oxytocin and Placenta-Accreta

Topics: Blood Transfusion; Blood Transfusion, Autologous; Carboprost; Dinoprostone; Drug Combinations; Embolization, Therapeutic; Emergency Treatment; Ergot Alkaloids; Female; Humans; Methylergonovine; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pressure; Prostaglandins; Tromethamine; Ultrasonography, Prenatal

This review of vaginal birth after caesarean (VBAC) focuses on practical issues that will be useful for the physician in training and the obstetrician in clinical practice. Although VBAC has long been a common practice in many European nations, the same has not been true in North America. As recently as 1970 essentially all hospitals in the United States maintained a policy that women with a history of previous caesarean delivery would undergo repeat caesarean operations for any and all subsequent births. Although VBAC rates in many nations increased dramatically in the 1980s and 1990s, many aspects of trial of labour (also known as trial of scar) remain controversial at the dawn of the 21st century.

Topics: Female; Fetal Death; Humans; Informed Consent; Maternal Mortality; Oxytocin; Parity; Patient Education as Topic; Placenta Accreta; Placenta Previa; Pregnancy; Prostaglandins; Risk Factors; Trial of Labor; Uterine Rupture; Vaginal Birth after Cesarean

Topics: Cervix Uteri; Embolism, Amniotic Fluid; Episiotomy; Ergot Alkaloids; Female; Hematoma; Humans; Labor Stage, Third; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Uterine Inertia; Uterine Rupture; Vagina

In a single-blind study 51 patients with retention of the placenta were randomized into one of three groups: Group 1 was given 10 IU of oxytocin in 10 ml of sodium chloride into the umbilical vein; group 2 was given 10 ml of sodium chloride; group 3 was treated with manual removal of the placenta. No significant differences were recorded in groups 1 and 2, and no advantages were found in comparison with the procedure normally used.

Topics: Clinical Trials as Topic; Female; Humans; Injections, Intravenous; Oxytocin; Placenta Accreta; Pregnancy; Sodium Chloride; Umbilical Veins

Postpartum haemorrhage (PPH), especially resulting from placenta accreta spectrum (PAS), has become a worldwide concern in maternity care. We describe a novel method of uterine compression sutures (the 'Nausicaa' technique) as an alternative to hysterectomy for patients who have suffered from major PPH. We applied this technique in 68 patients with major PPH during caesarean section (including 43 patients with PAS, 20 patients with placenta praevia totalis, and five patients with uterine atony), and none of these patients required further hysterectomy. We conclude that our Nausicaa suture is a simple and feasible alternative to hysterectomy in patients suffering from major PPH.

Topics: Adult; Cesarean Section; Female; Humans; Hysterectomy; Massage; Middle Aged; Misoprostol; Oxytocics; Oxytocin; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Severity of Illness Index; Suture Techniques; Treatment Failure; Uterine Inertia; Young Adult

The worldwide incidence of abnormally invasive placenta is rapidly rising, following the trend of increasing cesarean delivery. It is a heterogeneous condition and has a high maternal morbidity and mortality rate, presenting specific intrapartum challenges. Its rarity makes developing individual expertise difficult for the majority of clinicians. The International Society for Abnormally Invasive Placenta aims to improve clinicians' understanding and skills in managing this difficult condition. By pooling knowledge, experience, and expertise gained within a variety of different healthcare systems, the Society seeks to improve the outcomes for women with abnormally invasive placenta globally. The recommendations presented herewith were reached using a modified Delphi technique and are based on the best available evidence. The evidence base for each is presented using a formal grading system. The topics chosen address the most pertinent questions regarding intrapartum management of abnormally invasive placenta with respect to clinically relevant outcomes, including the following: definition of a center of excellence; requirement for antenatal hospitalization; antenatal optimization of hemoglobin; gestational age for delivery; antenatal corticosteroid administration; use of preoperative cystoscopy, ureteric stents, and prophylactic pelvic arterial balloon catheters; maternal position for surgery; type of skin incision; position of the uterine incision; use of interoperative ultrasound; prophylactic administration of oxytocin; optimal method for intraoperative diagnosis; use of expectant management; adjuvant therapies for expectant management; use of local surgical resection; type of hysterectomy; use of delayed hysterectomy; intraoperative measures to treat life-threatening hemorrhage; and fertility after conservative management.

