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Nan Shan - One of the best experts on this subject based on the ideXlab platform.
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clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with Placenta Accreta a systematic review and meta analysis
BMC Pregnancy and Childbirth, 2019Co-Authors: Li Chen, Xiaodan Wang, Hengyu Wang, Nan ShanAbstract:Severe obstetric hemorrhage caused by Placenta Accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with Placenta Accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies. We used a three-check subset including Placenta Accreta (Placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding Placenta previa or Placenta Accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments. We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD − 1480 ml, 95% CI -1806 to − 1154 ml, P < 0.001) and blood transfusion volume (MD − 1125 ml, 95% CI -1264 to − 987 ml, P < 0.001). Similarly, obvious reductions in the hysterectomy rate (OR 0.30, 95% CI 0.19 to 0.48, P < 0.001), hospitalization duration (MD − 1.35 days, 95% CI -2.40 to − 0.31 days, P = 0.01), and operative time (MD − 29.23 min, 95% CI -46.04 to − 12.42 min, P < 0.001) were observed in the AABO group. The prophylactic use of AABO in patients with Placenta Accreta is safe and effective.
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Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with Placenta Accreta: a systematic review and meta-analysis
BMC, 2019Co-Authors: Li Chen, Xiaodan Wang, Hengyu Wang, Nan ShanAbstract:Abstract Background Severe obstetric hemorrhage caused by Placenta Accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with Placenta Accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies. Methods We used a three-check subset including Placenta Accreta (Placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding Placenta previa or Placenta Accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments. Results We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD − 1480 ml, 95% CI -1806 to − 1154 ml, P
Li Chen - One of the best experts on this subject based on the ideXlab platform.
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clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with Placenta Accreta a systematic review and meta analysis
BMC Pregnancy and Childbirth, 2019Co-Authors: Li Chen, Xiaodan Wang, Hengyu Wang, Nan ShanAbstract:Severe obstetric hemorrhage caused by Placenta Accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with Placenta Accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies. We used a three-check subset including Placenta Accreta (Placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding Placenta previa or Placenta Accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments. We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD − 1480 ml, 95% CI -1806 to − 1154 ml, P < 0.001) and blood transfusion volume (MD − 1125 ml, 95% CI -1264 to − 987 ml, P < 0.001). Similarly, obvious reductions in the hysterectomy rate (OR 0.30, 95% CI 0.19 to 0.48, P < 0.001), hospitalization duration (MD − 1.35 days, 95% CI -2.40 to − 0.31 days, P = 0.01), and operative time (MD − 29.23 min, 95% CI -46.04 to − 12.42 min, P < 0.001) were observed in the AABO group. The prophylactic use of AABO in patients with Placenta Accreta is safe and effective.
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Clinical evaluation of prophylactic abdominal aortic balloon occlusion in patients with Placenta Accreta: a systematic review and meta-analysis
BMC, 2019Co-Authors: Li Chen, Xiaodan Wang, Hengyu Wang, Nan ShanAbstract:Abstract Background Severe obstetric hemorrhage caused by Placenta Accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with Placenta Accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies. Methods We used a three-check subset including Placenta Accreta (Placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding Placenta previa or Placenta Accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments. Results We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD − 1480 ml, 95% CI -1806 to − 1154 ml, P
Robert Resnik - One of the best experts on this subject based on the ideXlab platform.
