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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: 2.43). 02/2004; 83(1):115-6. DOI: 10.1111/j.1600-0412.2004.0033d.x
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    • "Ogawa et al. 16 reported a case of successful transfundal approach, and Boehm et al. 17 reported 2 cases of paramedian incision when the placenta was located in the anterior position, refusing direct placental incision; however, they did not evaluate the effect of neonatal anemia. Furthermore, another well-known method for preventing neonatal anemia—delayed umbilical cord clamping—is reported to be dangerous enough to increase maternal hemorrhage 18; therefore, more studies on the optimal surgical approach for lowering the incidence of neonatal anemia are needed. "
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    ABSTRACT: Placenta previa is a major cause of neonatal anemia. The purpose of this study was to elucidate the risk factors of neonatal anemia in placenta previa. The study was conducted on 158 placenta previa patients at 3 hospitals in affiliation with the Catholic Medical Center, Seoul, Korea from May 1999 through December 2009. The subjects were divided in to 2 groups: 47 placenta previa patients with neonatal anemia, and 113 placenta previa patients without neonatal anemia. The subjects' characteristics were compared. Logistic regression was used to control for confounding factors. Anterior placental location (OR 2.48; 95% CI: 1.20-5.11) was an independent risk factor of neonatal anemia after controlling for potential confounders. To manage neonatal anemia in placenta previa patients, obstetricians should do their best to detect placental location. Pediatricians should consider the high possibility of neonatal anemia in cases involving anterior placental location.
    Preview · Article · Sep 2011 · International journal of medical sciences
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    • "Until now, placental previa has been classified by the degree of encroachment upon the internal cervical os, because most studies reported that in complete previa, the possibility of massive perinatal hemorrhage, transfusion, placental accreta, and hysterectomy are strong 3,7-10. But most obstetricians have concerns about massive hemorrhage not only when complete previa exists, but also when placenta is located on the anterior portion of the uterus, beneath the cesarean incision site 11,12. Yet, the subject has rarely been studied; therefore, the authors have sought for statistical significance that the location of placenta is an independent prognostic factor of maternal pregnancy outcomes. "
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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.
    Full-text · Article · Jul 2011 · International journal of medical sciences
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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.
    No preview · Article · Mar 2005 · Gynecological Surgery
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