Cases reported "Placenta Previa"

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1/23. Placenta percreta: report of a case.

    placenta accreta, increta, or percreta are rare but potentially lethal obstetric emergencies. Removal of abnormal growth of the placenta into the uterine wall is difficult or impossible and results in massive blood loss. hysterectomy may be necessary to save the mother's life. The common predisposing factors in development of placenta percreta are repeat cesarean and placenta previa. The diagnosis of placenta percreta may remain undiagnosed until delivery. The case presented describes a scenario involving placenta percreta with bladder involvement in which the diagnosis was known in advance. The article describes the preoperative preparation, intraoperative events, and postoperative status of this particular case.
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2/23. Second-trimester presentation of placenta percreta.

    Placenta percreta is diagnosed usually in the third trimester as massive postpartum hemorrhage when an attempt to remove the placenta reveals lack of a cleavage plane. However, placenta percreta may present in the second trimester with signs and symptoms of uterine rupture. The diagnosis of this event may be difficult because of mild abdominal discomfort often associated with normal pregnancy. We describe two cases that occurred in the second trimester with an unusual presentation. Both patients suffered considerable surgical morbidity. Other cases reported in the literature are mentioned as well. When a patient with risk factors for abnormal placentation presents with abdominal pain and/or vaginal bleeding in the second trimester of pregnancy, the diagnosis of placenta percreta should be considered. A laparotomy is indicated immediately when hemoperitoneum is suspected because uterine rupture has most likely occurred. Placenta percreta in the second trimester is a potentially life-threatening condition that warrants expeditious diagnosis to limit maternal postoperative morbidity.
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keywords = operative
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3/23. Modified cesarean hysterectomy for placenta previa percreta with bladder invasion: retrovesical lower uterine segment bypass.

    BACKGROUND: Present conservative and radical surgical management of placenta previa percreta with bladder invasion is associated with significant hemorrhage and the need for blood salvage, transfusion, and component therapy. Conventional cesarean hysterectomy strategies have high surgical morbidity, despite adequate personnel and resources. CASE: A 37-year-old, gravida 3, para 2-0-0-2, with a radiographic diagnosis of placenta previa percreta with bladder invasion, and confirmed fetal lung maturity, had a modified cesarean hysterectomy at 34 weeks' gestation. The bladder was partially mobilized beneath the percreta invasion site via the paravesical spaces. Estimated blood loss was 900 mL. Superficial placental bladder invasion was confirmed by pathology. The postoperative course was uneventful. CONCLUSION: Modified cesarean hysterectomy prevented hemorrhage and need for blood salvage, transfusion, or component therapy in managing a case of placenta previa percreta with bladder invasion.
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4/23. Placenta percreta with bladder invasion as a cause of life threatening hemorrhage.

    PURPOSE: Abnormal placental penetration through the myometrium with bladder invasion is a rare obstetric complication with potential for massive blood loss. Urologists are usually consulted after a life threatening emergency has already arisen. Their familiarity with this condition is crucial for effective management. We describe 2 cases of placenta percreta with bladder invasion to highlight the catastrophic nature of this clinical entity, and review the literature on current diagnostic and management strategies. MATERIALS AND methods: Between 1986 and 1998, 250 cases of adherent placenta (0.9%) were identified in 25,254 births at our institution, including 2 (0.008%) of placenta percreta with bladder invasion. We treated these 2 multiparous women who were 33 and 30 years old, respectively. Each had undergone 2 previous cesarean sections. RESULTS: Presenting symptoms were severe hematuria in 1 patient and prepartum hemorrhage with shock in the other. Ultrasound showed complete placenta previa in each with evidence of bladder invasion in 1 patient. hysterectomy, bladder wall resection and repair, and bilateral internal iliac artery ligation were required to control massive intraoperative hemorrhage. The patients received 22 and 15 units of packed red blood cells, respectively. fetal death occurred in each case. convalescence was complicated by disseminated intravascular coagulation in patient 1 but subsequent recovery was uneventful. CONCLUSIONS: A high index of suspicion for placenta percreta with bladder invasion is required when evaluating pregnant women with a history of cesarean delivery and placenta previa who present with hematuria and lower urinary tract symptoms. ultrasonography and magnetic resonance imaging may assist in establishing the diagnosis preoperatively. With proper planning and a multidisciplinary approach fetal and maternal morbidity and mortality may be decreased.
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keywords = operative
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5/23. Three-dimensional color power Doppler imaging in the assessment of uteroplacental neovascularization in placenta previa increta/percreta.

