Multidisciplinary approach in management of placenta accreta

Publish Year: 1398
نوع سند: مقاله کنفرانسی
زبان: English
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DTOGIMED03_129

تاریخ نمایه سازی: 26 بهمن 1398

Abstract:

Background and Aim : Placenta accreta is an abnormal adherence of the placenta to the uterine wall thatcan lead to significant maternal morbidity and mortality. The incidence of placenta accreta has increased13-fold since the early 1900s and directly correlates with the increasing cesarean delivery rate. The prenataldiagnosis of placenta accreta by ultrasound along with risk factors including placenta previa and priorcesarean delivery can aid in delivery planning and improved outcomes. Referral to a tertiary care centerand the use of a multidisciplinary care team is recommended.Methods : We report a 23-year-old primigravid woman without previous history of uterine surgery orcurettage who refered to imam Khomeini hospital with diagnosis of adherent placenta after NVD.she hadnot any abnormal finding during pregnancy and after delivery placenta did not exteract.she was stable andin the imaging study the uterus was bicornate and placenta was accretaand remain in uterine cavity.shewanted saving the uterus.she was admitted and receving antibiotics and 80mg MTX and.the utrine arteryambolization was done .because of cotinuing fever and utrine tenderness after embolizatin she wascandidated for laparotomy.A hystrotomy was done and necrotic and adherent placenta in one horne ofuterus removed with small bleeding.we can saving uterus.2years later she was conceived and hadasuccessful pregnancy termination with cesarean section.Results : Planned cesarean hysterectomy with no attempt at placental delivery is standard management.Alternative approaches, such as leaving the placenta in situ without hysterectomy, have increased risks andshould be reserved for individualized patients Women at highest risk for placenta accreta have a history ofa prior cesarean delivery with the current pregnancy complicated by placenta previa as well as placentalimplantation over the prior uterine scar.placcenta accreta can created in uterus with anomaly of mulerian.Conclusion : we find that there is no contraindication in using several methods simultaneously and ifindicated, we can use them together. As mentioned, different conservative managements were used in ourcase and finally she was discharged in good condition while saving her uterus.

Authors

Akram Ghahghaei Nezamabadi

depatment of gyneoncology,tehran university of medcal science