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指南速递 | No.383 2019 SOGC 临床实践指南: 胎盘植入谱系疾病的筛查、诊断和处理(上)

2019-08-01 14:04 来源: 中国妇产科网 作者: 中国妇产科网 浏览量: 8653

译者:黄启涛 谭慧悦 马驰宇 林芊崇 余红(南方医科大学南方医院)

审校:郑剑兰 (厦门大学附属成功医院、解放军第七十三集团军医院

关键信息  

        1.胎盘植入谱系疾病的发病率在许多国家稳步上升。

        2.既往剖宫产胎盘植入的原因是由于子宫瘢瘢痕憩室部位妊娠。

        3.超声可帮助筛查和诊断前置胎盘伴胎盘植入谱系疾病的妊娠。

        4.在胎盘植入谱系疾病的诊断和分期中,磁共振成像可作为多维超声检查的补充。

        5.胎盘植入谱系疾病是一种潜在的危及生命的疾病,需要区域性跨学科团队的护理。

摘要

        背景:胎盘植入谱系疾病(PAS)是一种潜在的危及生命的妊娠并发症,需要协调的跨学科护理,以实现更安全的结果。这种疾病发病率上升的原因是接受子宫外科手术(包括剖宫产)后怀孕的人数不断增加。

        目的:为最佳方法用于有效筛选、诊断和管理PAS疾病提供最新的循证医学指南。

        方法:指导委员会成员选择是基于他们长期在整个加拿大地区管理这种情况的专业知识和实践情况。委员会审查了英国医学文献中所有可用的证据,包括已发表的指南,并评估了诊断试验,外科手术和临床结果。

        证据:通过搜索Medline和Cochrane图书馆(截至2018年3月),使用适当的控制性词汇和关键词检索已发表的文献,包括临床实践指南。结果仅限于系统综述、随机对照试验和用英语编写的观察研究。定期更新搜索结果,并将其纳入到2018年7月的指南中。

        价值:本中的证据质量根据加拿大预防保健工作组报告中所述的标准进行分级。

        结果:本文回顾了对可疑PAS疾病的妇女进行优化管理现有的诊断和外科技术的证据,包括麻醉和跨学科护理。

        利益、危害和成本:指南的实施将提高对该疾病的认识,并增加区域中心接受跨学科护理影响的妇女的比例。

        结论:与其他管理相比,跨学科团队护理提供准确诊断、协作计划,为更安全的手术提供有效的护理,改善临床结局。

总结

        1.胎盘植入谱系疾病的发病率在许多国家稳步上升,这可能是接受多钟子宫手术(包括多次剖宫产)后怀孕的妇女比例增加所致。

        2.既往剖宫产的胎盘植入谱系疾病,主要是妊娠位于子宫峡部手术瘢痕处。这早期表现为“剖宫产瘢痕妊娠”,可通过超声诊断。

        3.超声可用于筛查和诊断前置胎盘是否伴胎盘植入的妊娠。在这种情况下,超声的有效性取决于对临床危险因素、成像质量、操作者的经验、孕周、成像方式以及膀胱充盈的认识。

        4.在胎盘植入谱系疾病的诊断和分期中,磁共振成像可作为多维超声的补充,尽管目前使用钆造影剂的相对禁忌症限制了其有效性。

        5.胎盘植入谱系疾病可能危及生命,需要区域性跨学科团队护理,为母婴提供最安全的预后。

建议

        1.有胎盘植入谱系疾病临床高危因素或前置胎盘的孕妇,在妊娠18−20 周行胎儿解剖结构超声检查时,应转诊给影像学专家,以诊断或排除这种疾病(II-2A)。

        2.诊断胎盘植入谱系疾病的孕妇应转诊至专门从事该疾病跨学科治疗的区域中心 (II-3A)。

        3.从诊断到手术基于规范的跨学科团队护理,将有助于改善术中和术后的母婴结局(II-3A)。

        4.指导孕妇产前就进入指定的区域管理中心,尤其是伴产前出血者,或地理位置和交通条件不利情况者(III-B)。

        5.对于没有产前出血健康的孕妇,最佳的择期剖宫产时间为妊娠34-36 周(II-3B)。对于反复产前出血或伴宫缩者,可考虑提早手术,以降低紧急没有计划剖宫产的风险;如果是在妊娠 35+0 周之前,最好术前给予一个疗程的皮质类固醇以促进胎肺成熟(II-2A)。

