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The Canadian Veterinary Journal = La... Jun 2020A 3-year-old intact female Labradoodle bitch was referred due to fever and lethargy 4 days postpartum. The dog was reported to have had prolonged labor that required...
A 3-year-old intact female Labradoodle bitch was referred due to fever and lethargy 4 days postpartum. The dog was reported to have had prolonged labor that required assistance and fetal membranes were retained. Physical examination and diagnostics led to a suspicion of metritis and uterine perforation. Ovariohysterectomy was performed. Gross and histopathology findings revealed multifocal uterine perforation, necrosuppurative metritis, and placenta percreta. Post-operative antibiotic therapy and supportive care resulted in an uneventful clinical recovery. This is the first reported case of placenta percreta in a bitch. It is presumed that this pathology was paramount in the patient's development of metritis and subsequent uterine rupture. Key clinical message: Placenta percreta may lead to more severe clinical consequences of metritis, including uterine rupture.
Topics: Animals; Dog Diseases; Dogs; Female; Hysterectomy; Placenta Accreta; Postpartum Period; Pregnancy; Uterine Perforation; Uterine Rupture
PubMed: 32675809
DOI: No ID Found -
European Review For Medical and... Jun 2022Our aim is to describe and assess a Sandwich Excision (placenta-uterine-bladder excision together) surgical technique for women with clinically confirmed placenta...
OBJECTIVE
Our aim is to describe and assess a Sandwich Excision (placenta-uterine-bladder excision together) surgical technique for women with clinically confirmed placenta percreta involving the maternal bladder.
PATIENTS AND METHODS
A retrospective cohort study was performed on all patients with clinically confirmed placenta percreta involving the maternal bladder who underwent Sandwich Excision at our large academic institution from January 1, 2014, to June 30, 2019.
RESULTS
Twenty-three patients were included. Four patients underwent hysterectomy, and one patient underwent subhysterectomy. The mean duration of surgery was 228.04 ± 85.59 minutes (range, 90.00-503.00 minutes). The mean estimated blood loss was 5,269.57 ± 2,745.81 mL (range, 1,000.00-12,500.00 mL). No thromboembolic events occurred, and there were no maternal or neonatal deaths among the subjects in this study.
CONCLUSIONS
Sandwich excision is associated with a low rate of hysterectomy in women with placenta percreta involving the maternal bladder. The procedure is a relatively safe technique and can be performed safely by experienced obstetricians who are familiar with the uterus-bladder space. Meanwhile, the success rates and complications of the Sandwich Excision in these patients also need to be evaluated in prospective studies.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Placenta Accreta; Pregnancy; Prospective Studies; Retrospective Studies; Urinary Bladder
PubMed: 35776024
DOI: 10.26355/eurrev_202206_29062 -
Acta Obstetricia Et Gynecologica... Jun 2021
Topics: Female; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Prenatal Diagnosis
PubMed: 34002367
DOI: 10.1111/aogs.14148 -
Acta Obstetricia Et Gynecologica... Jul 2022A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to...
INTRODUCTION
A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies.
MATERIAL AND METHODS
Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy.
RESULTS
The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications).
CONCLUSIONS
The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.
Topics: Cesarean Section; Female; Hospitals, University; Humans; Hysterectomy; Peripartum Period; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35388907
DOI: 10.1111/aogs.14358 -
Ultrasound in Obstetrics & Gynecology :... Apr 2022Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal...
OBJECTIVES
Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal morbidity and mortality. Our objectives were to assess the performance of classic ultrasound signs and to determine the value of novel ultrasound signs in the detection of PAS.
METHODS
This was a retrospective cohort study of women with second-trimester placenta previa who underwent third-trimester transvaginal ultrasound and all women with PAS in seven medical centers. A retrospective image review for signs of PAS was conducted by three maternal-fetal medicine physicians. Classic signs of PAS were defined as placental lacunae, bladder-wall interruption, myometrial thinning and subplacental hypervascularity. Novel signs were defined as small placental lacunae, irregular placenta-myometrium interface (PMI), vascular PMI, non-tapered placental edge and placental bulge towards the bladder. PAS was diagnosed based on difficulty in removing the placenta or pathological examination of the placenta. Multivariate regression analysis was performed and receiver-operating-characteristics (ROC) curves were generated to assess the performance of combined novel signs, combined classic signs and a model combining classic and novel signs.
RESULTS
A total of 385 cases with placenta previa were included, of which 55 had PAS (28 had placenta accreta, 11 had placenta increta and 16 had placenta percreta). The areas under the ROC curves for classic markers, novel markers and a model combining classic and novel markers for the detection of PAS were 0.81 (95% CI, 0.75-0.88), 0.84 (95% CI, 0.77-0.90) and 0.88 (95% CI, 0.82-0.94), respectively. A model combining classic and novel signs performed better than did the classic or novel markers individually (P = 0.03). An increasing number of signs was associated with a greater likelihood of PAS. With the presence of 0, 1, 2 and ≥ 3 classic ultrasound signs, PAS was present in 5%, 24%, 57% and 94% of cases, respectively.
