Conservative Management Of Placenta Accreta Research Articles

Maternal Outcome After Conservative Treatment of Placenta Accreta

To estimate maternal outcome after conservative management of placenta accreta. This retrospective multicenter study sought to include all women treated conservatively for placenta accreta in tertiary university hospital centers in France from 1993 to 2007. Conservative management was defined by the obstetrician's decision to leave the placenta in situ, partially or totally, with no attempt to remove it forcibly. The primary outcome was success of conservative treatment, defined by uterine preservation. The secondary outcome was a composite measure of severe maternal morbidity including sepsis, septic shock, peritonitis, uterine necrosis, fistula, injury to adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis or pulmonary embolism, or death. Of the 40 university hospitals that agreed to participate in this study, 25 institutions had used conservative treatment at least once (range 1-46) and had treated a total of 167 women. Conservative treatment was successful for 131 of the women (78.4%, 95% confidence interval [CI] 71.4-84.4%); of the remaining 36 women, 18 had primary hysterectomy and 18 had delayed hysterectomy (10.8% each, 95% CI 6.5-16.5%). Severe maternal morbidity occurred in 10 cases (6.0%, 95% CI 2.9-10.7%). One woman died of myelosuppression and nephrotoxicity related to intraumbilical methotrexate administration. Spontaneous placental resorption occurred in 87 of 116 cases (75.0%, 95% CI 66.1-82.6%), with a median delay from delivery of 13.5 weeks (range 4-60 weeks). Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.

Fertility and obstetric outcome after conservative management of placenta accreta

Objective To determine the fertility and obstetric outcomes after conservative management of placenta accreta. Methods A retrospective observational cohort study of all identified cases of placenta accreta from 1993 to 2007 in 2 tertiary university hospitals in France. For patients treated conservatively, maternal and fetal morbidity, reproductive function, fertility, and subsequent pregnancies were recorded. Results During the study period, 46 patients were treated by conservative management; 6 patients underwent a secondary hysterectomy. Of the remaining 40 patients, 35 were followed up for a median of 65 months (range 18–156 months). Patients resumed their menstrual cycles after a median of 130 days (range 48–176 days). Menses were irregular in 11 patients (31%), but none had amenorrhea. Twelve of the 14 patients desiring another pregnancy achieved a total of 15 pregnancies; 2 patients had recurrent placenta accreta. Five spontaneous abortions and 1 termination of pregnancy occurred during the first trimester. The median term at delivery was 37 weeks (range, 35–40 weeks). Four patients delivered prematurely. Conclusion Conservative management of placenta accreta can preserve fertility, although the risk of recurrent placenta accreta appears to be high.

Conservative Management of Placenta Accreta in a Multiparous Woman

Placenta accreta refers to any abnormally invasive placental implantation. Diagnosis is suspected postpartum with failed delivery of a retained placenta. Massive obstetrical hemorrhage is a known complication, often requiring peripartum hysterectomy. We report a case of presumed placenta accreta in a patient following failed manual removal of a retained placenta. We describe an attempt at conservative management with methotrexate in a stable patient desiring future fertility. Treatment was unsuccessful and led to the development of a disseminated intrauterine infection complicated by a bowel obstruction, requiring both a hysterectomy and small bowel resection. In hemodynamically stable patients, conservative management of placenta accreta may involve leaving placental tissue in situ with subsequent administration of methotrexate. However, ongoing close observation is required to identify complications.

Conservative management of clinically diagnosed placenta accreta following vaginal delivery

Placenta accreta can result in substantial maternal morbidity and mortality. Conservative management of placenta accreta following vaginal delivery is discussed in this case series. These cases demonstrate serial ultrasonographic resorption of placenta accreta left in situ following vaginal delivery with minimal blood product requirements and preservation of fertility.

I46 Conservative management of placenta accreta: Technique, immediate and long-term outcomes

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S12-S12 Invited presentations I46 Conservative management of placenta accreta: Technique, immediate and long-term outcomes F. Bretelle, F. BretelleSearch for more papers by this authorM. Provansal, M. ProvansalSearch for more papers by this authorC. Mazouni, C. MazouniSearch for more papers by this authorA. Agostini, A. AgostiniSearch for more papers by this authorC. D'Ercole, C. D'ErcoleSearch for more papers by this authorL. Cravello, L. CravelloSearch for more papers by this authorM. Gamerre, M. GamerreSearch for more papers by this authorL. Boubli, L. BoubliSearch for more papers by this author F. Bretelle, F. BretelleSearch for more papers by this authorM. Provansal, M. ProvansalSearch for more papers by this authorC. Mazouni, C. MazouniSearch for more papers by this authorA. Agostini, A. AgostiniSearch for more papers by this authorC. D'Ercole, C. D'ErcoleSearch for more papers by this authorL. Cravello, L. CravelloSearch for more papers by this authorM. Gamerre, M. GamerreSearch for more papers by this authorL. Boubli, L. BoubliSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60046-1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S12-S12 RelatedInformation

