Placental adhesive disorders

Автор: Palacios-Jaraquemada J. M.

Год выпуска: 2012

Издательство: De Gruyter

Страниц: 171

Аннотация:

Abnormal placental adhesive disorders are associated to massive hemorrhage and high maternal morbidity and mortality. The main risk factor for abnormal invasive placentation is the repeated cesarean, although other factors were identified. There are specific techniques to provide a high confidence diagnosis. However, precise skills must be acquired to recognize detailed diagnostic signs, to avoid common technical mistakes, and also to know when, how and why it is necessary to use each of them. Presurgical study provides diagnosis, extension and compromise of neighboring structures such as the bladder or the parametrium. Knowledge of placental invasion extension is needed to plan any resective surgery such as hysterectomy or one-step conservative surgery. Due to the fact that topography of the invaded area has direct relation with the specific arterial pedicles, a map of the invasion is required to know which type of proximal vascular control can be more effective. Leaving the placenta in situ seems to be the best option when resources or a skilled team are not available, but it requires intensive postoperative controls to detect infection, bleeding or coagulation disorders. Hysterectomy can be an easy solution for non-experimented operators; however, it is usually a very complicated procedure with demonstrated morbidity and mortality due to hemodynamic and hemostatic problems.
This book gathers the latest knowledge in relation with the etiology, diagnosis, treatment and also the authors personal experience in more than 500 cases. All aspects of this condition have been analyzed to provide an accurate management, which includes vascular control, urology, anesthesia and hemodynamic management among others.

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Placental adhesive disorders

1 General knowledge 1
1.1 Introduction 1
1.2 Epidemiology 3
1.3 Risk factors 4
1.4 Terminology 7
1.5 Types of placental invasion 8
1.6 Etiology 14
1.7 Intrinsic problems 15
2 Diagnosis 17
2.1 Presurgical stage 17
2.2 Clinical suspicion 17
2.3 Auxiliary diagnosis 18
2.3.1 Ultrasound, Doppler, Three dimensional Doppler 20
2.3.2 Placental magnetic resonance imaging (pMRI) 30
2.3.3 Placental magnetic resonance imaging (pMRI) gallery 32
2.3.4 Serologic diagnosis 32
3 Surgical anatomy 43
3.1 Anatomic and surgical problems 43
3.2 Uterine blood supply 46
3.3 Induced vascular neoformation 51
3.4 Bladder dissection 53
3.5 Ureteral dissection 58
3.6 Pelvic access spaces 63
3.7 Proximal vascular control 66
3.7.1 Aortic 66
3.7.2 Common iliac 70
3.7.3 Internal iliac 72
3.7.4 Uterine 76
4 Tactics and strategy 79
4.1 Alternative management in different settings 79
4.2 Scheduled surgery 85
4.3 Emergency 86
4.4 Additional resources 87
4.5 Training 88
5 Clinical problems 91
5.1 Hemostatic problems 91
5.2 Hemodynamic management 93
5.3 Anesthesia 94
6 Surgical alternatives 95
6.1 Surgical approach 95
6.2 Resective procedure (hysterectomy) 101
6.3 Conservative procedures 107
6.3.1 In situ placenta 107
6.3.2 One step conservative surgery 114
6.3.3 Two step conservative surgery 123
6.3.4 Cesarean scar pregnancy 124
6.4 Surgical hemostasis 127
6.4.1 Arterial ligatures and compression methods 127
6.4.2 Embolization 129
6.5 Postoperative care 137
6.5.1 Thromboprophylaxis 137
6.5.2 Analgesia 138
7 Results 139
7.1 General overview 139
7.2 Maternal outcomes 141
7.3 Reproductive outcome 142
8 Summary 143
8.1 Quick guide 143
8.1.1 Clinical risk 143
8.1.2 Ultrasound 143
8.1.3 Placental magnetic resonance imaging (pMRI) 145
8.1.4 Doppler 145
8.1.5 Surgery 145
8.1.6 Interventional radiologist’s assistance 146
8.1.7 Hemodynamic and hemostatic status 147
8.1.8 Reproductive outcome 147
8.2 Conclusions 148

2018