Management Of Placenta Previa Research Articles

S. Rao Spiral Suturing (SRSS) of Lower Uterine Segment: An Innovative Hemostatic Technique in the Management of Placenta Previa and Accreta Spectrum.

The study aimed to demonstrate the efficacy and safety of an innovative hemostatic technique in managing Placenta Previa and Accreta Spectrum by S. Rao Spiral Suturing (SRSS) of a lower uterine segment. In this retrospective study conducted at Department of Obstetrics & Gynecology Unit-II of Nishtar Medical University, Multan between December 2018 to January 2021, one hundred and thirty consenting patients' clinical records were reviewed with major degree placenta previa/placenta accrete spectrum, either operated electively or presented in an emergency, with or without a history of previous cesarean section. The enrolled patients underwent SRSS, procedure's efficacy and safety were measured by the number of obstetrical hysterectomies, the time required for the procedure, estimated blood loss, blood transfusion volume, need for any other hemostatic technique, bladder trauma, pelvic infection, scar site hematoma or abscess, sepsis, duration of hospital stay and maternal mortality. Out of 130 patients, 17(12.6%) had Placenta Accreta, 86(66.3%) Increta, and 27(21%) Percreta. The Placenta location was anterior dominant in 102(78.4%) cases and posterior in 17(8.4%). Of the patients who underwent surgery, only two required obstetrical hysterectomy due to uncontrolled bleeding. The procedure took three to five minutes in 127 patients and five to seven minutes in three patients. Regarding intraoperative blood transfusion, 54.6% of patients were transfused 1000-2000 ml blood, and 5.38% required > 3000 ml. No blood transfusion was required postoperatively in any patient. Postpartum hemorrhage, infection, fever, and sepsis were not observed in any patient postoperatively. None of the patients suffered bladder injury. All patients were discharged as per routine. SRSS is an innovative, safe, effective, and simple suturing technique for patients with Placenta Previa and Accreta spectrum.

Clinical audit of management of placenta previa at international general hospital

Clinical audit of management of placenta previa at international general hospital

Maternal and neonatal outcomes in delivery with diagnosis of antepartum hemorrhage due to placenta previa at a tertiary hospital in Surabaya, Indonesia

HIGHLIGHTS 1. To provide effective prevention and management of placenta previa, maternal and neonatal outcomes should be identified.2. Among mothers studied, no maternal mortality was found, but most newborns had prematurity and low birthweight. ABSTRACT Objective: To identify maternal and neonatal outcomes in delivery with diagnosis of antepartum hemorrhage (APH) due to placenta previa. Materials and Methods: This was a descriptive retrospective study with cross-sectional design. Samples were taken using medical records with convenience sampling technique. Deliveries with history of APH due to placenta previa at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, on January 1 until December 31, 2019, were included. Results: In our study, 36 mothers were included. Maternal characteristics included age of 20–35 years in 72.2%, overweight in 50%, referral visits in 69.4%, from out of town (66.7%), bleeding onset at 3rd trimester (97.2%), primigravida (8.3%), nulliparity (13.9%), 69.4% with history of C-section, and 83.3% no hospital readmissions. Maternal outcomes included 100% mothers diagnosed with complete placenta previa and performed C-section. The mothers were mostly (69.4%) diagnosed with placenta accreta spectrum (PAS). There were 36.1% hysterectomy, 33.3% postpartum hemorrhage, 50% blood transfusions, and zero maternal mortality. Neonatal outcomes included prematurity in 80%, low birth weight (LBW) in 51.5%, while 77.1% and 85.7% of newborns had no asphyxia at 1 and 5 minutes, consecutively. Conclusion: All mothers experienced complete placenta previa, and underwent C-section with most of the mothers were diagnosed with PAS. Less than half of them needed hysterectomy intervention because other patients with focal type PAS were planned for conservative surgery. Moreover, they mostly did not have postpartum hemorrhage with half of them needed blood transfusion. There was zero maternal mortality, with most newborns experienced prematurity, LBW but no significant asphyxia.