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effect of predelivery diagnosis in 99 consecutive cases of Placenta Accreta
Obstetrics & Gynecology, 2010Co-Authors: Carri R Warshak, Ramez N Eskander, Kurt Benirschke, Gladys A Ramos, Cheryl C Saenz, Thomas F Kelly, Thomas Moore, Robert ResnikAbstract:OBJECTIVE: To estimate the effects of prenatal diagnosis and delivery planning on outcomes in patients with Placenta Accreta. METHODS: A review was performed of all patients with pathologically confirmed Placenta Accreta at the University of California, San Diego Medical Center from January 1990 to April 2008. Cases were divided into those with and without predelivery diagnosis of Placenta Accreta. Patients with prenatal diagnosis of Placenta Accreta were scheduled for planned en bloc hysterectomy without removal of the Placenta at 34-35 weeks of gestation after betamethasone administration. Maternal and neonatal outcomes were assessed. RESULTS: Ninety-nine women with Placenta Accreta were identified, of whom 62 were diagnosed before delivery and 37 were diagnosed intrapartum. Comparing women with predelivery diagnosis with those diagnosed at the time of delivery, there were fewer units of packed red blood cells transfused (4.7+/-2.2 compared with 6.9+/-1.8 units, P=.02) and a lower estimated blood loss (2,344+/-1.7 compared with 2,951+/-1.8 mL, P=.053), although this trend did not reach statistical significance. Comparison of neonatal outcomes demonstrated a higher rate of steroid administration (65% compared with 16%, P
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accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of Placenta Accreta
Obstetrics & Gynecology, 2006Co-Authors: Carri R Warshak, Ramez N Eskander, Andrew D Hull, Angela L Scioscia, Robert F Mattrey, Kurt Benirschke, Robert ResnikAbstract:BACKGROUND: The incidence of Placenta Accreta has increased dramatically over the last three decades, in concert with the increase in the cesarean delivery rate. Optimal management requires accurate prenatal diagnosis. The purpose of this study was to determine the precision and reliability of ultrasonography and magnetic resonance imaging (MRI) in diagnosing Placenta Accreta. METHODS: A historical cohort study was performed with information gathered from our obstetric, radiologic, and pathology databases. Records from January 2000 to June 2005 were reviewed to identify patients with a diagnosis of Placenta previa, low-lying Placenta with a prior cesarean delivery, or history of a myomectomy to determine the accuracy of pelvic ultrasonography in the diagnosis of Placenta Accreta. The records of those considered to be suspicious for Placenta Accreta and subsequently referred for additional confirmation by MRI were also analyzed. The sonographic and MRI diagnoses were compared with the final pathologic or operative findings or with both. RESULTS: Of the 453 women with Placenta previa, previous cesarean delivery and low-lying anterior Placenta, or previous myomectomy, 39 had Placenta Accreta confirmed by pathological examination. Ultrasonography accurately predicted Placenta Accreta in 30 of 39 of women and correctly ruled out Placenta Accreta in 398 of 414 without Placenta Accreta (sensitivity 0.77, specificity 0.96). Forty-two women underwent MRI evaluation because of findings suspicious or inconclusive of Placenta Accreta by ultrasonography. Magnetic resonance imaging accurately predicted Placenta Accreta in 23 of 26 cases with Placenta Accreta and correctly ruled out Placenta Accreta in 14 of 14 (sensitivity 0.88, specificity 1.0). CONCLUSION: A two-stage protocol for evaluating women at high risk for Placenta Accreta, which uses ultrasonography first, and then MRI for cases with inconclusive ultrasound features, will optimize diagnostic accuracy.
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accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of Placenta Accreta
Obstetrics & Gynecology, 2006Co-Authors: Carri R Warshak, Ramez N Eskander, Andrew D Hull, Angela L Scioscia, Robert F Mattrey, Kurt Benirschke, Robert ResnikAbstract:BACKGROUND:The incidence of Placenta Accreta has increased dramatically over the last three decades, in concert with the increase in the cesarean delivery rate. Optimal management requires accurate prenatal diagnosis. The purpose of this study was to determine the precision and reliability of ultras
Eric Jauniaux - One of the best experts on this subject based on the ideXlab platform.
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figo classification for the clinical diagnosis of Placenta Accreta spectrum disorders
International Journal of Gynecology & Obstetrics, 2019Co-Authors: Eric Jauniaux, Karin A Fox, Sally L Collins, Diogo Ayresdecampos, Jens LanghoffroosAbstract:Placenta Accreta spectrum is impacting maternal health outcomes globally and its prevalence is likely to increase. Maternal outcomes depend on identification of the condition before or during delivery and, in particular, on the differential diagnosis between its adherent and invasive forms. However, accurate estimation of its prevalence and outcome is currently problematic because of the varying use of clinical criteria to define it at birth and the lack of detailed pathologic examination in most series. Adherence to this new International Federation of Gynecology and Obstetrics (FIGO) classification should improve future systematic reviews and meta-analyses and provide more accurate epidemiologic data which are essential to develop new management strategies.
