with the three commonly used surgical strategies: local resection, hysterectomy or leaving the placenta in situ, and to describe the outcome, with respect to blood loss and transfusion requirements, with the different endovascular interventions that may be used as adjuncts in the management of the conditions. A PubMed search was performed in April 2013 and the final review included 119 published placenta percreta cases. Conservative management, where the placenta is left in situ for resorption, seems to be associated with severe long-term complications of hemorrhage and infections, including a 58% risk that a hysterectomy will eventually be needed up till nine months after the delivery. Local resection seems to be associated with fewer complications within 24 h postoperatively compared with hysterectomy or leaving the placenta in situ. A selection bias in the direction of less severe cases for the local resection technique might in part explain the lower complication rates with that approach. Future prospective data collection activities should include intended as well as actual management, and long-term follow-up of all cases is of vital importance.
Topics: Blood Loss, Surgical; Blood Volume; Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Pregnancy Complications; Treatment Outcome; Uterine Artery Embolization
PubMed: 24266548
DOI: 10.1111/aogs.12295 -
Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review.Radiologia 2023Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis... (Review)
Review
Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis and treatment. Pathological examination or imaging evaluation are not very dependable when considered as stand-alone diagnostic tools. On the other hand, timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patient goes through the third phase of delivery in a not well-suited facility. A multidisciplinary approach for diagnosis (incorporating clinical, imaging, and pathological evaluation) is mandatory, particularly in complicated cases. For imaging evaluation, the diagnostic modality of choice in most scenarios is ultrasound (US) exam; patients are referred for MRI when US is equivocal, inconclusive, or not visualizing placenta properly. Herewith, we review the reported US and MRI features of PAS disorders (mainly focusing on MRI), going over the normal placental imaging and imaging pitfalls in each section, and lastly, covering the imaging findings of PAS disorders in the first trimester and cesarean section pregnancy (CSP).
Topics: Pregnancy; Humans; Female; Placenta Accreta; Placenta; Cesarean Section; Magnetic Resonance Imaging
PubMed: 38049252
DOI: 10.1016/j.rxeng.2023.02.001 -
JPMA. the Journal of the Pakistan... Jul 2019Morbidly adherent placenta in the absence of risk factors is a rare entity in primigravida, and its conservative management becomes important in such patients to...
Morbidly adherent placenta in the absence of risk factors is a rare entity in primigravida, and its conservative management becomes important in such patients to preserve future fertility. We report a case where a primigravida was discovered accidentally having placenta increta while her caesarean section was being performed due to foetal distress (grade 2 meconium). There was unexpected delay in delivery of the placenta. It was managed conservatively by performing a bilateral uterine artery ligation and methotrexate post operatively. On weekly follow-ups serum beta Human Chorionic Gonadotropin(bHCG) levels were done as well as and two weekly ultrasounds. Conservative management of morbidly adherent placenta can be considered in primigravidas where there is a great need to preser ve fer tility and avoid hysterectomy.
Topics: Adult; Cesarean Section; Conservative Treatment; Female; Gravidity; Humans; Placenta Accreta; Pregnancy
PubMed: 31983746
DOI: No ID Found -
Pediatric and Developmental Pathology :... 2016Morbid adherence remains a puzzling disease. This paper suggests that normal and morbidly adherent placentation may be viewed best in terms of trophoblastic stem cells...
Morbid adherence remains a puzzling disease. This paper suggests that normal and morbidly adherent placentation may be viewed best in terms of trophoblastic stem cells and the mutually exclusive branches of the trophoblastic differentiation pathway-villous trophoblast (VT), interstitial and endovascular nonvillous trophoblast (NVT) at the implantation site, and a positional variation in the chorion. Based on cases of hysterectomies for morbid adherence seen over 30 years at a community hospital, analyzed with routine keratin stains, with actin and trichrome stains as indicated, and with attempts at ultrasonography-pathology correlation, we present selected observations. In true accreta, the site of morbid adherence was to dilated basal plate vessels infiltrated by endovascular NVT, with scant interstitial NVT, and normal myometrium. It appeared that excess blood flow into the placenta was due to excessively deep keratin-positive endovascular NVT that spread-independently of interstitial NVT-in an angiocentric fashion in both accreta and increta. Retroplacental abnormalities were due to myometrial destruction by interstitial NVT in increta, sometimes requiring actin stains for detection; and to an admixture of markedly dilated endometrial glands and vessels in true accreta, best appreciated with keratin stains. Variations of depth and extent in increta may be due to variations in myometrial tone, and in the protease-antiprotease balance. Morbidly adherent fetal membranes are described, and the role of caesarean section scars in incretas is addressed.
Topics: Cell Differentiation; Female; Humans; Placenta Accreta; Pregnancy; Trophoblasts
PubMed: 26492199
DOI: 10.2350/15-05-1641-OA.1 -
Seminars in Perinatology Oct 2011The purpose of this article is to review the risks and benefits of scheduled preterm delivery in patients with placenta accreta, increta, and percreta and to provide... (Review)
Review
The purpose of this article is to review the risks and benefits of scheduled preterm delivery in patients with placenta accreta, increta, and percreta and to provide guidance regarding timing of delivery in such cases. Relevant documents for this opinion were identified through a search of the English literature for publications, including one or more of the keywords "accreta" or "increta" or "percreta" and "preterm" and "delivery time" by the use of PubMed (U.S. National Library Of Medicine, January 1990-January 2010), with results limited to studies involving humans. Additional information was obtained from references identified from within selected articles, from additional review articles, and from guidelines by organizations, including the American College of Obstetricians & Gynecologists. Each included article was evaluated according to study design and quality in accordance with scheme outlined by the U.S. Preventative Services Task Force, and final recommendations are provided based on the level of published evidence. On the basis of this search, we found that abnormal placentation, encompassing placenta accreta, increta, and percreta, is increasingly common. We also found that randomized controlled trials and well-controlled observational studies that can be used to define best practice in delivery time are lacking. Optimal delivery time must be determined from available case series, retrospective reviews and decision analysis studies. Given the best-available evidence, optimal time for delivery is believed to be between 34 and 35 weeks in most cases.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Placenta Accreta; Pregnancy; Premature Birth
PubMed: 21962623
DOI: 10.1053/j.semperi.2011.05.002 -
Ultrasound in Obstetrics & Gynecology :... Nov 2023To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To report on the occurrence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders (PAS).