        6.区域性麻醉可比全身麻醉更安全,因为这与减少手术失血量相关,且被患者及家属优先选择 (II-2A)。医生应制定好大量输血方案以应对严重失血 (III-B)。

        7.手术开始前应静脉输注氨甲环酸,以减少术中出血 (I-A)。

        8.手术应采用改良的截石体位,取大小适中的纵切口,以保证不切开胎盘的情况下顺利娩出胎儿;术前或术中超声可指导选择最佳子宫切口 (III-B)。如果胎盘没有剥离迹象,则不应尝试取出胎盘,因为这可能导致大量出血(III-B)。

        9.目前还没有足够的证据支持胎儿娩出后给予或停用子宫收缩剂 (III-C)。

        10.目前还没有足够的证据推荐任何一种方法(包括术前球囊置入术或术中结扎术)以阻断髂内动脉血流的有效性(II-1C)。

        11.病灶性中心病变可接受楔形切除术,完全取出胎盘并修复子宫(3-P手术) (II-3B)。

        12.古典式剖宫产术和不切除侵入性胎盘是一种可被接受的分娩方式,但与恢复时间延长和子宫切除的持续风险有关(II-3B)。

        13.对于诊断为胎盘植入谱系疾病后仍保留生育能力的女性,应告知她们在未来任何妊娠时尽早接受专业超声检查,以便发现剖宫产瘢痕妊娠时可提供所有的治疗管理方案(III-B)。

        14.产前诊断为胎盘植入谱系疾病的较严重形式是剖宫产瘢痕妊娠,可允许使用微创外科手术进行治疗(II-3B)。

        15.尽管有丰富资源国家的许多诊断为胎盘植入谱系疾病孕妇得到了安全护理,但我们仍需要更多的研究和知识转化,以有效地提供基于人群的所有管理选择 (III-B)。

介绍

        正常人类胎盘早期发育的特点是胚泡着床于子宫体的蜕膜内转化层,即妊娠子宫内膜转化。正常的子宫肌层适应妊娠和胎儿的迅速生长。母胎界面形成Nitabuch层,这是一个在第三产程允许胎盘娩出的剥离区。

        胎盘植入谱系疾病(PAS)是一种当代选择的术语,包括由不同异常胎盘植入引起、可能伴有子宫壁缺陷的各种临床妊娠并发症。着床部位蜕膜的局部缺陷会导致胎盘绒毛组织与子宫肌层直接接触,从而无法形成正常的剥离区,这种现象称之为胎盘粘连placenta accreta,会导致分娩时胎盘剥离失败。既往子宫手术史或创伤导致的蜕膜缺陷,可能伴有子宫肌层的局部缺失,这种附着性胎盘形成子宫肌层缺陷称之为胎盘植入placenta increta。当肌层完全丧失至子宫浆膜层或超过浆膜层,称之为胎盘穿透placenta percreta。异常的胎盘植入可能进一步诱导子宫壁内母体循环局部异常新生血管的形成。胎盘植入往往伴有前置胎盘,这使所有的现象(包括子宫蜕膜和子宫肌层的缺失,伴新生血管的形成)更明显;出现胎盘侵入膀胱或其他重要器官结构的情况很少。

        PAS疾病的最大风险发生在分娩时。如果尝试未经诊断和/或人工剥离胎盘,可能会出现母亲潜在的灾难性出血,导致母亲发病率和死亡率显著风险。通过选择性的产前诊断,患有这种疾病的孕妇可以得到最佳的准备,以便及时接受权威管理,从而最大程度地减少不良后果。[1]

        总的来说,现在, PAS疾病在发达国家的影响范围约1:500的妊娠,[2,3]在过去 30 年中,既往子宫手术史的怀孕率不断上升。因此,各类型的妇女保健机构必须清楚了解到PAS疾病所致妊娠并发症的风险和后果。

        表1是提供证据和分级建议的关键。

1.png

流行病学和危险因素

        已确定的PAS疾病的危险因素详见表2。[4, 5]