Comparaison historique de deux types de prises en charge de placenta accreta: radicale versus conservatrice

To compare the impact of conservative and radical strategies for placenta accreta on maternal morbidity and mortality. We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta admitted to our tertiary center from January 1993 through October 2005. Two consecutive periods, A and B, were compared: during period A (january 1993 to June 1997), our written protocol called for the systematic manual removal of the placenta, to leave the uterine cavity empty. In period B (July 1997 to October 2005), we changed our policy and attempted to treat patients with a placenta accreta conservatively. The following outcomes over the two periods were compared: need for blood product transfusion, hysterectomy, intensive care admission, duration of stay in intensive care unit, sepsis and disseminated intravascular coagulation. Fifty-one cases of placenta accreta were observed among 40281 deliveries (1.3/1000). Period B saw a reduction in the hysterectomy rate (11/13 versus 10/38; P < 0.01), the mean red blood cells transfused (3230+/-2170 versus 1081+/-1370 ml; P < 0.01) and disseminated intravascular coagulation (5/13 versus 1/38; P < 0.01) compared with period A. Seven cases of maternal infection were recorded during period B and none during period A (p = 0.22). Conservative management of placenta accreta appears to be a safe alternative to radical management.

Recurrence following conservative management of placenta accreta

This paper describes 4 cases of recurring placenta accreta in 3 women following conservative management of the condition in the previous pregnancy (the index pregnancy) (Table 1). The placentas were characterized by their location in the uterus, which was the same as in the index pregnancy, and by their extension. Patient 1 had 2 recurrences. The first was uncomplicated, but in the second the accreta area extended to the entire placenta. The patient again chose conservative treatment. Accordingly, delivery was by cesarean [1], with a vertical fundic incision preserving the placental bed. The placenta was left in place. After 1 month, the patient was admitted with a hemorrhage and fever. On digital examination the cervix was dilated 7 to 8 cm and the placenta, still tightly attached to the myometrium, was partially expelled into the vaginal cavity. It was removed vaginally under general anesthesia and antibiotics were prescribed. The aftermath was uneventful but resorption of placental remnants took 12 months. Case 2 was unremarkable. The recurring placenta accreta was managed conservatively without complications. In case 3, however, massive hemorrhage prevented conservative management of the recurring condition and a hysterectomy was performed. Placenta accreta is usually diagnosed after delivery, when manual removal of the placenta fails. Because forcible manual removal of placenta accreta can lead to dramatic hemorrhaging that may require hysterectomy, the approach most often recommended is surgical [2]. One possible management technique that may preserve fertility is treating placenta accreta conservatively, leaving the placenta in situ, partially or totally adhering to the myometrium [1]. Nonetheless, it is difficult to provide adequate information to women who are asked to choose between management options, as there are few reports of pregnancies following conservative treatment. Two reports of a recurrence of placenta accreta, both of which were eventually treated by hysterectomy, do not specify placental uterine location [3,4]. The possibility of recurrence should be discussed with the patient when she initially opts for conservative management. Furthermore, following conservative management, placentation should be carefully monitored for recurrence in any subsequent pregnancy, particularly if the placenta is located at the same site as the previous placenta accreta.

An Operative Technique for Conservative Management of Placenta Accreta

Control of bleeding is the goal of management for placenta accreta, which usually necessitates hysterectomy. A Committee Opinion of The American College of Obstetricians and Gynecologists (ACOG) has addressed the difficulties of conservative treatments. Placentas of 2 primiparous women with placenta accreta were removed operatively from their uteri. One woman underwent a low transverse cesarean delivery, and the other had delivered vaginally. In each case, the anterior uterine wall was incised vertically between the lower segment and fundus before manual removal. After eversion of the uterus, the placenta was successfully detached from the uterine wall after intramyometrial administration of oxytocin. A vertical incision in the anterior uterine wall and subsequent eversion of the uterus may aid in avoiding hysterectomy with placenta accreta.

