We present our own experience management in pregnant women with placenta percreta. For the timely diagnosis of placenta accreta or placenta percreta, it is recommended to conduct ultrasound and Magnetic Resonance Imag...We present our own experience management in pregnant women with placenta percreta. For the timely diagnosis of placenta accreta or placenta percreta, it is recommended to conduct ultrasound and Magnetic Resonance Imaging (MRI) studies in women with placenta previa and a history of caesarean section. Objective signs of placenta accreta, identified before delivery, make it possible to make the right decision about delivery and minimize complications in the mother and newborn. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease.展开更多
A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated w...A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.展开更多
Placenta percreta causing second trimester, spontaneous uterine rupture in non high risk women is less frequent and fewer cases have been reported in the literature. We report a case of uterine rupture in second trime...Placenta percreta causing second trimester, spontaneous uterine rupture in non high risk women is less frequent and fewer cases have been reported in the literature. We report a case of uterine rupture in second trimester of pregnancy due to placenta percreta with non specific symptoms in otherwise uncomplicated pregnancy without any high risk factors. This case report describes the case of young woman presenting second gravid with 21 weeks pregnancy with complaints of whole abdomen pain and dysuria. Ultrasonography shows single intrauterine dead fetus;placenta was fundoposterior in upper segment, a hypoechoic area seen below the placenta suggestive of abruption placentae or placenta accreta. Suddenly patient deteriorated in two hours of hospital stay, frank hemoperitoneum detected, emergency laparotomy done, per operatively whole fundal area of uterus became papery thin and cystic on touch, a small rent seen on fundal surface of uterus. The placenta was densely adhered to the fundoposterior aspect of the uterus. Patient had emergency subtotal hysterectomy. This case highlights that placenta percreta is a rare but serious complication of pregnancy which may present in early pregnancy without any associated high risk factors for placenta percreta with unusual symptoms.展开更多
Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple ges...Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.展开更多
Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Bo...Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.展开更多
Background:Massive bleeding is the main concern for the management of placenta percreta(PP).Intra-abdominal aortic balloon occlusion(IABO)is one method for pelvic devascularization,but the efficacy of IABO is uncertai...Background:Massive bleeding is the main concern for the management of placenta percreta(PP).Intra-abdominal aortic balloon occlusion(IABO)is one method for pelvic devascularization,but the efficacy of IABO is uncertain.This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015.PP cases with/without the use of IABO were analyzed.Propensity score matching analysis was performed to reduce the effect of selection bias.Postpartum hemorrhage(PPH)and the rate of hysterectomy,as well as neonatal outcomes,were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis.Compared with the control group,maternal outcomes,including PPH(68.9%vs.87.9%,χ^(2)=13.984,P<0.001),hysterectomy(8.3%vs.65.2%,χ^(2)=91.672,P<0.001),and repeated surgery(1.5%vs.12.1%,χ^(2)=11.686,P=0.001)were significantly reduced in the IABO group.For neonatal outcomes,Apgar scores at 1 minute(8.67±1.79vs.8.53±1.68,t=-0.638,P=0.947)and 5 minutes(9.43±1.55vs.9.53±1.26,t=0.566,P=0.293)were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss,hysterectomies,and repeated surgeries.This procedure has not shown harmful effects on neonatal outcomes.展开更多
Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).Methods:Patie...Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.展开更多
