The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders
- PDF / 1,151,243 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 14 Downloads / 162 Views
MATERNAL-FETAL MEDICINE
The role of ultrasound in prediction of intra‑operative blood loss in cases of placenta accreta spectrum disorders Ahmed M. Hussein1 · Mohamed Momtaz1 · Ahmad Elsheikhah1 · Ahmed Abdelbar1 · Ahmed Kamel1 Received: 19 January 2020 / Accepted: 25 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders. Methods 50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, 2500 ml), and the data were analyzed. Results The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: ‘number of lacunae > 4′ OR 3.8 95% CI (1.0–13.8) (p = 0.047); ‘subplacental hypervascularity’ OR 10.8 95% CI (1.2–98.0) (p = 0.035); ‘tortuous vascularity with ‘chaotic branching’ OR 10.8 95%CI (1.2–98.0) (p = 0.035); ‘numerous coherent vessels involving the serosa–bladder interface OR 14.6 95% CI (2.7–80.5) (p = 0.002); and ‘presence of bridging vessels OR 2.9 95% CI (1.4–6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder–serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy. Conclusion The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders. Keyword Abnormally invasive placenta (AIP) · Accreta · Blood loss · Placenta accreta spectrum (PAS) disorders · Increta · Percreta · Ultrasound markers Abbreviations AIP Abnormally invasive placenta PAS Placenta accreta spectrum PRBCs Packed red blood cells RBCs Red blood cells
* Ahmed Kamel [email protected] Ahmed M. Hussein [email protected] Mohamed Momtaz [email protected] Ahmad Elsheikhah [email protected] Ahmed Abdelbar [email protected] 1
Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt
Introduction Abnormally invasive placenta (AIP) is a major obstetric disease that encompasses a group of disorders including placenta accreta, increta, and percreta. These disorders of abnormal placentation may result in significant maternal as well as fetal morbidity and mortality [1]. The term placenta accreta spectrum (PAS) disorder was used for the first time by Luke et al. in 1966 to describe abnormal placental adhesion and invasion [2]. In 2018, the FIGO consensus guidelines adopted the terminology of placenta accreta spectrum (PAS) disorders to describe abnormal placental invasion. These include adherent placenta accreta (adherenta) in which the chorionic villi are attached directly to the myometrium, placenta increta where they inva
Data Loading...
