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"The Killer Placenta" — a threat to the lives of young women giving birth by cesarean section
- Clinical Department of Perinatology, Gynaecology and Obstetrics in Ruda Slaska, Medical University of Silesia, Ruda Slaska, Poland
open access
Abstract
Objectives: It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section.
Material and methods: This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging.
Results: A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 — 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage.
Conclusions: It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section — in this group the risk of placenta accreta spectrum is higher.
Abstract
Objectives: It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section.
Material and methods: This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging.
Results: A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 — 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage.
Conclusions: It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section — in this group the risk of placenta accreta spectrum is higher.
Keywords
cesarean section; placenta accreta spectrum; placenta invasion; placenta increta; algorithm
Title
"The Killer Placenta" — a threat to the lives of young women giving birth by cesarean section
Journal
Issue
Article type
Research paper
Pages
314-320
Published online
2022-02-10
Page views
5104
Article views/downloads
725
DOI
Pubmed
Bibliographic record
Ginekol Pol 2022;93(4):314-320.
Keywords
cesarean section
placenta accreta spectrum
placenta invasion
placenta increta
algorithm
Authors
Wojciech Cnota
Ewa Banas
Daria Dziechcinska-Poletek
Ewa Janowska
Agnieszka Jagielska
Boguslawa Piela
Bartosz Czuba
- Oyelese Y, Smulian J. Placenta previa, placenta accreta, and vasa previa. Obstetrics & Gynecology. 2006; 107(4): 927–941.
- Cahill A, Beigi R, Heine R, et al. Placenta Accreta Spectrum. American Journal of Obstetrics and Gynecology. 2018; 219(6): B2–B16.
- Miller D, Chollet J, Goodwin T. Clinical risk factors for placenta previa–placenta accreta. American Journal of Obstetrics and Gynecology. 1997; 177(1): 210–214.
- Carusi DA. The placenta accreta spectrum: epidemiology and risk factors. Clin Obstet Gynecol. 2018; 61(4): 733–742.
- Wlodarz-Ulman I, Nowosielski K, Poreba R, et al. P372 Placenta praevia increta with cesarean section scar invasion. International Journal of Gynecology & Obstetrics. 2009; 107: S520–S520.
- Levine D, Hulka CA, Ludmir J, et al. Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging. Radiology. 1997; 205(3): 773–776.
- Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012; 7(12): e52893.
- Chalmers B. WHO appropriate technology for birth revisited. Br J Obstet Gynaecol. 1992; 99(9): 709–710.
- Ye J, Zhang J, Mikolajczyk R, et al. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016; 123(5): 745–753.
- Betran AP, Torloni MR, Zhang J, et al. What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015; 12: 57.
- Sharma S, Dhakal I. Cesarean Vs Vaginal Delivery: An Institutional Experience. Journal of Nepal Medical Association. 2018; 56(209): 535–539.
- Gill P, Patel A, Van Hook JW. Uterine Atony. 2018.
- Huls C. Cesarean hysterectomy and uterine-preserving alternatives. Obstetrics and Gynecology Clinics of North America. 2016; 43(3): 517–538.
- Thiravit S, Lapatikarn S, Muangsomboon K, et al. MRI of placenta percreta: differentiation from other entities of placental adhesive disorder. Radiol Med. 2017; 122(1): 61–68.
- Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018; 218(1): 75–87.
- D'Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014; 44(1): 8–16.
- Baughman WC, Corteville JE, Shah RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 2008; 28(7): 1905–1916.
- Piñas Carrillo A, Chandraharan E. Placenta accreta spectrum: risk factors, diagnosis and management with special reference to the Triple P procedure. Womens Health (Lond). 2019; 15: 1745506519878081.
- Jauniaux E, Collins SL, Jurkovic D, et al. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am J Obstet Gynecol. 2016; 215(6): 712–721.
- Piñas Carrillo A, Chandraharan E. Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure. Womens Health (Lond). 2019; 15: 1745506519878081.
- Jauniaux E, Bhide A, Kennedy A, et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018; 140(3): 274–280.
- Jauniaux E, Alfirevic Z, Bhide AG, et al. Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG. 2019; 126(1): e1–e48.
- D'Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014; 44(1): 8–16.
- Lax A, Prince MR, Mennitt KW, et al. The value of specific MRI features in the evaluation of suspected placental invasion. Magn Reson Imaging. 2007; 25(1): 87–93.
- Allen L, Jauniaux E, Hobson S, et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet. 2018; 140(3): 281–290.
- American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018; 132(6): e259–e275.