    A case of placenta previa increta/percreta was diagnosed at 18 weeks' gestation with the 3-dimensional color power Doppler imaging technique. Unusually extensive uteroplacental vascular network architecture was seen on the 3-dimensional angiohistogram. After appropriate counseling, the patient chose to terminate the pregnancy. A hysterectomy was performed with prophylactic preoperative embolization of internal iliac arteries at 21 weeks' gestation, and histopathologic examination revealed placenta previa increta/percreta. This new 3-dimensional angiohistogram technique allowed us to visualize all 3 orthogonal planes of the angioarchitectural information. It appears to be a useful complementary tool and is likely to play a more defining and clarifying role in assessing the quantification of abnormal uteroplacental neovascularization for patients with placenta previa increta/percreta.
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ranking = 0.33333333333333
keywords = operative
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6/23. A useful technique for the control of severe cesarean hemorrhage: report of three cases.

    When we are confronted with a patient experiencing placenta previa with massive hemorrhage in cesarean delivery, hemostasis is first attempted using uterotonic drugs, uterine massage, and intrauterine packing. However, if these maneuvers fail, then uterine artery ligation, whole myometrial suture, and subendometrial vasopressin injection should be attempted. Perhaps these procedures alone or in combination can successfully control the hemorrhage. Every obstetrician must be familiar with these simple methods in order to avoid having to perform a hysterectomy and thus preserving the reproductive capability, as well as diminishing the operative morbidity. Finally, we described a full thickness suture for the placental site of bleeding for the lower uterine segment.
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ranking = 0.33333333333333
keywords = operative
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7/23. placenta previa percreta with urinary bladder and ureter invasion.

    A 26-year-old woman, with one previous cesarean delivery and two uterine curettage due to incomplete abortion, was admitted to the labor ward with the diagnosis of partial placenta previa at 35 weeks of gestation. Repeat cesarean section was performed due to profuse vaginal bleeding. placenta previa percreta invading the bladder trigone was confirmed with cystotomy. As bilateral hypogastric artery ligation and supracervical hysterectomy performed were not successful in stopping the profuse bleeding, the abdomen was packed with laparotomy pads. dilatation of the left ureter was noticed on the second postoperative day. Relaparotomy was performed to remove the pads, and placental invasion of the distal left ureter was noticed. Ureteroneocystostomy was performed. The postoperative course was uneventful, and the double-J-catheter was removed two months later.
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ranking = 0.66666666666667
keywords = operative
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8/23. Case report: Two cases of placenta previa terminated at 18 weeks' gestation.

    placenta previa is associated with increased maternal and fetal morbidity, caused primarily by hemorrhage, making an accurate diagnosis very important. However, diagnosis and treatment remain difficult, especially in the second trimester. We treated two cases with placenta previa at 18 weeks' gestation. In both patients, the cervical os was still closed when bleeding increased, necessitating emergency cesarean section. Postoperative course and the course of the subsequent pregnancy were uneventful. Terminating the pregnancy at the time of worsening of symptoms even in the second trimester should be considered as an option in the treatment of placenta previa.
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ranking = 0.33333333333333
keywords = operative
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9/23. Antepartum diagnosis of placenta previa percreta by magnetic resonance imaging.

    BACKGROUND: placenta previa percreta is a rare but highly morbid condition usually diagnosed intraoperatively. Placental manipulation results in severe bleeding. magnetic resonance imaging (MRI) might allow antepartum diagnosis of this condition. CASE: A multiparous woman with five previous abdominal deliveries had complete placenta previa diagnosed at 16 weeks' gestation. Bleeding ensured at 29 weeks and she was managed with bed rest. Before planned abdominal delivery, MRI was performed and placenta percreta was diagnosed, which allowed her physician to avoid placental manipulation. hysterectomy was accomplished with an estimated blood loss of only 2000 mL. CONCLUSION: Antepartum diagnosis of placenta previa percreta by MRI altered the usual diagnostic and surgical approach, diminishing blood loss and morbidity.
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ranking = 0.33333333333333
keywords = operative
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10/23. Conservative management of placenta previa percreta in a Jehovah's Witness.

    BACKGROUND: Hemorrhage is a serious threat with placenta accreta, often requiring aggressive operative intervention by hysterectomy and resuscitative measures with large-volume blood replacement to ensure survival. Refusal to accept transfusion makes management especially difficult. CASE: We report a Jehovah's Witness patient who had 9 previous cesarean deliveries and presented with anemia and placenta previa percreta invading the bladder wall. Management objectives were to enhance the patient's status, using erythropoietin and autologous transfusion, and to minimize the chance of hemorrhage by prophylactic uterine artery embolization. The placenta was left in situ after the delivery with no untoward consequences. methotrexate was held in readiness, but was not required as adjuvant therapy. CONCLUSION: Effective care of such patients requires close collaborative team effort and advanced planning to ensure a good outcome.
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ranking = 0.33333333333333
keywords = operative
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