Evaluation of uterine cavity and blood flow after conservative surgical management of placenta previa /accrete (Cross Sectional Study)

The aim of the work is aiming at determining the impact on Fertility and pregnancy outcomes of uterine artery ligation or Compression sutures for severe PPH based on a large single-center cohort, The secondary objectives were to compare maternal long term. 4 18 cases continued the follow up at 6 month Two out of 47 cases of the follow up got pregnant after 3 months postpartum by asking them by telephone and confirmed positive pregnancy tests. 6 months postpartum 5 women got pregnant .3 of the 7 cases we could follow up by telephone and they got delivered at GA of 38 w by elective C.S with no recurrence of placenta previa or accrete and no post-operative complications and for luck one of those we followed up at 3 month and moderate adhesions were found in office hysteroscopy and followed her by telephone by asking on her menstrual pattern which was irregular at first for 2months and regulated by hormonal treatment after which she got pregnant and was followed up for recurrence of placenta previa or accrete but her placenta was normal situated and underwent an elective C.S at 38 weeks with no postoperative or intraoperative complications .

Maternal outcomes after placenta previa and its spectrum at a single Saudi academic tertiary care center: 21-year experience

Background: Placenta previa with and without accreta spectrum are among the most serious obstetric conditions that needs a multidisciplinary team-work to achieve best maternal outcome. We reviewed our experience over 21 years at an academic tertiary hospital before and after establishment of placenta previa team Objective: To study the experience of a single academic center managing patients with placenta previa and placenta accreta spectrum over two decades. Design: Retrospective chart review Patients and Methods: This study included all cases with a confirmed diagnosis of placenta previa and/or placenta accreta spectrum that were managed at King Abdulaziz University Hospital from 2001 to 2021. Paper and electronic chart reviews and a search of the birth registry book were performed for all cases. Main Outcome Measures: Maternal morbidity and mortality due to abnormal placentation Sample Size: 521 patients Results: The establishment of a placenta previa team led to an increased prevalence of placenta previa, from 4 to 13.32 in 1000 deliveries, without increased maternal morbidity or mortality. Furthermore, it enhanced patient experience and resulted in satisfactory maternal outcomes. Conclusion: Management of placenta previa and placenta accreta spectrum by a well-coordinated team was cost-effective and markedly reduced maternal morbidity and morbidity. The involvement of this team also improved patient experience, especially in cases in which high-risk interventions were required. Limitations: Retrospective, single-center study; lack of statistical analysis; lack of a validated tool to differentiate treatment strategies

Knowledge of reproductive age women regarding placenta previa in Mosul City, Iraq

Objective: To assess knowledge about placenta previa among women of reproductive age in our community. Methodology: This descriptive cross-sectional study was done in Department of obstetrics and gynecology, Mosul Teaching Hospitals. Data were collected by interviewing 208 women of reproductive age. A detailed questionnaire was used and consisted of demographic characteristics and knowledge of women toward signs and symptoms, risk factor, diagnosis and management of placenta previa. Results: More than half of study sample (62.02%) had age between 15-26 years, most of them were housewives and had secondary education. There was statistically significant correlation between knowledge of women and socio-demographics, level education and women had history of placenta previa (p<0.05). Conclusion: Women participants at Mosul city had poor knowledge level about placenta previa.

Expectant management of placenta previa with intrauterine fetal death at 25 weeks of gestation in twin pregnancy: a case report and literature review

Expectant management of placenta previa with intrauterine fetal death at 25 weeks of gestation in twin pregnancy: a case report and literature review

Role of Abdominal Aortic Balloon Placement in Planned Conservative Management of Placenta Previa With Placenta Increta or Percreta