The use of serial βHCG to plan surgical evacuation of retained placenta in a case of placenta accreta

Placenta accreta is a rare condition. Its management is always a dilemma. Traditionally, hysterectomy has been the treatment of choice. However, with appropriate case selection, conservative management is possible with or without using methotrexate. This case report describes conservative management of placenta accreta with serial monitoring of βHCG.

Clinical aspects and conservative management of placenta accreta

The Obstetrician & GynaecologistVolume 6, Issue 4 p. 264-264 Clinical aspects and conservative management of placenta accreta Sujatha Thamban MRCOG, Sujatha Thamban MRCOG Specialist Registrar Department of Obstetrics and Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex, IG3 8YB, UKSearch for more papers by this authorGeoffrey W Cochrane FRCOG, Geoffrey W Cochrane FRCOG Consultant in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, King George Hospital, GoodmayesSearch for more papers by this author Sujatha Thamban MRCOG, Sujatha Thamban MRCOG Specialist Registrar Department of Obstetrics and Gynaecology, King George Hospital, Barley Lane, Goodmayes, Essex, IG3 8YB, UKSearch for more papers by this authorGeoffrey W Cochrane FRCOG, Geoffrey W Cochrane FRCOG Consultant in Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, King George Hospital, GoodmayesSearch for more papers by this author First published: 24 January 2011 https://doi.org/10.1576/toag.6.4.264.51591AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume6, Issue4October 2004Pages 264-264 RelatedInformation

Ectopic Pregnancy after Conservative Management of Placenta Accreta: A Case Report

Placenta accreta can be managed with preservation of the uterus, especially when further fertility is intended. We report a case of placenta accreta diagnosed intraoperatively and treated conservatively that was followed by an ectopic pregnancy. A 32-year-old woman was found to have placenta accreta during cesarean section. Some pieces of the placenta were left in situ after bleeding was controlled. The patient was followed up using levels of !-human chorionic gonadotropin. Hysteroscopy revealed fibrotic and scar tissue at the site of retained placenta 1 year later. The patient did not conceive until 2 years later, but it was an ectopic pregnancy. There are few reports of successful pregnancy following conservative treatment for placenta accreta. Conservative treatment may increase the risk of secondary infertility, recurrent placenta accreta, and probably ectopic pregnancy.

Clinical aspects and conservative management of placenta accreta

Placenta accreta is a rare complication of human placentation with fertility and life‐threatening sequelae. Traditional management has centred upon hysterectomy and its prompt undertaking has been well documented in saving lives. While in many situations hysterectomy will remain appropriate, there are other management options available involving conservative approaches. This article reviews the diagnosis and demographics of this potentially frightening pathology and highlights the important aspects of conservative management if hysterectomy is to be avoided.

Late uterine wedge resection of placenta increta

Background: Recently, preferences for preserving reproductive potential has sparked increasing interest in the conservative management of placenta accreta, increta, and percreta. Case: A 23-year-old gravida 3 para 2 had a vaginal delivery complicated by retained placenta. The placenta was delivered in multiple fragments followed by sharp curettage. Her postpartum course was complicated by pelvic pain and menorrhagia, unrelieved by sharp curettage. Four months postpartum, transvaginal ultrasonography and magnetic resonance imaging demonstrated an intramyometrial mass. Exploratory laparotomy was done with wedge resection of the anterior wall of the uterus under real-time ultrasonographic guidance. Pathologic examination found placenta increta. Conclusion: Conservative management of placenta increta can be used selectively to preserve reproductive potential.

LATE UTERINE WEDGE RESECTION OF PLACENTA INCRETA

In Brief Background Recently, preferences for preserving reproductive potential has sparked increasing interest in the conservative management of placenta accreta, increta, and percreta. Case A 23-year-old gravida 3 para 2 had a vaginal delivery complicated by retained placenta. The placenta was delivered in multiple fragments followed by sharp curettage. Her postpartum course was complicated by pelvic pain and menorrhagia, unrelieved by sharp curettage. Four months postpartum, transvaginal ultrasonography and magnetic resonance imaging demonstrated an intramyometrial mass. Exploratory laparotomy was done with wedge resection of the anterior wall of the uterus under real-time ultrasonographic guidance. Pathologic examination found placenta increta. Conclusion Conservative management of placenta increta can be used selectively to preserve reproductive potential. Wedge resection of the uterine wall might help preserve reproductive function in placenta increta.

Conservative management of placenta accreta

Conservative management of placenta accreta