Placenta Accreta: Case Report From Ultrasound diagnosis to Treatment
Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 1, Issue 5
Abstract
Placenta accreta is the most common variant and is defined as trophoblastic attachment to the myometrium without intervening decidua [1]; placenta percretais the most serious variant because placenta invades the uterine serosa. All varieties are associated with a significant increase in maternal morbidity and mortality, mainly due to bloodloss, local organ damage, urgent hysterectomy (33-50%) and postoperative complications [2,3]. Placenta previa and previous uterine surgery are the major risk factors for invasive placentation [4,5]. Placenta previa is defined as a placenta that either lies in closeproximity to the internal cervicalos or partially or completelycoversit [1]. Placenta previa and accreta and theircomplications are increasing due to a higher number of Cesarean sections being performed and advanced maternal age [1-6]. Although placenta previa isper se a risk factor, the most common is a uterine scar. The risk increases from 0.3% after one prior Cesarean section to 0.6, 2.1, 2.3 and 6.7% after two, three, four and more than four Cesarean sections, respectively [7]. The principal maternal complication is massive hemorrhage, that then leads to disseminatedintravascular coagulation, multi organ failure ad even death; Wright et al estimated a median bloodloss in cohorts of accretas from 2.000 to 7800 ml [8]. Peripartum hysterectomy rates is 30-55% [9] and maternal death has been reported in 5-7% of cases [10]. As there are reports in the literature that maternal complications, such as peripartum blood loss andneed for blood transfusion, are reducedwhenthe delivery isarranged in a centre of execellence, an accurate antenatal diagnosis of invasive placentation is important [9,11,12]. Further more prenatal diagnosis allows for optimal management, which typically includes planned cesarean hysterectomu before the onset of labor or bleedig [10]. In referred center a case of placenta accreta is managed by a multidisciplinary team that includes specialists in maternal-fetal medicine, obstetric ultrasound, gynecologic surgery and oncology, urologic surgery trasfusion medicine, intensive care, neonatology and anesthesioloy. It’simportant to refercases of placenta accreta to a centre of excellencealso for the diagnosis: in factultrasoundsensitivity in the second-thirdtrimester of pregnancy for the identification of placenta accreta with expertsoperators and in case of anterior placenta previaisreported to be 80-90% [10,3,13]. Ultrasound criteria suggesting placenta accreta spectrum are: lossor irregularity of the hypoechoic area between theuterus and placenta (the ‘retroplacentalclear zone’),thinning or interruption of the uterineserosa-bladder wall interface,myometrial thickness<1mm,turbulent placental lacunae with high velocity flow (>15 cm/s), increased and irregular subplacental vascularity, vessels between placenta and bladder [13-15]. The optimal timing of delivery for placenta accretas and its variants remains controversials: the risks of prematurity must be balanced against the risk of emergency delivery in the setting of labor or bleeding.
Authors and Affiliations
E Pilloni, A Sciarrone, P Cortese, C Monzeglio, M Biasio, G Botta e G A Gregori
Keywords
Related Articles
- EP ID EP571507
- DOI 10.32474/IGWHC.2018.01.000124
- Views 70
- Downloads 0
Calponin 1 Serum Level A Biological Marker for Preterm Labor Predictability
Preterm birth is featured and defined as delivery before 37 gestational weeks global occurrence in 15 million neonates and represents around 11% of all living births. The threatened preterm delivery has an incidence arou...
Menopause Hormone Therapy Current Evidence and Clinical Use
Spontaneous menopause, the permanent cessation of menstruation caused by loss of ovarian function, occurs at a mean age of 51-52 years. As life expectancy increases,women are living far longer after menopauseonset than i...
Pethidine Infiltration in Intra Fascial Layer After Abdominal Hysterectomy
Introduction: multimodal analgesia regimen has a cornerstone component involving local wound infiltration with analgesic agents to manage and enhance post-operative pain to increase patient satisfaction. Aim: assessment...
Two Consecutive Successful Pregnancy Outcomes in a woman with Eisenmenger’s Syndrome: A Case Report
Eisenmenger’s syndrome is a very rare condition in pregnant women. The incidence of ES is about 3% of the pregnant patients with congenital heart defects; however, it can be accompanied with high incidence of maternal an...
Effects of Occupational Hazards on Mental and Reproductive Health of Women in Nepal
Women constitute 51.5 percent of Nepal’s population. Their socioeconomic condition is very backward. Because of forced or early marriage, women are compelled to work as breadwinner of family or worker of household. Some...