CONCLUSIONS
We have confirmed the value of classic ultrasound signs of PAS. The use of novel ultrasound signs in combination with classic signs improved the detection of PAS. These findings have clinical implications for the detection of PAS and may help guide the obstetric management of patients diagnosed with these placental disorders. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34725869
DOI: 10.1002/uog.24804 -
Ultrasound in Obstetrics & Gynecology :... Apr 2014To determine, by evaluation of histological slides, images and descriptions of early (second-trimester) placenta accreta (EPA) and placental implantation in cases of... (Review)
Review
OBJECTIVE
To determine, by evaluation of histological slides, images and descriptions of early (second-trimester) placenta accreta (EPA) and placental implantation in cases of Cesarean scar pregnancy (CSP), whether these are pathologically indistinguishable and whether they both represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester.
METHODS
The database of a previously published review of CSP and EPA was used to identify articles with histopathological descriptions and electronic images for pathological review. When possible, microscopic slides and/or paraffin blocks were obtained from the original researchers. We also included from our own institutions cases of CSP and EPA for which pathology specimens were available. Two pathologists examined all the material independently and, blinded to each other's findings, provided a pathological diagnosis based on microscopic appearance. Interobserver agreement in diagnosis was determined.
RESULTS
Forty articles were identified, which included 31 cases of CSP and 13 cases of EPA containing histopathological descriptions and/or images of the pathology. We additionally included six cases of CSP and eight cases of EPA from our own institutions, giving a total of 58 cases available for histological evaluation (37 CSP and 21 EPA) containing clear definitions of morbidly adherent placenta. In the 29 cases for which images/slides were available for histopathological evaluation, both pathologists attested to the various degrees of myometrial and/or scar tissue invasion by placental villi with scant or no intervening decidua, consistent with the classic definition of morbidly adherent placenta. Based on the reviewed material, cases with a diagnosis of EPA and those with a diagnosis of CSP showed identical histopathological features. Interobserver correlation was high (kappa = 0.93).
CONCLUSIONS
EPA and placental implantation in CSP are histopathologically indistinguishable and may represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester.
Topics: Cesarean Section; Cicatrix; Early Diagnosis; Female; Humans; Placenta; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Pregnancy, Ectopic; Ultrasonography
PubMed: 24357257
DOI: 10.1002/uog.13282 -
Frontiers in Endocrinology 2023Placenta accreta spectrum (PAS) is one of the major causes of maternal morbidity and mortality worldwide with increasing incidence. PAS refers to a group of pathological...
Placenta accreta spectrum (PAS) is one of the major causes of maternal morbidity and mortality worldwide with increasing incidence. PAS refers to a group of pathological conditions ranging from the abnormal attachment of the placenta to the uterus wall to its perforation and, in extreme cases, invasion into surrounding organs. Among them, placenta accreta is characterized by a direct adhesion of the villi to the myometrium without invasion and remains the most common diagnosis of PAS. Here, we identify the potential regulatory miRNA and target networks contributing to placenta accreta development. Using small RNA-Seq followed by RT-PCR confirmation, altered miRNA expression, including that of members of placenta-specific miRNA clusters (e.g., C19MC and C14MC), was identified in placenta accreta samples compared to normal placental tissues. hybridization (ISH) revealed expression of altered miRNAs mostly in trophoblast but also in endothelial cells and this profile was similar among all evaluated degrees of PAS. Kyoto encyclopedia of genes and genomes (KEGG) analyses showed enriched pathways dysregulated in PAS associated with cell cycle regulation, inflammation, and invasion. mRNAs of genes associated with cell cycle and inflammation were downregulated in PAS. At the protein level, NF-κB was upregulated while PTEN was downregulated in placenta accreta tissue. The identified miRNAs and their targets are associated with signaling pathways relevant to controlling trophoblast function. Therefore, this study provides miRNA:mRNA associations that could be useful for understanding PAS onset and progression.
Topics: Pregnancy; Humans; Female; Placenta Accreta; MicroRNAs; Endothelial Cells; Placenta; Myometrium
PubMed: 36936174
DOI: 10.3389/fendo.2023.1021640 -
Acta Obstetricia Et Gynecologica... Aug 2004To describe an accurate approach, hemostatic procedures and uterine repair in patients with anterior placenta percreta.
BACKGROUND
To describe an accurate approach, hemostatic procedures and uterine repair in patients with anterior placenta percreta.
METHODS
A total of 68 patients with anterior placenta percreta were included. A large retrovesical and parametrial dissection was performed in all cases. Hemostasis was achieved with selective vascular ligature or with surgical myometrial compression. The anterior wall defect was repaired using a myometrial suture, fibrin glue and polyglycolic mesh. Finally, a nonadherent cellulose layer was applied over this reconstruction. Hysteroscopy and T2 magnetic resonance imaging (MRI) were performed as a reconstruction control at 90 days after discharge.