Placenta percreta with bladder bleeding can occur during gestation or postpartum,posing a great threat to both mother and fetus.But it is rare and lacks standard management strategies.We reported four cases suffering ...Placenta percreta with bladder bleeding can occur during gestation or postpartum,posing a great threat to both mother and fetus.But it is rare and lacks standard management strategies.We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1^(st),2011 and December 31^(th),2020 in The First Affiliated Hospital of Zhengzhou University.Clinical information,including age,gravidity and parity,ultrasound and magnetic resonance imaging manifestations,onset gestational age,bladder bleeding volume,clinical manifestations under bleeding,diagnosis,hemostatic methods,hospital stay,treatment cost,and prognosis,are presented.Two cases had bladder bleeding during the second trimester,respectively on the 22^(+3)and 23^(+5)weeks.Pregnancy was terminated timely.The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity.All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels,and one of them received electrocoagulation hemostasis under cystoscopy,but failed.They all had favorable clinical outcomes and had no long-term complications.The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good.The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy.Timely termination of pregnancy is recommended when such a condition develops during gestation.Diagnosis of bladder bleeding is relatively easy,for it is characterized by fast speed and large volume,with concomitant distension of the lower abdomen,blood discharge from the urethral orifice,or the indwelling catheter.Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta,while electrocoagulation hemostasis under cystoscopy must be applied with great caution.For the pregnant women with a high risk of placenta percreta,timely and accurate diagnosis should be achieved during the gestational age,and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.展开更多
Objective::To evaluate the efficacy and safety of a modified cesarean hysterectomy(MCH)procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.Methods::A retrospective a...Objective::To evaluate the efficacy and safety of a modified cesarean hysterectomy(MCH)procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.Methods::A retrospective analysis was conducted on 23 patients with placenta previa complicated with placenta percreta from January 2016 to December 2018 in the Union Hospital.The patients’age ranged from 24 to 41 years,and had gestational durations of 32-38 weeks.Nine of them underwent MCH and 14 underwent conventional cesarean hysterectomy(CCH).In the MCH group,the bladder was not mobilized,deliberately.The uterus was excised horizontally above the tourniquet level.Placental tissue around the cervical os was cleaned thoroughly,and hemostatic suturing was performed under direct vision.In the CCH group,the uterus was removed gradually after programmed hemostasis and dissection of adhesions of the vesicouterine peritoneal fold and mobilization of the bladder.Results::There were no significant differences in general conditions between the two groups.The blood loss was significantly less in the MCH group(P<0.05).The operation time was also decreased dramatically and hospital stay(in days)was shorter than in the CCH group(P<0.05).There were no bladder or ureter injuries in the MCH group,compared with three cases in the CCH group.There were no statistically significant differences in neonatal birth weight,Apgar score,or intensive care unit admittance rates between the two groups(P>0.05).Conclusion::This MCH procedure reduced blood loss,avoided bladder injury,and had no long-term complications.It is a safe,rapid,and effective way to control fatal hemorrhage during surgery for women with placenta previa complicated with placenta percreta.展开更多
目的:探讨选择性血管阻断技术在妊娠晚期穿透性胎盘治疗中应用的价值。方法:回顾性分析2003年1月至2010年12月中南大学湘雅医院明确诊断的孕龄≥34周的15例穿透性胎盘患者的临床资料。根据患者是否使用血管阻断技术,分为血管阻断组(n=8...目的:探讨选择性血管阻断技术在妊娠晚期穿透性胎盘治疗中应用的价值。方法:回顾性分析2003年1月至2010年12月中南大学湘雅医院明确诊断的孕龄≥34周的15例穿透性胎盘患者的临床资料。根据患者是否使用血管阻断技术,分为血管阻断组(n=8)与血管未阻断组(n=7);血管阻断组按血管阻断技术应用的时机,又分为预防性应用组(n=4)和治疗性应用组(n=4,其中1例为髂总动脉球囊取出后)。比较血管阻断组与血管未阻断组出血量、子宫切除率及并发症发生情况。结果:15例穿透性胎盘患者术中平均出血量为3813 mL,子宫切除率为73.3%(11/15),近期并发症发生率为20.0%(3/15,包括2例凝血功能障碍和1例下肢血栓形成),远期并发症的发生率为0;其中血管阻断组平均出血量为2512 mL,子宫切除率为62.5%(5/8);血管未阻断组平均出血量5549 mL,子宫切除率85.7%(6/7);两组平均出血量及子宫切除率相比差异均有统计学意义(P<0.05)。且预防性应用组的平均出血量和子宫切除率亦显著低于治疗性应用组(1350 mL vs 3600 mL,60.0%vs 66.7%,P<0.05)。结论:穿透性胎盘患者术中出血量大,子宫切除率高;选择性血管阻断技术可减少其出血量,降低子宫切除率,但仍有严重出血以及切除子宫的风险。展开更多
文摘We present our own experience management in pregnant women with placenta percreta. For the timely diagnosis of placenta accreta or placenta percreta, it is recommended to conduct ultrasound and Magnetic Resonance Imaging (MRI) studies in women with placenta previa and a history of caesarean section. Objective signs of placenta accreta, identified before delivery, make it possible to make the right decision about delivery and minimize complications in the mother and newborn. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease.
