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Publications (4)10.34 Total impact

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    ABSTRACT: The aim of this study was to estimate the fertility and pregnancy outcomes after successful conservative treatment for placenta accreta. This retrospective national multicenter study included women with a history of conservative management for placenta accreta in French university hospitals from 1993 through 2007. Success of conservative treatment was defined by uterine preservation. Data were retrieved from medical files and telephone interviews. Follow-up data were available for 96 (73.3%) of the 131 women included in the study. There were eight women who had severe intrauterine synechiae and were amenorrheic. Of the 27 women who wanted more children, 3 women were attempting to become pregnant (mean duration: 11.7 months, range: 7-14 months), and 24 (88.9% [95% confidence interval (CI), 70.8-97.6%]) women had had 34 pregnancies (21 third-trimester deliveries, 1 ectopic pregnancy, 2 elective abortions and 10 miscarriages) with a mean time to conception of 17.3 months (range, 2-48 months). All 21 deliveries had resulted in healthy babies born after 34 weeks of gestation. Placenta accreta recurred in 6 of 21 cases [28.6% (95% CI, 11.3-52.2%)] and was associated with placenta previa in 4 cases. Post-partum hemorrhage occurred in four [19.0% (95% CI, 5.4-41.9%)] cases, related to placenta accreta in three and to uterine atony in one. Successful conservative treatment for placenta accreta does not appear to compromise the patients' subsequent fertility or obstetrical outcome. Nevertheless, patients should be advised of the high risk that placenta accreta may recur during future pregnancies.
    Human Reproduction 11/2010; 25(11):2803-10. · 4.67 Impact Factor
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    ABSTRACT: To estimate maternal outcome after conservative management of placenta accreta. This retrospective multicenter study sought to include all women treated conservatively for placenta accreta in tertiary university hospital centers in France from 1993 to 2007. Conservative management was defined by the obstetrician's decision to leave the placenta in situ, partially or totally, with no attempt to remove it forcibly. The primary outcome was success of conservative treatment, defined by uterine preservation. The secondary outcome was a composite measure of severe maternal morbidity including sepsis, septic shock, peritonitis, uterine necrosis, fistula, injury to adjacent organs, acute pulmonary edema, acute renal failure, deep vein thrombophlebitis or pulmonary embolism, or death. Of the 40 university hospitals that agreed to participate in this study, 25 institutions had used conservative treatment at least once (range 1-46) and had treated a total of 167 women. Conservative treatment was successful for 131 of the women (78.4%, 95% confidence interval [CI] 71.4-84.4%); of the remaining 36 women, 18 had primary hysterectomy and 18 had delayed hysterectomy (10.8% each, 95% CI 6.5-16.5%). Severe maternal morbidity occurred in 10 cases (6.0%, 95% CI 2.9-10.7%). One woman died of myelosuppression and nephrotoxicity related to intraumbilical methotrexate administration. Spontaneous placental resorption occurred in 87 of 116 cases (75.0%, 95% CI 66.1-82.6%), with a median delay from delivery of 13.5 weeks (range 4-60 weeks). Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.
    Obstetrics and Gynecology 03/2010; 115(3):526-34. · 4.80 Impact Factor
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    ABSTRACT: In the last 30 years, incidence of placenta accreta has dramatically increased to reach an alarming rate of more than one in 2500 deliveries. The rate of placenta accreta increased in conjunction with cesarean deliveries. 2D-ultrasonography is an useful tool to diagnose placenta accreta. The most reliable sign is the presence of abnormal placental lacunae. The lack of visualization of the echolucent area between the placenta and the myometrium with no other ultrasound finding has a poor sensitivity and positive predictive value. 3D power Doppler is useful to increase the diagnostic performance of 2D-ultrasonography. The presence of at least two ultrasound findings decreases the number of false-positive diagnosis and increases the performance of both 2D-ultrasonography and 3D power Doppler. Magnetic resonance imaging in cases with inconclusive ultrasound features optimizes diagnostic accuracy. In cases of prenatal diagnosis of placenta accreta, extirpative method should be to date abandoned. Advantages and disadvantages of both cesarean-hysterectomy and conservative treatment should be clearly explained to the patient and her partner, who have to be involved in the decision process. Currently, it seems to be reasonable to propose a cesarean-hysterectomy to multiparous patients with no desire of future pregnancy. In young women who want the option of future pregnancy and who agree to close follow-up monitoring, conservative treatment should be preferred. When placenta accreta is diagnosed during the delivery, the two options remain possible only if attempts of removal of the placenta are stopped before the occurrence of a severe postpartum hemorrhage. In cases of placenta percreta with bladder involvement, conservative treatment may be the optimal management.