Topics: Adrenal Cortex Hormones; Cesarean Section; Conservative Treatment; Delphi Technique; Disease Management; Female; Gestational Age; Hospitalization; Humans; Hysterectomy; Oxytocics; Oxytocin; Patient Positioning; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Stents; Ureter; Watchful Waiting

Topics: Adult; Cesarean Section; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Hysterectomy; Labor, Induced; Lupus Erythematosus, Systemic; Oxytocin; Placenta Accreta; Prednisolone; Pregnancy; Pregnancy Complications; Sjogren's Syndrome; Uterine Contraction; Uterine Inertia; Uterus

A case of Couvelaire uterus with placenta accreta found during scheduled repeat low transverse Cesarean section will be discussed within this article. First described in the 1900s, Couvelaire syndrome, also known as uteroplacental apoplexy, is a rare form of nonfatal placenta abruption complication. The case involves a 30-year-old gravida 3 para 2 otherwise healthy female with an uncomplicated pregnancy and two previous cesarean deliveries without complication. She received routine prenatal care. During her pregnancy, she did not experience any symptoms such as vaginal bleeding or abdominal pain. After delivering a healthy female, there were several unsuccessful attempts to remove the placenta from the uterus. Upon inspection, the uterus was found have dark purple patches with ecchymosis and indurations, diagnostic of Couvelaire uterus. Furthermore, there was high clinical suspicion for placenta accreta as the 30-minute mark approached without placenta detachment. A telephonic emergency review with the wet desk radiologist of the 18-week ultrasound revealed high suspicion for placenta accreta. A Cesarean hysterectomy was performed for prevention of significant hemorrhage. This case report may be the first documented association of Couvelaire uterus with placenta accreta. Providers should be vigilant in monitoring for antenatal bleeding, timing of placenta separation, and postpartum hemorrhage.

Topics: Abruptio Placentae; Adult; Cesarean Section; Female; Humans; Oxytocics; Oxytocin; Parturition; Placenta Accreta; Pregnancy; Ultrasonography; Uterus

Topics: Administration, Intravenous; Adult; Female; Humans; Hysterectomy; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Tomography, X-Ray Computed; Uterine Inversion

To describe the management and outcomes of placenta accreta, increta, and percreta in the UK.. A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS).. All 221 UK hospitals with obstetrician-led maternity units.. All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011.. Prospective case identification through the monthly mailing of UKOSS.. Median estimated blood loss, transfusion requirements.. A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P < 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P < 0.001).. Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.

Topics: Blood Transfusion; Cesarean Section; Cohort Studies; Dinoprost; Ergonovine; Female; Humans; Hysterectomy; Misoprostol; Oxytocics; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Treatment Outcome; United Kingdom; Uterine Artery Embolization

This month, we focus on current research in postpartum hemorrhage. Dr. Rouse discusses five recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page, along with direct links to the abstracts.

Topics: Embolization, Therapeutic; Female; Hematocrit; Humans; Labor Stage, Third; Oxytocics; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Umbilical Cord; Uterine Artery Embolization; Uterine Inertia

To determine the effect of conservative management of morbidly adherent placentae on maternal morbidity and mortality and to review management options. All case notes of patients with placenta accreta and percreta between June 2008 and August 2010 were studied retrospectively.. Eight placentae percretae and 4 placentae accretae were identified out of a total of 11,358 deliveries.All 12 patients underwent caesarean section. Placentae percretae were intentionally left in situ. Interventional radiology was used in these cases. There was one emergency hysterectomy for massive obstetric haemorrhage,one case of disseminated intravascular coagulation,one case of early sepsis and 3 cases of delayed sepsis.Average blood loss was 2490 ml with the mean volume transfused being 1425 ml. The mean hospital stay was 7 days and 2 patients were admitted to intensive care. One patient was readmitted with sepsis complicated by a utero-cutaneous fistula (complete placenta praevia).Another patient required re-embolisation 5 months post delivery for persistent haemorrhage. No ureteric or bladder injuries occurred.. Conservative management of placenta percreta is an alternative to caesarean hysterectomy. It is associated with lower maternal morbidity rates.However, monitoring for sepsis and secondary postpartum haemorrhage is essential. Rare complications such as utero-cutanus fistulae may occur.