文摘A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.
文摘Placenta percreta causing second trimester, spontaneous uterine rupture in non high risk women is less frequent and fewer cases have been reported in the literature. We report a case of uterine rupture in second trimester of pregnancy due to placenta percreta with non specific symptoms in otherwise uncomplicated pregnancy without any high risk factors. This case report describes the case of young woman presenting second gravid with 21 weeks pregnancy with complaints of whole abdomen pain and dysuria. Ultrasonography shows single intrauterine dead fetus;placenta was fundoposterior in upper segment, a hypoechoic area seen below the placenta suggestive of abruption placentae or placenta accreta. Suddenly patient deteriorated in two hours of hospital stay, frank hemoperitoneum detected, emergency laparotomy done, per operatively whole fundal area of uterus became papery thin and cystic on touch, a small rent seen on fundal surface of uterus. The placenta was densely adhered to the fundoposterior aspect of the uterus. Patient had emergency subtotal hysterectomy. This case highlights that placenta percreta is a rare but serious complication of pregnancy which may present in early pregnancy without any associated high risk factors for placenta percreta with unusual symptoms.
文摘Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.
文摘Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.
基金The study was supported by the National Key Technology Research and Development Program of China(No.2015BAI13B06)the Beijing Top Young Talents Program(No.2016000021223ZK20)。
文摘Background:Massive bleeding is the main concern for the management of placenta percreta(PP).Intra-abdominal aortic balloon occlusion(IABO)is one method for pelvic devascularization,but the efficacy of IABO is uncertain.This study aims to investigate the outcomes of IABO in PP patients.Methods:We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015.PP cases with/without the use of IABO were analyzed.Propensity score matching analysis was performed to reduce the effect of selection bias.Postpartum hemorrhage(PPH)and the rate of hysterectomy,as well as neonatal outcomes,were analyzed.Results:One hundred and thirty-two matched pairs of patients were included in the final analysis.Compared with the control group,maternal outcomes,including PPH(68.9%vs.87.9%,χ^(2)=13.984,P<0.001),hysterectomy(8.3%vs.65.2%,χ^(2)=91.672,P<0.001),and repeated surgery(1.5%vs.12.1%,χ^(2)=11.686,P=0.001)were significantly reduced in the IABO group.For neonatal outcomes,Apgar scores at 1 minute(8.67±1.79vs.8.53±1.68,t=-0.638,P=0.947)and 5 minutes(9.43±1.55vs.9.53±1.26,t=0.566,P=0.293)were not significantly different between the two groups.Conclusions:IABO can significantly reduce blood loss,hysterectomies,and repeated surgeries.This procedure has not shown harmful effects on neonatal outcomes.
基金This study was supported by the National Key R&D Program of China(2016YFC1000405)Guangdong Natural Science Foundation(2015A030310115)
文摘Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.
