Meeting paperSAAOG paperMorbidity associated with nonemergent hysterectomy for placenta accreta
Section snippets
Materials and Methods
This was a retrospective, institutional review board–approved, chart review of all patients who underwent nonemergent hysterectomy for suspected placenta accreta from June 1, 2003 through June 30, 2009. Cases were identified through a medical records department and labor and a delivery records search with ICD-9 codes and search words (placenta accreta, cesarean hysterectomy). Patients whose surgery was precipitated by bleeding that was nonemergent in nature were included. Cesarean section
Results
Thirty-seven patients were identified in the database. Eight surgeries that were clearly emergent were excluded, which left 29 patients whose data were available for analysis. Patient characteristics are given in Table 1. Diagnosis was suspected on ultrasound scanning in 26 women (6 diagnoses were magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. Nine of the 29 patients were referred from the region based on the suspected diagnosis. Nine of the
Comment
Most patients in the present series were suspected preoperatively of having placenta accreta. It is likely that antenatal diagnosis has contributed to the overall drop in maternal morbidity and deaths that has been associated with this condition.1, 2 Physicians must maintain a high level of suspicion, particularly in patients with risk factors such as multiparity (especially previous cesarean section deliveries) in association with placenta previa.3, 4, 5
Antenatal diagnosis of placenta accreta
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Placenta Accreta Spectrum Disorders: How to reduce maternal transfusion? A center experience on extraperitoneal retrograde hysterectomy
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2022, American Journal of Obstetrics and GynecologyCitation Excerpt :Although direct ureteral invasion is uncommon, surgical extirpation of invasive retroperitoneal placental tissue may result in ureteral injury. Although urologic complications associated with cesarean deliveries have previously been comprehensively described, similar data regarding urologic injury associated with PAS are lacking.4,5 In a retrospective study of 49 women with PAS in 2015, Norris et al6 concluded that patients with PAS frequently required urologic intervention to prevent or repair injury to the urinary tract.
Conservative approach: Intentional retention of the placenta
2021, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Discovering this condition at delivery has become among the most daunting situations for obstetricians and anaesthesiologists. Many consider the caesarean-hysterectomy as the gold standard for the delivery of women with PAS [1,2], although the rate of severe maternal morbidity associated with caesarean delivery is so high [8,10–13] that some authors have proposed alternative conservative approaches to attempt to improve maternal outcomes. Specifically, the largest series of these caesarean-hysterectomies for PAS shows transfusion of at least four units of packed red blood cells (RBCs) and cystotomy (deliberate or not), and re-operation occurred respectively in about 50%, 20% and 4–15% of cases, while ureteral injury rates ranged from 3 to 8% and vesicovaginal fistula from 0 to 4% (Table 1) [8,10–13].
Surgical training in gynecologic oncology: Past, present, future
2020, Gynecologic OncologyCitation Excerpt :The increased cesarean section rate especially during the 21st century has resulted in a dramatic increase in the incidence of placenta accreta. Gynecologic oncologists are often asked to assist with the surgical management of these cases for a number of reasons, including surgical difficulty, dramatic blood loss, and relative operative inexperience of obstetricians [41]. The incidence of such cases is dependent on obstetric volume, and gynecologic oncologists at large centers may gain substantial experience with this condition.
Authorship and contribution to the article is limited to the 7 authors indicated. There was no outside funding or technical assistance with the production of this article.
Reprints not available from the authors.
Cite this article as: Hoffman MS, Karlnoski RA, Mangar D, et al. Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol 2010;202:628.e1-5.