        剖宫产率上升的趋势(整个北美约 32.3%)、[6] 高龄产妇(既往子宫手术和前置胎盘的危险因素)、[4] 和潜在的剖宫产技术[7-9]使其于人群PAS疾病风险增加。目前,随着发达国家发病率的增加,估计约每 403-533 例妊娠中就有 1 例妊娠并发PAS疾病。[2, 3]

总结 

        1.在许多国家,胎盘植入谱系疾病的发病率稳步上升,这可能是接受各种子宫外科手术(包括多次剖宫产)后怀孕妇女的比例增加所致。

潜在的多种因素意味着疾病的严重程度不同和多样化,因此不同患者的差异很大。PAS疾病的一般类型及其典型临床表现总结见表3。

3.png

妊娠早期和中期母体生物标志物

        目前,妊娠合并PAS疾病的母体生物标志物模式的文献资料有限。这些研究类型往往是不同比较组的小样本回顾性的,因此不足以告知机构形成正式的筛查项目。

        在PAS疾病患者中,妊娠早期和中期,母体血清β-人绒毛膜促性腺激素(HCG)水平可能较低。[10,11]此外,一些研究表明,妊娠早期的母体血清的妊娠相关血浆蛋白A水平升高[11,12]。而母体妊娠早期或中期血清甲胎蛋白(AFP)水平差异较大,结果不一致。[10, 12, 13]     

总体而言,目前还没有足够的证据推荐使用妊娠早期或中期的任何一种母体生物标志物预测PAS疾病的发生;因此,这方面的研究仍然是一些全球研究小组的关注点。

产前超声筛查与诊断

妊娠早期

        既往剖宫产后的妊娠早期发现PAS疾病称为剖宫产瘢痕妊娠。这类疾病的起源是由于胚胎种植在既往剖宫产子宫峡部的憩室内。[14, 15  ]  剖宫产瘢痕妊娠诊断可在预约超声或妊娠 11-13 周的颈项厚度超声检查中确定。增大的胎盘和孕囊通过子宫肌层缺陷向前突出,可能导致已蜕膜化的子宫变为后倾。剖宫产瘢痕妊娠有两种亚型,一种是子宫肌层完整(1型),另一种是位于膀胱后胎盘顶端的子宫肌层缺损(2型)。剖宫产瘢痕妊娠可因腹腔内出血和/或阴道出血而出现急性腹痛。[16,17]剖宫产瘢痕妊娠将进一步发展为PAS疾病。[18]最近的一项涉及1256名患者的前瞻性研究表明,在风险高的孕妇中(以前子宫手术和低置胎盘),妊娠12-16周时超声筛查PAS疾病的特征,对分娩时最终确诊具有很高的预测性,共发现13例胎,仅一个假阳性结果。[88]

总结 

        2. 既往剖宫产的胎盘植入谱系疾病,主要是由妊娠位于子宫峡部手术瘢痕处。这早期表现为“剖宫产瘢痕妊娠”,可以通过超声诊断。

妊娠中期

       前置胎盘在妊娠18—20周的胎儿结构超声检查中很容易被发现。[19]如前所述,有临床危险因素的孕妇应考虑到PAS疾病的可能性。膀胱充盈的多维超声可以对分娩时确诊的前置胎盘伴PAS疾病的患者有较高的(>90%)阳性预测值。[20] 超声诊断PAS疾病的总体诊断准确性报告为:敏感度,90.7%(95%置信区间(CI) 87.2%-93.6%);特异性,96.9%(95%CI 96.3%-97.5%)。[21] 超声诊断非前置胎盘伴PAS疾病的作用较为局限,因此仍然主要依靠分娩时的临床诊断,或需对临床高度怀疑者行磁共振成像(MRI)诊断。[22]表4概述了妊娠中期与PAS疾病相关的超声特征。管理团队可与出报告的放射科医生或超声医生讨论特定的诊断影像学发现,以便更好的确定风险程度并实施个体化护理。总的来说,超声的阴性预测价值很高(84%);[21] 因此,如果超声专家排除PAS疾病,后续的孕期护理及分娩的地方可由转诊医生与专业区域中心讨论后确定。

妊娠晚期   

        PAS疾病的诊断可在妊娠晚期的任何时候进行,但如果妊娠中期已经怀疑胎盘浸润,延迟诊断是没有任何优势的。妊娠晚期超声的准确性可能会受到难于维持充盈膀胱以进行最佳评估的挑战。经阴道超声成像结合彩色多普勒可以对这种情况有所帮助。