Background: We investigated the role of balloon placement in the abdominal aorta (BPAA) in planned conservative management of placenta previa with placenta increta or percreta and the effects of BPAA on perinatal adverse maternal events.Methods: This retrospective case-control study included women with placenta previa (increta or percreta), who underwent pregnancy termination at the Qilu Hospital of Shandong University between January 2016 and June 2019. Patients were categorized into the BPAA and non-BPAA groups based on the BPAA placement before delivery. The Chi-square and non-parametric rank-sum tests were used for the intergroup comparison of patient characteristics. The propensity score matching algorithm was used to minimize the intergroup differences in clinical characteristics. Logistic regression analysis was used to identify the factors associated with a high risk of adverse pregnancy outcomes. The area under the receiver operating characteristic curve [area under the curve (AUC)] was used to evaluate the classification of the selected high-risk factors.Results: The study included 260 patients, and 104 patients were identified after propensity score matching. In the post-matched cohort, intraoperative blood loss was significantly lower in the BPAA than in the non-BPAA group (median 1,000 vs. 2,250 ml, P < 0.001). Intraoperative B-Lynch suture was performed in fewer patients in the BPAA (15.4 vs. 34.6%, P = 0.024) than in the non-BPAA group. The packed red blood cell (PRBC) transfusion rate was lower in the BPAA group (median 4 vs. 8 units, P < 0.001). Overall, 46 (45.1%) patients developed adverse maternal events; however, the rate of adverse maternal events was lower in the BPAA group (19.6 vs. 80.4%, P < 0.001). No ligation of the ascending branch of the uterine artery (P = 0.034), no BPAA (P < 0.001), intraplacental vascular lacunae (P = 0.046), and cervical hypervascularity (P = 0.001) were associated with a high risk of adverse perinatal maternal events. The AUC of the high-risk factors was 0.89 in the post-matched and 0.76 in the pre-matched cohorts.Conclusion: Planned conservative management using BPAA significantly minimized the intraoperative blood loss, the need for a B-Lynch suture, and PRBC transfusion in patients with severe placenta accreta spectrum and placenta previa.

Congenital absence of bilateral common iliac arteries.

The common iliac arteries originate at the body of the fourth lumbar vertebra and bifurcate after approximately 5 cm into the external and internal iliac arteries. Anomalies of the iliac arteries are rare, with a reported incidence of only 6 in 8000 patients.1Greebe J. Congenital anomalies of the iliofemoral artery.J Cardiovasc Surg. 1977; 18: 317-323PubMed Google Scholar We present a case of a 66-year-old man with a history of diabetes and hypertension who presented with an ischemic left foot wound. Preoperative aortoiliac imaging studies were not obtained because the patient had palpable bilateral femoral pulses. Aortoiliac angiography demonstrated the absence of bilateral common iliac arteries (A and B/Cover). The aorta terminated into two internal and two external iliac arteries. The left external iliac artery was cannulated, and the remainder of the case was uneventful. The congenital absence of bilateral common iliac arteries has been described once after incidental finding on autopsy2Mansfield A.O. Howard J.M. Absence of both common iliac arteries: a case report.Anat Rec. 1964; 150: 363-364Crossref PubMed Scopus (16) Google Scholar and once intraoperatively during a placenta accreta case requiring internal iliac artery ligation for hemorrhage control.3El-Agwany A.S. Bilateral absence of common iliac artery: abnormal anatomical variation of the internal iliac artery during ligation in conservative surgical management of placenta previa accreta.Indian J Gynaecol Oncol. 2016; 14: 329-330Google Scholar Other case reports have described the unilateral absence of common iliac arteries with various symptoms depending on the presence of in-line flow to the femoral artery.4Dumanian A.V. Frahm C.J. Benchik F.A. Wooden T.F. Intermittent claudication secondary to congenital absence of iliac arteries.Arch Surg. 1965; 91: 604-606Crossref PubMed Scopus (15) Google Scholar,5Llauger J. Sabate J.M. Guardia E. Escudero J. Congenital absence of the right common iliac artery: CT and angiographic demonstration.Eur J Radiol. 1995; 21: 128-130Abstract Full Text PDF PubMed Scopus (11) Google Scholar The absence of a common iliac artery has been described with an associated absence of the ipsilateral external iliac artery. In that case, collateral branches from the ipsilateral internal iliac artery had reconstituted the common femoral artery.4Dumanian A.V. Frahm C.J. Benchik F.A. Wooden T.F. Intermittent claudication secondary to congenital absence of iliac arteries.Arch Surg. 1965; 91: 604-606Crossref PubMed Scopus (15) Google Scholar No other arterial variations were identified in this case. To the best of our knowledge, this is the only angiographic image demonstrating the absence of bilateral common iliac arteries in the literature. This rare anatomic variant will likely just be an incidental finding, but it could have clinical implications if a distal landing zone for endovascular aortic aneurysm repair or covered endovascular reconstruction of an aortoiliac bifurcation for occlusive disease is required. The patient provided written informed consent for the description of his case before submission of our report. Download .docx (.15 MB) Help with docx files Figure B Congenital absence of bl cia.docx

