Cesarean section by transfundal approach for placenta previa percreta attached to anterior uterine wall in a woman with a previous repeat cesarean section: case report

Department of Obstetrics and Gynecology, Akita University, Akita, Akita, Japan
Acta Obstetricia Et Gynecologica Scandinavica (Impact Factor: 1.99). 02/2004; 83(1):115-6. DOI: 10.1111/j.1600-0412.2004.0033d.x
Source: PubMed
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    ABSTRACT: A 32-year-old woman, gravida 2 para 1, was hospitalized in the 31st week of gestation with a diagnosis of preterm labor. Ritodrine tocolysis failed to control uterine contractions, and an emergency cesarean section was performed for a decelerative fetal heart rate tracing. After the infant was delivered, ligation of the bilateral uterine arteries and their anastomoses with the ovarian arteries was performed. A 46-cm ellipsoid area of the anterior uterine corpus with placenta percreta was excised. Unilateral tubal occlusion was noted on hysterosalpingography 3months after surgery, but the patient refused further interventions. The second case we present is that of a 28-year-old woman, gravida 3 para 2, who had her third cesarean delivery at the 38th week of gestation because of bleeding from placenta previa. We performed a repeat laparotomy for decreasing hemoglobin levels and drained 1,600ml of blood from the abdomen. The bilateral uterine arteries and their anastomoses with ovarian arteries were ligated. Retained placental fragments were removed, and the bleeding areas were sutured. Despite resuturing of the vertical incision, uterine bleeding and hypotonia were observed, and transuterine sutures were inserted. Unilateral left tubal occlusion was observed on hysterosalpingography 3months after surgery, and hysteroscopic balloon tuboplasty and laparoscopic tubal adhesiolysis were performed.
    Gynecological Surgery 03/2005; 2(1):29-31. DOI:10.1007/s10397-004-0081-5
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    ABSTRACT: The placental adhesive disorders such as placenta accreta andplacenta percreta are the rare causes of serious obstetric hemorrhages.They are associated with high maternal morbidity andmortality. Placenta percreta is usually diagnosed in the thirdtrimester of pregnancy as a massive postpartum hemorrhagewhen an attempt to remove the placenta reveals lack of acleavage plane. Here we report an unusual presentation of placentapercreta as hemoperitoneum and hemorrhagic shock inthe third trimester of pregnancy. A 33-year-old woman wasadmitted to hospital at the 35th weeks of gestation with abdominalpain and hemorrhagic shock. Laparotomy was immediatelyperformed because of intra-abdominal bleeding. Uponinspection, a posterior laceration of the uterus was noted.Pathologic investigation of the uterus showed placenta percreta.The patient recovered uneventfully. Spontaneous ruptureof the uterus can be occured in the absence of uterinetrauma. In the differential diagnosis of a pregnant woman presentingwith hypotension, abdominal pain, and fetal death, ruptureof the uterus caused by placenta percreta should be considered.Rapid diagnosis, blood transfusion, and emergency laparotomyare the key steps in successful management.
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    ABSTRACT: The purpose of this retrospective cohort study was to elucidate whether the location of placenta below uterine incision in cesarean section is important in the development of maternal complications in placenta previa patients. The study was conducted on 409 patients 414 parturition at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 to December 2009. The subjects were divided to two groups: the group whose placenta was located in the anterior portion of the uterus (anterior group) and the group whose placenta was located in the posterior portion of the uterus (posterior group). And then they are compared to each other. Logistic regression was used to control for confounding factors. In the anterior group, regardless of confounding factors, the incidence of excessive blood loss (OR 2.97; 95% CI: 1.64-5.37), massive transfusion (OR 3.31; 95% CI: 1.33-8.26), placental accreta (OR 2.60, 95% CI: 1.40-4.83), and hysterectomy (OR 3.47, 95% CI: 1.39-8.68) was higher. Sonographic determination of the placental position where its location beneath the uterine incision is very important to predict maternal outcomes in placenta previa patients, and such cases, close attention should be paid for massive hemorrhage.
    International journal of medical sciences 07/2011; 8(5):439-44. · 1.55 Impact Factor
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