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impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of Placenta Accreta spectrum or vasa previa
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Yaakov Melcer, Eric Jauniaux, Shlomit Maymon, Anna Tsviban, Marina Pekarzlotin, Moshe Betser, Ron MaymonAbstract:Background Placenta Accreta spectrum and vasa previa (VP) are congenital disorders of Placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes. Objective The objective of the study was to compare perinatal outcome in women with Placenta Accreta spectrum or vasa previa before and after implementation of targeted scanning protocols. Study Design This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004–1012 vs 2013–2016 for Placenta Accreta spectrum and 1988–2007 vs 2008–2016 for vasa previa). Clinical reports of women diagnosed with Placenta Accreta spectrum and vasa previa during the study periods were reviewed and outcomes were compared. Results In total, there were 97 cases of Placenta Accreta spectrum and 51 cases with vasa previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P Conclusion The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for Placenta Accreta spectrum and vasa previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.
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figo consensus guidelines on Placenta Accreta spectrum disorders prenatal diagnosis and screening
International Journal of Gynecology & Obstetrics, 2018Co-Authors: Eric Jauniaux, Paula J Woodward, Anne M Kennedy, A Bhide, Corrine Hubinont, Sally L CollinsAbstract:Recent population studies have shown that Placenta Accreta spectrum (PAS) disorders remain undiagnosed before delivery in half to two-thirds of cases. In a series from specialist diagnostic units in the USA, around onethird of cases of PAS disorders were not diagnosed during pregnancy. Maternal mortality and morbidity are reduced when women with PAS disorders, particularly the invasive forms—Placenta increta or percreta—deliver in a center of excellence by a multidisciplinary care team with experience in managing the surgical risks and perioperative challenges presented by these disorders. Transfer to a center of excellence, however, relies on both recognition of the women at risk of PAS disorders and on accurate prenatal diagnosis.
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Placenta Accreta spectrum pathophysiology and evidence based anatomy for prenatal ultrasound imaging
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Eric Jauniaux, Sally L Collins, Graham J BurtonAbstract:Placenta Accreta spectrum is a complex obstetric complication associated with high maternal morbidity. It is a relatively new disorder of Placentation, and is the consequence of damage to the endometrium-myometrial interface of the uterine wall. When first described 80 years ago, it mainly occurred after manual removal of the Placenta, uterine curettage, or endometritis. Superficial damage leads primarily to an abnormally adherent Placenta, and is diagnosed as the complete or partial absence of the decidua on histology. Today, the main cause of Placenta Accreta spectrum is uterine surgery and, in particular, uterine scar secondary to cesarean delivery. In the absence of endometrial reepithelialization of the scar area the trophoblast and villous tissue can invade deeply within the myometrium, including its circulation, and reach the surrounding pelvic organs. The cellular changes in the trophoblast observed in Placenta Accreta spectrum are probably secondary to the unusual myometrial environment in which it develops, and not a primary defect of trophoblast biology leading to excessive invasion of the myometrium. Placenta Accreta spectrum was separated by pathologists into 3 categories: Placenta creta when the villi simply adhere to the myometrium, Placenta increta when the villi invade the myometrium, and Placenta percreta where the villi invade the full thickness of the myometrium. Several prenatal ultrasound signs of Placenta Accreta spectrum were reported over the last 35 years, principally the disappearance of the normal uteroPlacental interface (clear zone), extreme thinning of the underlying myometrium, and vascular changes within the Placenta (lacunae) and Placental bed (hypervascularity). The pathophysiological basis of these signs is due to permanent damage of the uterine wall as far as the serosa, with Placental tissue reaching the deep uterine circulation. Adherent and invasive Placentation may coexist in the same Placental bed and evolve with advancing gestation. This may explain why no single, or set combination of, ultrasound sign(s) was found to be specific for the depth of abnormal Placentation, and accurate for the differential diagnosis between adherent and invasive Placentation. Correlation of pathological and clinical findings with prenatal imaging is essential to improve screening, diagnosis, and management of Placenta Accreta spectrum, and standardized protocols need to be developed.
