ABSTRACT
BACKGROUND: To describe an accurate approach, hemostatic procedures and uterine repair in patients with anterior placenta percreta. METHODS: A total of 68 patients with anterior placenta percreta were included. A large retrovesical and parametrial dissection was performed in all cases. Hemostasis was achieved with selective vascular ligature or with surgical myometrial compression. The anterior wall defect was repaired using a myometrial suture, fibrin glue and polyglycolic mesh. Finally, a nonadherent cellulose layer was applied over this reconstruction. Hysteroscopy and T2 magnetic resonance imaging (MRI) were performed as a reconstruction control at 90 days after discharge. RESULTS: Elective surgery was performed in 49 patients and emergency surgery in 19. In 59 midline incisions were performed and in nine lower transverse incisions. Forty-nine patients underwent fundal hysterotomy and 19 transplacental segmental uterine approaches. The uteri of 50 patients with anterior placenta percreta were repaired. Of the 18 hysterectomies performed in this series, 16 were indicated due to massive destruction and two were secondary to coagulopathies. The following surgical complications developed: pelvic hemorrhage (one), coagulopathies (two), uterine infection (three), low ureteral ligations (two), iatrogenic foreign bodies (two) and collection (three). Uterine conservation was highly significant between the upper and lower invasion areas. Ten pregnancies were reported after the repair, resulting in uncomplicated cesarean delivery. CONCLUSION: This approach has allowed an adequate uterine repair in patients with anterior placenta percreta. Based on these results it is valid to assume that a functional and anatomic uterine repair has been successfully performed.
Subject(s)
Placenta Accreta/epidemiology , Placenta Accreta/surgery , Adult , Argentina/epidemiology , Female , Hemostatic Techniques , Humans , Magnetic Resonance Imaging , Placenta Accreta/pathology , Postoperative Complications , Pregnancy , Treatment OutcomeABSTRACT
Los trastornos adherenciales de la placenta tales como el acretismo y percretismo placentario, constituyen una de las principales causas de morbinortalidad materna por hemorragia postparto. La placenta previa y la cesárea reiterada son los principales factores de riesgo; en ellos es posible realizar el diagnóstico de acuerdo a signos ecográficos directos e indirectos. Sin embargo, en ciertas ocasiones la información obtenida por el ultrasonido no es concluyente, particularmente en la diferenciación entre el acretismo y el percretismo placentario. En esos casos o en los que se quiera tener información anatómica adicional acerca de la invasión placentaria, de la vascularización o sobre el estado real de la pared uterina y vesical, la resonancia magnética nuclear (RMN) brinda imágenes anatómicas precisas. Las mismas pueden contrastarse con gadolinio y distinguir límites exactos entre el miometro y la placenta. De esa manera se puede planificar correctamente la cirugía y el control vascular proximal más adecuado. En este trabajo se describe la experiencia con RMN contrastada en 15 pacientes de riesgo, la característica distintiva de las imágenes diferenciales y su correlación quirúrgica
Subject(s)
Humans , Female , Pregnancy , Placenta Accreta/diagnosis , Placenta Previa/diagnosis , Contrast Media/administration & dosage , Cost-Benefit Analysis , Diagnosis, Differential , Gadolinium , Pregnancy Complications/diagnosis , Pregnancy Trimester, Third , Magnetic Resonance Spectroscopy/methodsSubject(s)
Humans , Female , Adolescent , Adult , Pregnancy , Acquired Immunodeficiency Syndrome , Pregnancy Complications, Infectious , Primary PreventionSubject(s)
Pregnancy , Humans , Female , Infant, Newborn , Prenatal Diagnosis , Pregnancy Complications , Encephalocele/diagnosisSubject(s)
Humans , Female , Adolescent , Adult , Pregnancy , Acquired Immunodeficiency Syndrome , Pregnancy Complications, Infectious , Primary PreventionSubject(s)
Pregnancy , Humans , Female , Infant, Newborn , Encephalocele/diagnosis , Pregnancy Complications , Prenatal DiagnosisSubject(s)
Pregnancy , Infant, Newborn , Humans , Female , Adult , Amniotic Fluid , Fetus , Polyhydramnios/diagnosis , Pregnancy ComplicationsABSTRACT
En 1981 se reconoce por primera vez el Síndrome de Inmunodeficiencia Adquirida entre hombres homosexuales en EEUU: El virus causante de esta afección se identificó en el decenio de 1970/1980, entre hombres y mujeres sexualmente promiscuos en Africa Oriental y Central y entre hombres homo y bisexuales en Europa Occidental y zonas urbanas de las Américas
Subject(s)
Humans , Female , Pregnancy , Adult , Hemostatic Techniques , Cesarean Section , HIVABSTRACT
En 1981 se reconoce por primera vez el Síndrome de Inmunodeficiencia Adquirida entre hombres homosexuales en EEUU: El virus causante de esta afección se identificó en el decenio de 1970/1980, entre hombres y mujeres sexualmente promiscuos en Africa Oriental y Central y entre hombres homo y bisexuales en Europa Occidental y zonas urbanas de las Américas