421 Hysteroscopic evaluation of the uterine cavity after conservative surgical management of placenta previa

To assess the consequences of different conservative surgical techniques used for management of intraoperative hemorrhage due to placenta previa through hysteroscopic evaluation of the uterine cavity. A cross sectional study encompassing all women managed by conservative surgical techniques during cesarean section after intraoperative hemorrhage due to placenta previa. The The study conducted in tertiary university between January 2017 and December 2018. All women were counseled for inclusion in the study before delivery during the preoperative counseling about the consequences of placenta previa. Patients who were managed by conservative surgical techniques were followed up till hospital discharge then they were contacted by phone calls for scheduled follow-up after 3 months. Office hysteroscopy for uterine cavity evaluation was done by expert gynecologist in the proliferative phase of the menstrual cycle if menses were resumed. Forty-seven women were included in the study; 14 (29.8%) were managed by compression uterine sutures, 7 (14.9%) were managed by bilateral uterine ligation only and 26 (55.3%) were managed by both of them. Regarding menses resumption, 22 (46.8%) still had amenorrhea, 13 (27.7%) had regular menses, and 12 (25.5%) had irregular menses. Hysteroscopic evaluation of the uterine cavity revealed normal cervical canal and uterine cavity with no adhesions in all cases Conservative surgical techniques for management of placenta previa had no late consequences on the uterine cavity and subsequent fertility.

Management of Placenta Previa with Accreta: A Case Series in Public Tertiary Care Hospital

Placenta previa with accreta is a rare cause of major obstetric hemorrhage resulting in maternal morbidity and mortality. A case series of 08 patients of placenta previa with accreta presented at Abbasi Shaheed hospital Gynecology unit 1 from January 2018 to December 2018. Seven (07) patients were delivered by Caesarean Section and one vaginally. In 05 patients placenta was left in situ and injection methotrexate was given. Removal of placenta during Lower Segment Caesarean Section (LSCS) and bilateral internal iliac artery ligation was done in 02 cases. Febrile illness occurred in 02 patients. One patient required laparotomy on fifteenth postoperative day due to uterine scar dehiscence. Two cases required obstetrical hysterectomy due to torrential hemorrhage. Conservative management in women with placenta previa with accreta has proven to be successful in carefully selected cases at tertiary care hospital with multi-disciplinary team.

Amniocele after laparoscopic myomectomy: is expectant management acceptable?

Amniocele after laparoscopic myomectomy: is expectant management acceptable?

Guideline No. 402: Diagnosis and Management of Placenta Previa.

To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality. Family physicians, obstetricians, midwives, and other maternal care providers. Pregnant women with placenta previa or low-lying placenta. Medline, PubMed, Embase, and the Cochrane Library were searched from inception to October 2018. Medical Subject Heading (MeSH) terms and key words related to pregnancy, placenta previa, low-lying placenta, antepartum hemorrhage, short cervical length, preterm labour, and cesarean. This document represents an abstraction of the evidence rather than a methodological review. This guideline has been reviewed by the Maternal-Fetal Medicine and Diagnostic Imaging committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and approved by the SOGC Board of Directors. Women with placenta previa or low-lying placenta are at increased risk of maternal, fetal and postnatal adverse outcomes that include a potentially incorrect diagnosis and possibly unnecessary hospitalization, restriction of activities, early delivery, or cesarean delivery. Optimization of diagnosis and management protocols has potential to improve maternal, fetal and postnatal outcomes. RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).

