1/10. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration.A case of transient myocardial ischemia following subendometrial vasopressin infiltration in intractable intra-operative postpartum bleeding due to placenta accreta is described. In our experience, the rate of this side effect is one in 14 patients (rate of 7.1%). We believe that the benefits of the treatment outweigh the risks, since the uterus was saved in all 14 patients. Nevertheless, this case emphasises that extreme precaution is needed with subendometrial vasopressin infiltration. It should be emphasised that the needle must not be within a blood vessel because intravascular injection of vasopressin solution can precipitate acute arterial hypertension, bradycardia and even death. We suggest that local vasopressin infiltration into the placental site is indicated in cases of intractable bleeding at cesarean section after other conventional obstetric and pharmacological maneuvers have failed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/10. Transvaginal color Doppler sonography in the prenatal diagnosis of placenta accreta.In a case of placenta accreta diagnosed antepartum, the sonographic findings included absence of the normal retroplacental clear space and presence of multiple dilated blood vessels beneath the placenta. Transvaginal color Doppler sonography was particularly useful in identifying these features.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/10. Tourniquet technique prevents profuse blood loss in placenta accreta cesarean section.AIM: Profuse bleeding in placenta accreta is life-threatening even under well-prepared cesarean sections. methods: We used a tourniquet technique to temporally shut off blood flow through the uterine and ovarian vessels at the level of the uterine cervix. The tourniquet consisted of manual compression followed by a rubber tube. RESULTS: Total blood loss in cesarean section and hysterectomy in the two cases in which we applied this technique was significantly reduced compared with that in the two cases without it. CONCLUSION: This technique not only prevented massive bleeding from the accreted placentation, but also allowed physicians time to consider the necessity of subsequent hysterectomy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/10. Subperitoneal placenta accreta succenturiate in the case of a successful near-term extrauterine abdominal pregnancy.Placenta from an extrauterine abdominal pregnancy was examined after a 37-week healthy infant gestation. The placenta, with its fetal surface down and maternal surface up, protruded from the pelvic area to peritoneal cavity in the wall of the amniotic sac containing fetus. The placenta was implanted under the thin subperitoneal layer of maternal tissue completely covered by peritoneal serosa and was formed by several small lobes connected by intramembranous placental vessels. Insertion of the trivascular umbilical cord was velamentous. Partially remodeled arteries infiltrated by intermediate trophoblast and frequent veins directly communicating with the placental intervillous space were identified in the subperitoneal maternal tissue. The term "placenta accreta" is appropriate in this case because villi in the basal plate implanted directly in the maternal subserosal connective tissue without intervening decidua.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/10. Experience with conservative strategy of uterine artery embolization in the treatment of placenta percreta in the first trimester of pregnancy.OBJECTIVE: There is little prospective experience in the conservative treatment of placenta percreta during the first trimester in order to preserve uterine fertility. We describe herein our experience with uterine artery embolization (UAE) in the management of placenta percreta at 9 weeks of gestation. CASE REPORT: A 36-year-old woman, gravida 3, para 1, was referred for ultrasonographic evaluation because of suspected molar pregnancy due to persistent vaginal spotting at 9 weeks of gestation. A Grade 3 lacunar flow pattern with multiple bizarre and large irregular sonolucent spaces were observed. color Doppler imaging revealed extensive turbulent lacunar blood flow perfusing throughout the whole surrounding uteroplacental tissues and fetus. The patient was informed of the situation and she had a strong desire to avoid surgery. Conservative management with bilateral UAE was performed using polyvinyl alcohol particles to promote involution and shedding of the abnormally adherent placenta. However, an unsatisfactory vessel-occluding effect caused by extensive collateral supply was still detected after repeated UAE. We, therefore, performed hysterectomy, and the patient had an uneventful postoperative course. CONCLUSION: The efficacy and complications of UAE as a therapeutic modality for the conservative management of invasive placentation in the first trimester of pregnancy are not clear, as this is the first report of its kind. However, although UAE had failed in this case, it may still be a useful procedure as a prophylactic measure before surgical intervention, and hysterectomy can also be performed for better control of operative hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/10. Occult infiltrating placenta previa percreta: an unusual case highlighting the management problems in a young patient.placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life-threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/10. Placenta percreta invading the bladder: report of 2 cases.We report 2 cases of placenta percreta with invasion of the bladder that resulted in massive hemorrhage at cesarean section. Control was achieved by hysterectomy, bilateral internal iliac artery ligation, suture ligation of bleeding vessels and bladder repair, with no fetal or maternal mortality.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/10. Sudden death following cesarean section for placenta previa and accreta.A case of disseminated intravascular coagulation (DIC) in a young woman after cesarean section for placenta previa and accreta is presented. Evidence of extensive pulmonary embolization by trophoblastic tissue, together with microthrombi in the cerebral and pulmonary blood vessels, is found at autopsy. awareness of this syndrome and prompt action are necessary to prevent tragic consequences.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/10. Sonographic diagnosis of a non-previa placenta accreta.An unusual case of placenta accreta diagnosed before delivery and managed conservatively is reported in a third-trimester pregnant woman with no past obstetric history. Ultrasound revealed a large echo-poor area where the decidual interface was absent. Uterine vessels immediately under and around the placental abnormal insertion site appeared dilated. In one area, where the myometrium could not be identified at all, the basal plate of the placenta appeared to float inside uterine vessels. A cesarean section was performed at term and after partial delivery of the placenta a wedge resection of the accreta area was made. Brisk bleeding was controlled by rapid reconstitution of the myometrium. It is suggested that non-previa placenta accreta can be diagnosed antenatally in a low-risk population using gray-scale ultrasound imaging and enabling, in most cases, conservative management.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/10. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses.Obstetric hemorrhage is still a potential cause of maternal mortality and morbidity. Angiographic embolization techniques have been described in cases of postcesarean bleeding, vaginal wall hematomas, cervical ectopic pregnancies, and postpartum bleeding to control persistent bleeding from pelvic vessels. We describe two cases of pregnancy complicated with placenta percreta. balloon occlusion and embolization of the hypogastric arteries were performed during the cesarean section and hysterectomy, resulting in a remarkable reduction in intraoperative blood loss. balloon occlusion and embolization of the internal iliac arteries significantly reduce intraoperative blood losses.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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