Int J Surg Case Rep
Department of surgery, KIST medical college and Teaching Hospital, Gwarko, Lalitpur, Nepal. Electronic address:
Published: January 2024
Introduction And Importance: Postpartum hemorrhage (PPH) can be defined as excessive bleeding (>500 ml) from the genital tract after the delivery of baby upto 6 weeks. PPH accounts for major cause of maternal mortality rate. Prevention and early intervention can prevent this complication of delivery. However condition like placenta accreta leads to retention of placenta and makes PPH inevitable.
Case Summary: We present the case of massive postpartum hemorrhage secondary to Placenta accreta in young primigravida with RH negative pregnancy. Clinical findings and investigations were not significant during her admission. She delivered the baby via vaginal route but placenta was not expelled till 30 min. Due to failed manual removal of placenta patient was shifted to OT.Manual vacuum aspiration was done in OT setting and chunks of placenta along with blood clots were obtained.Uterine balloon tamponade was inserted. Due to persistent PV bleeding subtotal hysterectomy was carried out in line for placenta accreta.
Discussion: Placenta accreta being one of the life threatening obstetric condition, it should be diagnosed as early as possible and need prompt management so as to prevent maternal mortality. Due to increasing number of cesarean delivery the cases of placenta accreta has been rising but rarely in some cases can it present in young primigravida with Rh negative pregnancy.
Conclusion: In the cases of morbidly adherent placenta it is necessary for obstetrician to early identify such conditions and timely intervene to save the mother's life. Moreover Rh negative could be a hidden risk factor.
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http://dx.doi.org/10.1016/j.ijscr.2023.109121 | DOI Listing |
Eur J Obstet Gynecol Reprod Biol
January 2025
Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Purpose: While strategies aimed at preventing urological injuries complicating hysterectomy for gynaecological indications and placenta accreta surgery have been proposed, a comprehensive model for pregnancy-related hysterectomy (PRH) is lacking. The aim of this study was to investigate risk factors for urological complications of obstetric hysterectomy, and to propose strategies to improve the quality of care.
Methods: This retrospective study of patients undergoing PRH was conducted in an academic centre between 2009 and 2022.
Obstet Gynecol Surv
January 2025
Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC.
Importance: To decrease associated infectious and thrombotic morbidity, it is important to understand the indications and risks of peripherally inserted central catheters (PICCs) and other vascular access means in pregnancy.
Objectives: The objectives are 3-fold: (1) discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; (2) review available data regarding complications associated with these catheters in pregnancy; and (3) propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.
Evidence Acquisition: A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines, with a focus on obstetrical anesthesia and obstetric literature.
J Matern Fetal Neonatal Med
December 2025
Director of Global Academy of Medical Education & Training, London, UK.
Background: Placenta Accreta Spectrum (PAS) disorders has been reported to be associated with a maternal mortality rate of 7-10%, worldwide, and many women who survive, experience life changing morbidity. Triple P procedure (- perioperative placental localization and incision on the myometrium above the upper border of the placenta; - pelvic devascularisation; and -placental non-separation and myometrial excision) was developed in 2010 as a novel conservative alternative to peripartum hysterectomy to avoid severe maternal morbidity and mortality). There have been several modifications to the original Triple P Procedure to achieve "pelvic devascularisation" based on locally available resources.
View Article and Find Full Text PDFCureus
December 2024
Department of Obstetrics and Gynecology Faculty of Medicine, Fukuoka University, Fukuoka, JPN.
An adherent placenta is a life-threatening condition that impairs the mother's life owing to hemorrhagic shock and disseminated intravascular coagulation. Profound hemorrhage resulting from placental abruption is often managed using hysterectomy to preserve the mother's life, although the consequent loss of fertility can be devastating, particularly in younger women. Thus, strategies that facilitate fertility preservation while effectively controlling hemorrhage should be considered viable alternatives.
View Article and Find Full Text PDFCureus
December 2024
Radiology Department, Hospital Regional Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Monterrey, Universidad de Monterrey, Monterrey, MEX.
Placenta percreta is a rare form of disorder found in the spectrum of placenta accreta and represents a considerable cause of maternal complications with an increase in mortality. The radiologist's role is essential due to the support of images acquired by magnetic resonance imaging, given their high sensitivity and specificity to predict the degree of placental invasion in substitution or accompaniment of the ultrasound study between 28 and 32 weeks of gestation. We present the case of a 29-year-old patient who was in her third pregnancy with a history of two cesarean sections at the ISSSTE Regional Hospital in Monterrey, Nuevo León.
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