Guidelines for the diagnosis and management of placenta previa (2020)

前置胎盘是妊娠晚期出血和早产的重要原因，与围产期母儿并发症及死亡密切相关。随着对前置胎盘疾病的不断认识及经验积累，结合国内外相关领域最新的循证医学证据，围绕前置胎盘的定义、分类、高危因素、诊断、并发症的风险评估和临床处理，中华医学会妇产科学分会产科学组对2013年的"前置胎盘的临床诊断与处理指南"进行了更新，旨在规范和指导妇产科医师对前置胎盘的诊治做出更合理的临床决策及处理。.

The role of cervical pessary and progesterone therapy in the phenomenon of placenta previa migration

Objective: This study aimed to evaluate the effects of combined management of placenta previa with the Arabin cervical pessary and progesterone.Study design: In this randomized controlled study, we followed up 217 patients with placenta previa and high risk of preterm birth. The main group (n = 81) underwent combined management with the Arabin cervical pessary and progesterone; the control group (n = 136) received progesterone only. Placental migration was monitored using Doppler scanning from 24 weeks of pregnancy onwards.Results: Patients receiving the combination of the Arabin cervical pessary and progesterone had a three-fold reduced rate of bleeding during pregnancy compared with patients in the control group (11.3% versus 33.1%; p = .006). Placental migration occurred 1.8 times more often in the pessary group (48.1% versus 26.4%; p = .037), and preterm labor <34 weeks occurred 2.7 times less often compared with the control group (p = .031). The use of the Arabin cervical pessary caused a change in the anterior cervico-uterine angle by 7.4 degrees, and reduction in the arcuate artery RI at 32−33 weeks of pregnancy compared with the control group.Conclusions: The use of the Arabin cervical pessary combined with progesterone in patients with placenta previa significantly reduced the rate of preterm delivery <34 weeks and bleeding during pregnancy.

Diagnosis and management of placenta previa and low placental implantation

Objective: To evaluate the migration of low-placental implantation (LPI) during the third trimester of pregnancy and its effect on delivery and post-partum hemorrhage.Methods: We conducted a retrospective study at a level 3 maternity center including all cases of placenta previa (PP) and LPI between 1998 and 2014. The distance (d) between cervical internal os (CIO) and placental edge (PE) were measured by vaginal ultrasonography in the third trimester of pregnancy at 32 and 3 weeks after. We analyzed CIO-PE distance, volume of post-partum hemorrhage, delivery decision, and mode of delivery using Kruskall–Wallis test.Results: In total, 319 patients presented with PP or LPI. All complete PP (121) and 90.6% (58 of 64) of the placentas less than 1 cm from the CIO did not migrate. Among the 138 placentas with an initial CIO-PE d greater than 1 cm, only 17 (12.3%) did not migrate above 2 cm. The patients for whom the decision to perform a cesarean section (C-section) was retained and realized had a CIO-PE d significantly lower than those who delivered vaginally (p < .001). The patients who delivered by C-section had a lower CIO-PE d when an emergency C-section was performed, specifically for hemorrhage (p < .001). The mean volume of hemorrhage was significantly higher for patients with a CIO-PE d less than 2 cm.Conclusion: Complete PP and the majority of the placentas less than 1 cm from the CIO did not migrate. Above 1 cm, the majority of the placentas migrated three to four weeks later. For the placentas less than 1 cm from the CIO, a significant risk of hemorrhage at delivery was observed. Thus, prophylactic cesarean section is required for CIO-PE distances <1 cm. For distances between 1 and 2 cm, the volume of blood loss tends to be more important than for distances >3 cm without statistical significance. A vaginal delivery could be tried after information of patients.