METHODS
MEDLINE, EMBASE and the Cochrane databases were searched electronically up to 1 November 2022. Studies reporting on the urological outcome of women undergoing Cesarean section for PAS were included. Two independent reviewers performed data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with disagreements resolved by consensus.The primary outcome was the overall occurrence of urological complications. Secondary outcomes were the occurrence of any cystotomy, intentional cystotomy, unintentional cystotomy, ureteral damage, ureteral fistula and vesicovaginal fistula. All outcomes were explored in the overall population of women undergoing surgery for PAS. In addition, we performed subgroup analyses according to the type of surgery (Cesarean hysterectomy, or conservative surgery or management), severity of PAS at histopathology (placenta accreta/increta and placenta percreta), type of intervention (planned vs emergency) and number of cases per year. Random-effects meta-analyses of proportions were used to analyze the data.
RESULTS
There were 62 studies included in the systematic review and 56 were included in the meta-analysis. Urological complications occurred in 15.2% (95% CI, 12.9-17.7%) of cases. Cystotomy complicated 13.5% (95% CI, 9.7-17.9%) of surgical operations. Intentional cystotomy was required in 7.7% (95% CI, 6.5-9.1%) of cases, while unintentional cystotomy occurred in 7.2% (95% CI, 6.0-8.5%) of cases. Urological complications occurred in 19.4% (95% CI, 16.3-22.7%) of cases undergoing hysterectomy and 12.2% (95% CI, 7.5-17.8%) of those undergoing conservative treatment. In the subgroup analyses, urological complications occurred in 9.4% (95% CI, 5.4-14.4%) of women with placenta accreta/increta and 38.5% (95% CI, 21.6-57.0%) of those described as having placenta percreta, and included mainly cystotomy (5.5% (95% CI, 0.6-15.1%) and 22.0% (95% CI, 5.4-45.5%), respectively). Urological complications occurred in 15.4% (95% CI, 8.1-24.6%) of cases undergoing a planned procedure and 24.6% (95% CI, 13.0-38.5%) of those undergoing an emergency intervention. In subanalysis of studies reporting on ≥ 12 cases per year, the incidence of urological complication was similar to that reported in the primary analysis.
CONCLUSIONS
Women undergoing surgery for PAS are at high risk of urological complication, mainly cystotomy. The incidence of these complications was particularly high in women described as having placenta percreta at birth and in those undergoing emergency surgical intervention. The high heterogeneity between the included studies highlights the need for a standardized protocol for the diagnosis of PAS to identify prenatal imaging signs associated with the increased risk of urological morbidity at delivery. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Cesarean Section; Placenta Accreta; Obstetrics; Ureter; Ultrasonography, Prenatal; Retrospective Studies; Hysterectomy; Placenta
PubMed: 37401769
DOI: 10.1002/uog.26299 -
PloS One 2012Placenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the...
BACKGROUND
Placenta accreta/increta/percreta is associated with major pregnancy complications and is thought to be becoming more common. The aims of this study were to estimate the incidence of placenta accreta/increta/percreta in the UK and to investigate and quantify the associated risk factors.
METHODS
A national case-control study using the UK Obstetric Surveillance System was undertaken, including 134 women diagnosed with placenta accreta/increta/percreta between May 2010 and April 2011 and 256 control women.
RESULTS
The estimated incidence of placenta accreta/increta/percreta was 1.7 per 10,000 maternities overall; 577 per 10,000 in women with both a previous caesarean delivery and placenta praevia. Women who had a previous caesarean delivery (adjusted odds ratio (aOR) 14.41, 95%CI 5.63-36.85), other previous uterine surgery (aOR 3.40, 95%CI 1.30-8.91), an IVF pregnancy (aOR 32.13, 95%CI 2.03-509.23) and placenta praevia diagnosed antepartum (aOR 65.02, 95%CI 16.58-254.96) had raised odds of having placenta accreta/increta/percreta. There was also a raised odds of placenta accreta/increta/percreta associated with older maternal age in women without a previous caesarean delivery (aOR 1.30, 95%CI 1.13-1.50 for every one year increase in age).
CONCLUSIONS
Women with both a prior caesarean delivery and placenta praevia have a high incidence of placenta accreta/increta/percreta. There is a need to maintain a high index of suspicion of abnormal placental invasion in such women and preparations for delivery should be made accordingly.
Topics: Adult; Case-Control Studies; Cesarean Section; Epidemiological Monitoring; Female; Humans; Incidence; Maternal Age; Odds Ratio; Placenta Accreta; Placenta Previa; Pregnancy; Risk Factors; United Kingdom
PubMed: 23300807
DOI: 10.1371/journal.pone.0052893