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Placenta Accreta pathogenesis of a 20th century iatrogenic uterine disease
Placenta, 2012Co-Authors: Eric Jauniaux, D JurkovicAbstract:Placenta Accreta refers to different grades of abnormal Placental attachment to the uterine wall, which are characterised by invasion of trophoblast into the myometrium. Placenta Accreta has only been described and studied by pathologists for less than a century. The fact that the first detailed description of a Placenta Accreta happened within a couple of decades of major changes in the caesarean surgical techniques is highly suggestive of a direct relationship between prior uterine surgery and abnormal Placenta adherence. Several concepts have been proposed to explain the abnormal Placentation in Placenta Accreta including a primary defect of the trophoblast function, a secondary basalis defect due to a failure of normal decidualization and more recently an abnormal vascularisation and tissue oxygenation of the scar area. The vast majority of Placenta Accreta are found in women presenting with a previous history of caesarean section and a Placenta praevia. Recent epidemiological studies have also found that the strongest risk factor for Placenta praevia is a prior caesarean section suggesting that a failure of decidualization in the area of a previous uterine scar can have an impact on both implantation and Placentation. Ultrasound studies of uterine caesarean section scar have shown that large and deep myometrial defects are often associated with absence of re-epithelialisation of the scar area. These findings support the concept of a primary deciduo-myometrium defect in Placenta Accreta, exposing the myometrium and its vasculature below the junctional zone to the migrating trophoblast. The loss of this normal plane of cleavage and the excessive vascular remodelling of the radial and arcuate arteries can explain the in-vivo findings and the clinical consequence of Placenta Accreta. Overall these data support the concept that abnormal decidualization and trophoblastic changes of the Placental bed in Placenta Accreta are secondary to the uterine scar and thus entirely iatrogenic.
Robert M. Silver - One of the best experts on this subject based on the ideXlab platform.
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Placenta Accreta spectrum disorder uterine dehiscence not Placental invasion
Obstetrics & Gynecology, 2020Co-Authors: Brett D Einerson, Robert M. Silver, Jessica M Comstock, Ware D Branch, Paula J Woodward, Anne M KennedyAbstract:For decades, Placenta Accreta spectrum disorder has been classified, staged, and described as a disorder of Placental invasion. In this commentary, we argue that Placenta Accreta spectrum exists as a disorder of defective decidua and uterine scar dehiscence, not as a disorder of destructive trophoblast invasion. Adopting this understanding of Placenta Accreta spectrum will help direct research efforts and clinical resources toward the prevention, accurate diagnosis, and safe treatment of this devastating-and increasingly common-disorder.
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abnormal Placentation Placenta previa vasa previa and Placenta Accreta
Obstetrics & Gynecology, 2015Co-Authors: Robert M. SilverAbstract:Placental disorders such as Placenta previa, Placenta Accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and Accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology. The routine use of obstetric ultrasonography as well as improving ultrasonographic technology allows for the antenatal diagnosis of these conditions. In turn, antenatal diagnosis facilitates optimal obstetric management. This review emphasizes an evidence-based approach to the clinical management of pregnancies with these conditions as well as highlights important knowledge gaps.