Marginal sinus placenta previa is a different entity in placenta previa: A retrospective study using magnetic resonance imaging

ObjectiveThe current definition of placenta previa does not include whether the placental edge is parenchyma or marginal sinus defined as placenta previa in which the placental marginal sinus just reached the internal os and/or in which the placental parenchyma might be located at > 2 cm from internal os. Materials and MethodsCases with placenta previa were identified through the review of magnetic resonance imaging (MRI) from among 210 cases at our institution between 2007 and 2016. The clinical outcomes of patients with marginal sinus placenta previa (Group A) were compared with patients with low-lying placenta and marginal placenta (Group B) and patients with partial placenta and total placenta previa (Group C), respectively. This study was a retrospective analysis. ResultsTwenty-seven (12.7%) cases were included in Group A. The patients in Group B and Group C were 72 and 108 cases, respectively. First, Group A more frequently underwent emergency cesarean section than Group B (p = 0.02). There was no statistical significance with other maternal history, post–or pre-operative hemorrhage, and/or additional treatment for hemorrhage between the two groups. Additionally, Group A delivered at a later gestational age (p < 0.01); were less frequently complicated with antenatal bleeding (p < 0.01); underwent emergency cesarean section (p < 0.01), allogenic blood transfusion (p < 0.01), and uterine artery embolization (p < 0.01) for postpartum hemorrhage less often; and had less perioperative hemorrhage (p < 0.01) than Group C. ConclusionsMarginal sinus placenta previa may be a mild type of placenta previa. This new classification could be useful in the management of placenta previa.

Updated Protocol for Management of Placenta Previa

Background: Antepartum hemorrhage complicates 2-5% of pregnancies, whichapproximately one-third are due to placenta previa. Placenta previa is acondition derived to an abnormal implantation of the embryos in thelower uterine segment. In placenta previa hemorrhage is more likely to occur during third trimester,as a consequence of the development of the lower uterine segment and of the dilation of the cervix due to the uterine contractions; alsovaginal examination may lead to an antepartum hemorrhage. Risk factors for the development of placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age and the rising rates of Cesarean section. Placenta previa is associated with adverse consequences for both mother and children, such as Intra-Uterine Growth Restriction (IUGR), preterm birth, antenatal and intra-partum hemorrhage, maternal blood transfusion and emergency hysterectomy. Placenta previa has been diagnosed increasingly in recent decades, due to mostly to the widespread use of ultrasound (US). Apart from ultrasound a valid imaging modality to study and investigate placenta in antepartum period seems to be magnetic resonance (MR).Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the placenta previa. In diagnosed cases, preoperative planning, preoperative decisions and good postoperative management can safe a mother and child.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 26-30

A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa-accreta: A STROBE compliant article.

We studied the efficacy of prophylactic internal iliac artery balloon catheterization for managing severe hemorrhage caused by pernicious placenta previa.This prospective observational study was conducted in Tongji Hospital, Wuhan, China. One hundred sixty-three women past 32-week's gestation with placenta previa–accreta were recruited and managed. Women in the balloon group accepted prophylactic internal iliac artery balloon catheterization before scheduled caesarean delivery and controls had a conventional caesarean delivery. Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complications, and neonatal outcomes were discussed.Significant differences were detected in estimated blood loss (1236.0 mL vs 1694.0 mL, P = .01), calculated blood loss (CBL) (813.8 mL vs 1395.0 mL, P < .001), CBL of placenta located anteriorly (650.5 mL vs 1196.0 mL, P = .03), and anterioposteriorly (928.3 mL vs 1680.0 mL, P = .02). Prophylactic balloon catheterization could reduce intraoperative red blood cell transfusion (728.0 mL vs 1205.0 mL, P = .01) and lessen usage of perioperative hemostatic methods. The incidence of hysterectomy was lower in balloon group. Mean radiation dose was 29.2 mGy and mean exposure time was 92.2 seconds. Neonatal outcomes and follow-up data did not have significant difference.Prophylactic internal iliac artery balloon catheterization is an effective method for managing severe hemorrhage caused by placenta previa–accreta as it reduced intraoperative blood loss, lessened perioperative hemostatic measures and intraoperative red cell transfusions, and reduce hysterectomies.

Management of Placenta Previa during Pregnancy

Placenta previa is an obstetric complication (OS) that traditionally shows painless vaginal bleeding in the third trimester secondary to a strange placentation close or covering the interior cervical OS. Due to the inherent risk of hemorrhage, placenta previa may cause serious morbidity and mortality to both the fetus and the mother. Recently there have been two defined types of placenta previa: complete, and marginal. We here review the complications, incidence, risk factors, and management options of placenta previa.