RESULTS
Elective surgery was performed in 49 patients and emergency surgery in 19. In 59 midline incisions were performed and in nine lower transverse incisions. Forty-nine patients underwent fundal hysterotomy and 19 transplacental segmental uterine approaches. The uteri of 50 patients with anterior placenta percreta were repaired. Of the 18 hysterectomies performed in this series, 16 were indicated due to massive destruction and two were secondary to coagulopathies. The following surgical complications developed: pelvic hemorrhage (one), coagulopathies (two), uterine infection (three), low ureteral ligations (two), iatrogenic foreign bodies (two) and collection (three). Uterine conservation was highly significant between the upper and lower invasion areas. Ten pregnancies were reported after the repair, resulting in uncomplicated cesarean delivery.
CONCLUSION
This approach has allowed an adequate uterine repair in patients with anterior placenta percreta. Based on these results it is valid to assume that a functional and anatomic uterine repair has been successfully performed.
Topics: Adult; Argentina; Female; Hemostatic Techniques; Humans; Magnetic Resonance Imaging; Placenta Accreta; Postoperative Complications; Pregnancy; Treatment Outcome
PubMed: 15255846
DOI: 10.1111/j.0001-6349.2004.00517.x -
BMC Pregnancy and Childbirth Aug 2023A previous study investigated the effect of adenomyosis on perinatal outcomes. Some studies have reported varying effect of adenomyosis on pregnancy outcomes in some...
BACKGROUND
A previous study investigated the effect of adenomyosis on perinatal outcomes. Some studies have reported varying effect of adenomyosis on pregnancy outcomes in some patients and dependence on the degree and subtype of uterine lesions. To elucidate the impact of adenomyosis on perinatal outcomes.
METHODS
This large-scale cohort study used the perinatal registry database of the Japan Society of Obstetrics and Gynecology. A dataset of 203,745 mothers who gave birth between January 2020 and December 2020 in Japan was included in the study. The participants were divided into two groups based on the presence or absence of adenomyosis. Information regarding the use of fertility treatment, delivery, obstetric complications, maternal treatments, infant, fetal appendages, obstetric history, underlying diseases, infectious diseases, use of drugs, and maternal and infant death were compared between the groups.
RESULTS
In total, 1,204 participants had a history of adenomyosis and 151,105 did not. The adenomyosis group had higher rates of uterine rupture (0.2% vs. 0.01%, P = 0.02) and placenta accreta (2.0% vs. 0.5%, P < 0.001) than the non-adenomyosis group. A history of adenomyosis (odds ratio: 2.26; 95% confidence interval: 1.43-3.27; P < 0.001), uterine rupture (odds ratio: 3.45; 95% confidence interval: 0.89-19.65; P = 0.02), placental abruption (odds ratio: 2.11; 95% confidence interval: 1.27-3.31; P < 0.01), and fetal growth restriction (odds ratio: 2.66; 95% confidence interval: 2.00-3.48; P < 0.01) were independent risk factors for placenta accreta.
CONCLUSION
Adenomyosis in pregnancies is associated with an increased risk of placenta accreta, uterine rupture, placental abruption, and fetal growth restriction.
TRIAL REGISTRATION
Institutional Review Board of Tottori University Hospital (IRB no. 21A244).
Topics: Pregnancy; Female; Humans; Cohort Studies; Abruptio Placentae; Uterine Rupture; Placenta Accreta; Fetal Growth Retardation; Retrospective Studies; Placenta; Adenomyosis
PubMed: 37568120
DOI: 10.1186/s12884-023-05895-w -
Journal of Perinatal Medicine May 2023"Placenta Accreta Spectrum" (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release... (Review)
Review
"Placenta Accreta Spectrum" (PAS) is a rare but serious pregnancy condition where the placenta abnormally adheres to the uterine wall and fails to spontaneously release after delivery. When it occurs, PAS is associated with high maternal morbidity and mortality - as PAS management can be particularly challenging. This two-part review summarizes current evidence in PAS management, identifies its most challenging aspects, and offers evidence-based recommendations to improve management strategies and PAS outcomes. The first part of this two-part review highlighted the general anesthetic approach, surgical and interventional management strategies, specialized "centers of excellence," and multidisciplinary PAS treatment teams. The high rates of PAS morbidity and mortality are often provoked by PAS-associated coagulopathies and peripartal hemorrhage (PPH). Anesthesiologists need to be prepared for massive blood loss, transfusion, and to manage potential coagulopathies. In this second part of this two-part review, we specifically reviewed the current literature pertaining to hemostatic changes, blood loss, transfusion management, and postpartum venous thromboembolism prophylaxis in PAS patients. Taken together, the two parts of this review provide a comprehensive survey of challenging aspects in PAS management for anesthesiologists.
Topics: Pregnancy; Female; Humans; Retrospective Studies; Placenta Accreta; Cesarean Section; Hemostatics; Postpartum Hemorrhage; Hysterectomy; Placenta; Placenta Previa
PubMed: 36181735
DOI: 10.1515/jpm-2022-0233