    La Presse Médicale 03/2010; 39(7-8):765-77. · 0.87 Impact Factor
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    ABSTRACT: En quelques décennies, l’incidence des placentas accretas s’est considérablement majorée (1/2 000–2 500 naissances environ). Cette augmentation est corrélée à l’augmentation du taux de césarienne dans les 30 dernières années. L’échographie 2D est un examen utile pour le diagnostic des placentas accretas. Le critère échographique le plus performant est les lacunes intraplacentaires. L’absence isolée d’un liseré hypoéchogène entre le placenta et le myomètre a une faible sensibilité et valeur prédictive positive. Le doppler énergie en 3D est un outil utile en complément de l’échographie 2D. La présence d’au moins deux critères échographiques permet d’augmenter la performance de l’échographie 2D ou 3D et de diminuer le nombre de faux-positifs. L’imagerie par résonance magnétique (IRM) chez les patientes dont l’échographie 2D suspecte un placenta accreta permet d’améliorer la performance diagnostique de cette dernière. En cas de diagnostic prénatal de placenta accreta, la méthode extirpative doit être aujourd’hui abandonnée. Les avantages et inconvénients de la césarienne-hystérectomie et du traitement conservateur seront clairement exposés à la patiente et au conjoint, qui doivent être impliqués dans l’option choisie. Dans l’état actuel des connaissances, il semble raisonnable de proposer une césarienne-hystérectomie si la patiente n’a plus de désir de grossesse, à un âge avancé et est multipare. Par contre, si la patiente a un désir de grossesse, est jeune et nulli- ou primipare, un traitement conservateur sera proposé. Dans les rares situations de placenta percreta avec invasion vésicale, il semble raisonnable de privilégier le traitement conservateur. In the last 30 years, incidence of placenta accreta has dramatically increased to reach an alarming rate of less than 1 in 2500 deliveries. The rate of placenta accreta increased in conjunction with cesarean deliveries. 2D-ultrasonography is an useful tool to diagnose placenta accreta. The most reliable sign is the presence of abnormal placental. The lack of visualization of the echolucent area between the placenta and the myometrium with no other ultrasound finding has a poor sensitivity and positive predictive value. 3D power Doppler is useful in increasing the diagnostic performance of 2D-ultrasonography. The presence of at least two ultrasound findings decreases the number of false-positive diagnosis and increases the performance of both 2D-ultrasonography and 3D power Doppler. Magnetic resonance imaging in cases with inconclusive ultrasound features optimizes diagnostic accuracy. In the cases of prenatal diagnosis of placenta accreta, extirpative method should be to date abandoned. Advantages and disadvantages of both cesarean-hysterectomy and conservative treatment should be clearly explained to the patient and her partner, who have to be involved in the decision process. Currently, it seems to be reasonable to suggest a cesarean-hysterectomy to multiparous patients with no desire for future pregnancy. In young patients with desire for future pregnancy, conservative treatment should be preferred. When placenta accreta is diagnosed during the delivery, the two options remain possible only if the attempts for the removal of placenta stop before the occurrence of a postpartum hemorrhage. In the cases of placenta percreta with bladder involvement, conservative treatment may be the optimal management. Mots clésPlacenta accreta ou percreta-Échographie et doppler-Imagerie par résonance magnétique (IRM)-Césarienne-hystérectomie-Traitement conservateur KeywordsPlacenta accreta ou percreta-Ultrasonography-Doppler-Magnetic resonance imaging-Conservative treatment
    Revue de médecine périnatale 2(1):19-25.