OB-GYN-L Messages for February, 2008: Re: Placenta Accreta

Re: Placenta Accreta

From: Bernard Cristalli

bcrist@club-internet.fr

Fri Feb 15 23:26:13 2008

J Gynecol Obstet Biol Reprod (Paris). <javascript:AL_get(this, 'jour', 'J Gynecol Obstet Biol Reprod (Paris).');> 1991;20(6):851-4. Links <javascript:PopUpMenu2_Set(Menu1822495);>

[Padding of the uterine wall in severe obstetrical hemorrhage]

[Article in French]

*Cristalli B* <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cristalli B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>, *Levardon M* <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Levardon M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>, *Izard V* <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Izard V%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>, *Cayol A* <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Cayol A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>.

Severe obstetrical hemorrhage demand an emergency treatment, and hysterectomy is not always adequate. We report our technique of uterine wall padding (UWP), as performed on five women who underwent surgery with UWP for an obstetrical hemorrhage that was severe either at the onset (n = 3) or after transfer to our department (n 2). The technique consists of padding the uterine walls with X stitches of slowly resorbable thread. The reasons for the operation were: uterine muscle atonia in 2 cases and vaginal laceration, placenta preavia and placenta accreta in 1 case each. The UWP technique was carried out during or after subtotal hysterectomy for hemorrhage in 4 patients, and with preservation of the uterus in one patient. No secondary operation was required after UWP. Less blood products were transfused in women who had immediate UWP than in those for whom UWP was a second-line operation. UWP was more efficient when performed at an early stage. In the woman with placenta accreta the uterus could be salvaged by UWP. This simple technique contributes to the reduction of blood transfusions in severe obstetrical hemorrhage.

ainsron a écrit : >
> Be prepared for C-Hysterectomy – consent, blood available (lots). MRI
> could be useful for diagnosis, but at this point it sounds like it is
> highly likely, so what difference would an MRI make? Either way you’re
> going to need to be prepared for C-hysterectomy. If it doesn’t
> separate easily I would go quickly to hysterectomy. If she wanted
> conservative options, I would refer to tertiary care center and let
> them roll the dice if they feel lucky. For my part, I would do
> everything I can safely do to protect the patient, not the uterus.
>
> Ronald E. Ainsworth, MD, FACOG
>
> -----Original Message-----
> *From:* ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] *On Behalf Of
> *Andrew Folley
> *Sent:* Friday, February 15, 2008 9:53 AM
> *To:* Multiple recipients of list OB-GYN-L
> *Subject:* RE: Placenta Accreta
>
> G3P2 now at 27 weeks with know complete previa since 12 weeks. Admit
> to hospital wednesday for steroids in light of short cervix or 9mm and
> +Ffn. Echo in hospital confirms previa and also suggests placenta
> accreta on "right lateral side". Patient would like more children. Any
> thoughts on management?? ie plan for c-hyst? Use interventional
> radiology? Do c-section and leave placenta and treat with
> methotrexate? Do section and do the best I can in extracting placenta
> and be prepared....???? thanks agf PS Benefits tif any for Cat scan or
> MRI to diagnose percreta or increta??
>

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