文摘Placenta percreta with bladder bleeding can occur during gestation or postpartum,posing a great threat to both mother and fetus.But it is rare and lacks standard management strategies.We reported four cases suffering from bladder bleeding caused by placenta percreta even with hemorrhagic shock admitted between January 1^(st),2011 and December 31^(th),2020 in The First Affiliated Hospital of Zhengzhou University.Clinical information,including age,gravidity and parity,ultrasound and magnetic resonance imaging manifestations,onset gestational age,bladder bleeding volume,clinical manifestations under bleeding,diagnosis,hemostatic methods,hospital stay,treatment cost,and prognosis,are presented.Two cases had bladder bleeding during the second trimester,respectively on the 22^(+3)and 23^(+5)weeks.Pregnancy was terminated timely.The other two cases had bladder bleeding on the 2nd day post near-term cesarean section when activity.All the four cases achieved successful hemostasis following angiography and concomitant embolization for iliac vessels,and one of them received electrocoagulation hemostasis under cystoscopy,but failed.They all had favorable clinical outcomes and had no long-term complications.The neonatal outcome in the two cases that bladder hemorrhage occurred after near-term c-section was good.The newborns did not survive in two cases in which bladder hemorrhage occurred at the second trimester of pregnancy.Timely termination of pregnancy is recommended when such a condition develops during gestation.Diagnosis of bladder bleeding is relatively easy,for it is characterized by fast speed and large volume,with concomitant distension of the lower abdomen,blood discharge from the urethral orifice,or the indwelling catheter.Interventional embolization is an effective means to treat bladder bleeding caused by placenta percreta,while electrocoagulation hemostasis under cystoscopy must be applied with great caution.For the pregnant women with a high risk of placenta percreta,timely and accurate diagnosis should be achieved during the gestational age,and bladder bleeding should be concerned when placenta penetrates through the anterior wall of uterus.
文摘Objective::To evaluate the efficacy and safety of a modified cesarean hysterectomy(MCH)procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.Methods::A retrospective analysis was conducted on 23 patients with placenta previa complicated with placenta percreta from January 2016 to December 2018 in the Union Hospital.The patients’age ranged from 24 to 41 years,and had gestational durations of 32-38 weeks.Nine of them underwent MCH and 14 underwent conventional cesarean hysterectomy(CCH).In the MCH group,the bladder was not mobilized,deliberately.The uterus was excised horizontally above the tourniquet level.Placental tissue around the cervical os was cleaned thoroughly,and hemostatic suturing was performed under direct vision.In the CCH group,the uterus was removed gradually after programmed hemostasis and dissection of adhesions of the vesicouterine peritoneal fold and mobilization of the bladder.Results::There were no significant differences in general conditions between the two groups.The blood loss was significantly less in the MCH group(P<0.05).The operation time was also decreased dramatically and hospital stay(in days)was shorter than in the CCH group(P<0.05).There were no bladder or ureter injuries in the MCH group,compared with three cases in the CCH group.There were no statistically significant differences in neonatal birth weight,Apgar score,or intensive care unit admittance rates between the two groups(P>0.05).Conclusion::This MCH procedure reduced blood loss,avoided bladder injury,and had no long-term complications.It is a safe,rapid,and effective way to control fatal hemorrhage during surgery for women with placenta previa complicated with placenta percreta.
文摘目的:探讨选择性血管阻断技术在妊娠晚期穿透性胎盘治疗中应用的价值。方法:回顾性分析2003年1月至2010年12月中南大学湘雅医院明确诊断的孕龄≥34周的15例穿透性胎盘患者的临床资料。根据患者是否使用血管阻断技术,分为血管阻断组(n=8)与血管未阻断组(n=7);血管阻断组按血管阻断技术应用的时机,又分为预防性应用组(n=4)和治疗性应用组(n=4,其中1例为髂总动脉球囊取出后)。比较血管阻断组与血管未阻断组出血量、子宫切除率及并发症发生情况。结果:15例穿透性胎盘患者术中平均出血量为3813 mL,子宫切除率为73.3%(11/15),近期并发症发生率为20.0%(3/15,包括2例凝血功能障碍和1例下肢血栓形成),远期并发症的发生率为0;其中血管阻断组平均出血量为2512 mL,子宫切除率为62.5%(5/8);血管未阻断组平均出血量5549 mL,子宫切除率85.7%(6/7);两组平均出血量及子宫切除率相比差异均有统计学意义(P<0.05)。且预防性应用组的平均出血量和子宫切除率亦显著低于治疗性应用组(1350 mL vs 3600 mL,60.0%vs 66.7%,P<0.05)。结论:穿透性胎盘患者术中出血量大,子宫切除率高;选择性血管阻断技术可减少其出血量,降低子宫切除率,但仍有严重出血以及切除子宫的风险。
