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Titre du document / Document title

The management of placenta percreta : Conservative and operative strategies

Auteur(s) / Author(s)

O'BRIEN J. M. (1) ; BARTON J. R. (1) ; DONALDSON E. S. (2) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Central Baptist Hospital, ETATS-UNIS
(2) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Central Baptist Hospital, ETATS-UNIS

Résumé / Abstract

OBJECTIVE: Our purpose was to assess preferences for the management of placenta percreta and identify aspects of care related to an improved outcome. STUDY DESIGN: Both an analysis of a questionnaire issued to members of the Society of Perinatal Obstetricians and a retrospective study at our institution were used to obtain case histories of women with placenta percreta during a recent 3-year period. RESULTS: Fifty-five of the 109 cases (50%) reported by members of the Society of Perinatal Obstetricians were suspected ante partum. Complications associated with this disorder included uterine rupture (3 cases), transfusion of >10 units (44 cases, 40%), ureteral ligation or fistula formation (5 cases each, 5%), infection (31 cases, 28%), perinatal death (10 cases, 9%), and maternal death (8 cases, 7%). Management options included surgical removal of the uterus and involved tissues (101 cases, 93%) and conservative treatment with the placenta left in situ after delivery (8 cases, 7%). More members of the Society of Perinatal Obstetricians responding to our survey opted for conservative management if adjacent tissues were involved (69% with extension into the bladder or gastrointestinal tract) compared with 31% when the percreta was confined to the uterus, p < 0.001. Conservative therapy was also associated with less blood loss in reported cases (median units red blood cells transfused, 0 vs 7, p = 0.003). Two of the three cases of placenta percreta at our institution were identified ante partum. The third case represents the first reported with antepartum identification of percreta followed by deliberate conservative treatment. CONCLUSIONS: With greater involvement of surrounding tissues, conservative treatment was preferred in hemodynamically stable patients. If surgical excision of the placenta is attempted or necessary, physicians experienced in pelvic dissection must be involved because of the frequency of maternal morbidity and mortality.

Revue / Journal Title

American journal of obstetrics and gynecology    ISSN  0002-9378   CODEN AJOGAH 

Source / Source

Congrès
Annual Meeting of the Society of Gynecologic Surgeons No22, Albuquerque, New Mexico , ETATS-UNIS (04/03/1996)
1996, vol. 175, no 6, pp. 1414-1492 (25 ref.), pp. 1632-1638

Langue / Language

Anglais

Editeur / Publisher

Elsevier, New York, NY, ETATS-UNIS  (1920) (Revue)

Mots-clés anglais / English Keywords

Placenta percreta

;

Conservative surgery

;

Treatment

;

Hysterectomy

;

Clinical management

;

Result

;

Human

;

Female

;

Pregnancy disorders

;

Delivery disorders

;

Placenta diseases

;

Mots-clés français / French Keywords

Placenta percreta

;

Chirurgie conservatrice

;

Traitement

;

Hystérectomie

;

Conduite à tenir

;

Résultat

;

Homme

;

Femelle

;

Gestation pathologie

;

Accouchement pathologie

;

Placenta pathologie

;

Mots-clés espagnols / Spanish Keywords

Placenta percreta

;

Cirugía conservatriz

;

Tratamiento

;

Histerectomía

;

Actitud médica

;

Resultado

;

Hombre

;

Hembra

;

Gestación patología

;

Parto patología

;

Placenta patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 3053, 35400006124847.0340

Nº notice refdoc (ud4) : 2544022



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