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A comprehensive surgical procedure in conservative management of placenta accreta: a case series.

Kelekci S, Ekmekci E, Aydogmus S, Gencdal S - Medicine (Baltimore) (2015)

Bottom Line: The setting involved two education and research hospitals in Turkey.One patient preferred nonconservative treatment, the others opted for our procedure.We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes.We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Obstetrics and Gynecology (SK, EE, SA), School of Medicine, Izmir Katip Celebi University, Izmir; and Department of Obstetrics and Gynecology (SG), School of Medicine, Kafkas University, Kars, Turkey.

ABSTRACT
We aimed to present a combined surgical procedure in conservative treatment of placenta accreta based on surgical outcomes in our cohort of patients. The study was designed as a prospective cohort series study. The setting involved two education and research hospitals in Turkey. This study included 12 patients with placenta accreta who were prenatally diagnosed and managed. We offered the patients the choice of conservative or nonconservative treatment. We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. One patient preferred nonconservative treatment, the others opted for our procedure.We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes. We operated on 11 patients using this surgical procedure that we have developed for placenta accreta cases. We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients. No patient presented any septic complication or secondary vaginal bleeding.Our surgical procedure seems to be effective and useful in the conservative treatment of placenta accreta.

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Lacunar vascular areas in placenta.
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Figure 1: Lacunar vascular areas in placenta.

Mentions: In this 4-year period, among 22,543 deliveries only 16 patients met the diagnostic criteria of placenta accreta (0.71/1000). In our conservative treatment group, the patients’ mean age was 31.5 ± 3.2 years, and their mean body mass index was 28.2 ± 2.1. All cases except 1 were multiparous. One patient had had 3 cesarean sections, 5 patients had 2 cesarean sections, and 4 patients had 1 cesarean section. One patient was primigravid, and she had no uterine curettage history. Two patients had a history of spontaneous abortion, and 4 patients had a history of induced abortion of the pregnancy (Table 1). The placenta was posteriorly located at 4 patients (36%) and anterior localized at 7 patients (64%). Six patients had placenta previa totalis, and in 5 patients placenta was located away from internal cervical os. Vascular lacunae with turbulent flow were noted (Figures 1 and 2). Placental invasion of the myometrium was observed in MRI (Figure 3). Mean gestational age was 35.2 ± 4.1 weeks. The mean operation time was 110 ± 20 minutes. Median 4 (2–7) units of erythrocyte suspensions and median 2 (0–4) units of fresh frozen plasma were transfused intraoperatively and postoperatively (Table 2). In 1 patient, a postoperative wound infection developed. Postoperative febrile reactions developed in 2 patients. One of these was caused by wound infection, and the other was due to atelectasis. The mean hospitalization time was 4.2 ± 0.4 days. β-hCG measurements were negative for all patients in postoperative 6th week and 6th month.


A comprehensive surgical procedure in conservative management of placenta accreta: a case series.

Kelekci S, Ekmekci E, Aydogmus S, Gencdal S - Medicine (Baltimore) (2015)

Lacunar vascular areas in placenta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554183&req=5

Figure 1: Lacunar vascular areas in placenta.
Mentions: In this 4-year period, among 22,543 deliveries only 16 patients met the diagnostic criteria of placenta accreta (0.71/1000). In our conservative treatment group, the patients’ mean age was 31.5 ± 3.2 years, and their mean body mass index was 28.2 ± 2.1. All cases except 1 were multiparous. One patient had had 3 cesarean sections, 5 patients had 2 cesarean sections, and 4 patients had 1 cesarean section. One patient was primigravid, and she had no uterine curettage history. Two patients had a history of spontaneous abortion, and 4 patients had a history of induced abortion of the pregnancy (Table 1). The placenta was posteriorly located at 4 patients (36%) and anterior localized at 7 patients (64%). Six patients had placenta previa totalis, and in 5 patients placenta was located away from internal cervical os. Vascular lacunae with turbulent flow were noted (Figures 1 and 2). Placental invasion of the myometrium was observed in MRI (Figure 3). Mean gestational age was 35.2 ± 4.1 weeks. The mean operation time was 110 ± 20 minutes. Median 4 (2–7) units of erythrocyte suspensions and median 2 (0–4) units of fresh frozen plasma were transfused intraoperatively and postoperatively (Table 2). In 1 patient, a postoperative wound infection developed. Postoperative febrile reactions developed in 2 patients. One of these was caused by wound infection, and the other was due to atelectasis. The mean hospitalization time was 4.2 ± 0.4 days. β-hCG measurements were negative for all patients in postoperative 6th week and 6th month.

Bottom Line: The setting involved two education and research hospitals in Turkey.One patient preferred nonconservative treatment, the others opted for our procedure.We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes.We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Obstetrics and Gynecology (SK, EE, SA), School of Medicine, Izmir Katip Celebi University, Izmir; and Department of Obstetrics and Gynecology (SG), School of Medicine, Kafkas University, Kars, Turkey.

ABSTRACT
We aimed to present a combined surgical procedure in conservative treatment of placenta accreta based on surgical outcomes in our cohort of patients. The study was designed as a prospective cohort series study. The setting involved two education and research hospitals in Turkey. This study included 12 patients with placenta accreta who were prenatally diagnosed and managed. We offered the patients the choice of conservative or nonconservative treatment. We then offered 2 choices for patients who had preferred conservative treatment, leaving the placenta in situ as is the classical procedure, or our surgical procedure. One patient preferred nonconservative treatment, the others opted for our procedure.We evaluated demographic and obstetric characteristics of patients, sonographic and operative parameters of patients, and surgical outcomes. We operated on 11 patients using this surgical procedure that we have developed for placenta accreta cases. We found that there was no need for hysterectomy in any patient, and we preserved the uterus for all of these patients. No patient presented any septic complication or secondary vaginal bleeding.Our surgical procedure seems to be effective and useful in the conservative treatment of placenta accreta.

Show MeSH
Related in: MedlinePlus