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center of excellence for Placenta Accreta
American Journal of Obstetrics and Gynecology, 2015Co-Authors: Robert M. Silver, Karin A Fox, John R Barton, Alfred Abuhamad, Hyagriv N Simhan, Kevin C Huls, Michael A Belfort, Jason D WrightAbstract:Placenta Accreta spectrum is one of the most morbid conditions obstetricians will encounter. The incidence has dramatically increased in the last 20 years. The major contributing factor to this is believed to be the increase in the rate of cesarean delivery. Despite the increased incidence of Placenta Accreta, most obstetricians have personally managed only a small number of women with Placenta Accreta. The condition poses dramatic risk for massive hemorrhage and associated complication such as consumption coagulopathy, multisystem organ failure, and death. In addition, there is an increased risk for surgical complications such as injury to bladder, ureters, and bowel and the need for reoperation. Most women require blood transfusion, often in large quantities, and many require admission to an intensive care unit. As a result of indicated, often emergent preterm delivery, many babies require admission to a neonatal care intensive care unit. Outcomes are improved when delivery is accomplished in centers with multidisciplinary expertise and experience in the care of Placenta Accreta. Such expertise may include maternal-fetal medicine, gynecologic surgery, gynecologic oncology, vascular, trauma and urologic surgery, transfusion medicine, intensivists, neonatologists, interventional radiologists, anesthesiologists, specialized nursing staff, and ancillary personnel. This article highlights the desired features for a center of excellence in Placenta Accreta, and which patients should be referred for evaluation and/or delivery in such centers.
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maternal morbidity in cases of Placenta Accreta managed by a multidisciplinary care team compared with standard obstetric care
Obstetrics & Gynecology, 2011Co-Authors: Alexandra G Eller, Michele A Bennett, Margarita Sharshiner, Carol Masheter, Andrew P Soisson, Mark K Dodson, Robert M. SilverAbstract:OBJECTIVE:To compare maternal morbidity in cases of Placenta Accreta managed by a multidisciplinary care team with similar cases managed by standard obstetric care.METHODS:This was a retrospective cohort study of all cases of Placenta Accreta identified in the State of Utah from 1996 to 2008. Cases
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optimal management strategies for Placenta Accreta
Obstetrical & Gynecological Survey, 2009Co-Authors: Alexandra G Eller, T F Porter, P Soisson, Robert M. SilverAbstract:Placenta Accreta can be defined as Placenta attached to the uterine wall, which is difficult to detach. Its occurrence during childbirth is associated with considerable maternal and neonatal morbidity and places the mother at high risk of bleeding during its removal. The marked persistent increase in cesarean delivery rates in recent years has been paralleled by increases in the incidence of Placenta Accreta and may reflect a general trend. Various management strategies have been employed for Placenta Accreta but there are limited data on optimal management. This retrospective cohort study determined which interventions employed at 2 tertiary care teaching hospitals were associated with reduced maternal morbidity. Between 1996 and 2008, women with pregnancies complicated by Placenta Accreta were identified using ICD-9 codes for Placenta Accreta, Placenta praevia, and cesarean hysterectomy. Medical records were analyzed for maternal medical, obstetric, and gynecologic history, and for antepartum and intrapartum management. Maternal outcome measures analyzed were early morbidity (admission to intensive care unit >24 hours, early reoperation, coagulopathy, transfusion of ≥4 units of packed red blood cells, or ureteral injury) and late morbidity (occurrence of intra-abdominal infection, hospital readmission within 6 weeks, or need for delayed reoperation). Complications in women with suspected and unexpected Placenta Accreta were compared with respect to preoperative ureteric stent placement, attempts to remove the Placenta before hysterectomy, and ligation of the hypogastric arteries. A total of 76 women with Placenta Accreta were identified. Of these, 57 (75%) had antenatally suspected Accreta; 56 of the 57 (98%) had a hysterectomy at the time of delivery. Twenty-five percent (19/76) of the women had unsuspected Accreta. Attempt at Placental removal before hysterectomy in the women with antenatally suspected Placenta Accreta was associated with an increase in early maternal morbidity of almost 2-fold in comparison with women who had a cesarean hysterectomy without attempting Placenta removal (67% vs. 36%, P = 0.04). The incidence of early morbidity was significantly lower among women with preoperative bilateral ureteric stents than those without (18% vs. 55%, P = 0.02). Ligation of the hypogastric arteries did not reduce maternal morbidity. These findings indicate that maternal morbidity is reduced following scheduled cesarean hysterectomy performed with preoperative ureteric stents and without attempting to remove the Placenta before hysterectomy.