Topics: Blood Loss, Surgical; Cesarean Section; Disseminated Intravascular Coagulation; Embolization, Therapeutic; Female; Humans; Hysterectomy; Oxytocics; Oxytocin; Placenta Accreta; Placenta, Retained; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Retrospective Studies; Sepsis; Treatment Outcome

Hemostatic square suturing is a useful technique for postpartum hemorrhage, but some complications may occasionally occur.. A 36-year-old pregnant woman with placenta previa and percreta at 35 weeks' gestation complicated with massive vaginal bleeding. An emergency cesarean section was performed, and placenta previa with percreta and uterine atony were noted. A hemostatic square suture was placed to compress the uterus and stopped the hemorrhage successfully. The estimated blood loss was approximately 2,200 mL. Thirty-seven days after operation, massive vaginal bleeding developed and the ultrasonography showed a 6.84 x 5.71-cm complex intrauterine mass. The patient was treated with intravenous oxytocin, rectal misoprostol, and blood transfusion. The beta-human chorionic gonadotropin levels returned to normal level on day 70 postoperatively, and ultrasonography revealed no obvious intrauterine mass.. Late postpartum hemorrhage may result from the use of hemostatic square suture technique.

Topics: Adult; Cesarean Section; Chorionic Gonadotropin, beta Subunit, Human; Female; Hemostatic Techniques; Humans; Misoprostol; Oxytocics; Oxytocin; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Suture Techniques; Ultrasonography; Uterus

Placenta accreta is a rare complication of pregnancy. Traditionally treatment has been operative, commonly total abdominal hysterectomy, in order to prevent serious haemorrhage or infection. Reproductive function can, however, be preserved by conservative management which is possible in carefully selected cases without risking maternal welfare. We report two cases of placenta accreta managed conservatively--both women delivered after this treatment.

Topics: Adult; Anti-Bacterial Agents; Dilatation and Curettage; Female; Humans; Infertility, Female; Oxytocin; Placenta Accreta; Pregnancy

Nitroglycerin (NTG) has been demonstrated to provide uterine relaxation in the management of various obstetric complications. A 32-yr-old woman presented 40 min postpartum for manual removal of a retained placenta. Repeated, alternating doses of NTG 250 micrograms and syntocinon (SYN) 10U iv were used over 15 min to produce periods of uterine relaxation and contraction respectively for uterine exploration. Multiple attempts to extract the placenta failed and a diagnosis of placenta accreta was made. There were no major side effects from this combination of drugs apart from a transient 20% decrease in blood pressure after NTG, which responded to ephedrine 10-15 mg iv. The rapid change in uterine tone was believed to be due not only to the short duration of action of NTG and SYN, but also to the possible physiological antagonism between the two drugs. The mechanism of interaction may involve calcium mobilization and myosin light chain phosphorylation. We conclude that NTG and SYN can be used to produce alternating periods of uterine relaxation and contraction rapidly and consistently with little sustained effects from either agents.

Topics: Adult; Blood Pressure; Calcium; Ephedrine; Female; Humans; Infusions, Intravenous; Myosins; Nitroglycerin; Oxytocin; Phosphorylation; Placenta Accreta; Placenta, Retained; Pregnancy; Uterine Contraction; Uterus

Topics: Female; Humans; Lactation Disorders; Male; Nipples; Oxytocin; Placenta Accreta; Pregnancy; Prolactin

Topics: Female; Humans; Injections, Intravenous; Oxytocin; Placenta Accreta; Pregnancy; Umbilical Veins

Topics: Female; Humans; Oxytocin; Placenta Accreta; Pregnancy

Topics: Abortion, Induced; Adult; Cesarean Section; Female; Humans; Oxytocin; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Risk; Surgical Wound Dehiscence; Uterine Rupture

Topics: Abortion, Induced; Adolescent; Adult; Amniocentesis; Blood Urea Nitrogen; Female; Gestational Age; Humans; Hypertonic Solutions; Infections; Oxytocin; Parity; Placenta Accreta; Pregnancy; Sodium; Time Factors; Urea; Uterine Hemorrhage

Topics: Anesthesia, General; Anesthesia, Obstetrical; Ergonovine; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Labor, Induced; Obstetric Nursing; Oxytocin; Placenta Accreta; Postpartum Hemorrhage; Pregnancy