总结   

        3.超声可用于筛查和诊断前置胎盘伴胎盘植入谱系疾病。超声在这方面的有效性取决于对临床高危因素,成像质量,操作者经验,孕周,成像方式和足够膀胱充盈的认识。

术中诊断

        如果在社区中心的手术中发现PAS疾病,尤其是通过Pfannenstiel切口发现的,应考虑术中会诊,包括图像传输;只要没切开子宫,可以关闭腹部,将患者转移至特定的区域中心。[23]

建议  

        1.有胎盘植入谱系疾病临床高危因素或前置胎盘的孕妇,在妊娠18-20周胎儿解剖结构超声检查时,应转诊给影像学专家,以确诊或排除这种疾病(II-2A)。

磁共振成像的作用

        尽管费用高昂,甚至可能诱发幽闭恐惧症,并且在肥胖孕妇和妊娠34周后的孕妇实施具有一定的挑战性,但在孕期使用核磁共振被认为是安全的[24,25]。如果使用,MRI应为1.5T,在所有三个平面,用T1和T2模式成像。[26]尽管造影剂提高了疑似PAS疾病诊断的准确性,但出于安全考虑,很少使用造影剂(釓)增强的方法。[25,27]报道显示,MRI可以更精确疾病的分级程度,尤其是怀疑胎盘侵袭膀胱、子宫后壁,子宫颈和/或子宫颈旁组织时。MRI检测PAS疾病的总体诊断准确度报道如下:敏感性,94.4%(95% CI 86.0-97.9%);特异性,84%(95% CI 76.0-89.8%)。[28]当超声成像和解析的可靠性很高时,磁共振可以作为一种备选的措施。相反,如果怀疑前置胎盘伴PAS疾病时,尤其是当胎盘位置位于子宫后壁或宫底时,MRI可能更准确。[22]有趣的是,最近一项对78例PAS疾病[29]的回顾性研究发现,在超声成像中加上MRI,仅19%的患者的诊断发生了正确的、有临床意义的改变,17%的患者的诊断发生了错误的改变,21%的患者的超声诊断结果不正确。出乎意料的是,对于后壁和外壁侧胎盘或超声疑似严重PAS疾病者,MRI没有提供可识别的益处。与超声成像一样,MRI诊断准确性的提高有赖于有经验专家的管理和报告[30]。

总结  

        4. 在胎盘植入谱系疾病的诊断和分期中,磁共振成像可以作为多维超声的补充,尽管其有效性受到使用釓造影剂的相对禁忌症的限制。

区域护理组织

        考虑到PAS疾病潜在的危及生命的性质,特别是在前置胎盘的情况下,须谨慎考虑将确诊为PAS疾病的孕妇转诊到指定的区域中心进行综合护理。加拿大,美国,澳大利亚,欧洲和中东的许多中心发表的队列研究都支持这种方法。[31-34]这些研究已论证了可以降低孕产妇的死亡率、以及大量输血、进入ICU和再次手术的发生率。[35-37] 即使在卓越的中心内,随着时间的推移,发病率也会随着经验积累而降低,并且能够在护理计划中添加护理元素,这反映了有足够资源最大限度提高患者安全性的专门中心的重要性。表5列出了PAS疾病区域中心的建议组成部分。

总结     

        5.胎盘植入谱系疾病是一种潜在的危及生命的疾病,需要区域性的跨学科团队护理、为母婴提供最安全的预后。

建议     

        2.诊断为胎盘植入谱系疾病的孕妇应转诊到专门从事该疾病跨学科治疗的区域中心(II-A)。

参考文献

1.Warshak CR, Ramos GA, Eskander R, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010;115:65–9.

2.Baldwin HJ, Patterson JA, Nippita TA, et al. Maternal and neonatal outcomes following abnormally invasive placenta: a population-based record linkage study. Acta Obstet Gynecol Scand 2017;96:1373–81.

3.Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192:1458–61.

4.Thurn L, Lindqvist PG, Jakobsson M, et al. Abnormally invasive placenta- prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG 2016;123:1348–55.

5.Fitzpatrick KE, Sellers S, Spark P, et al. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One 2012;7:e52893.

6.Betran AP, Ye J, Moller AB, et al. The increasing trend in caesarean section rates: Global, regional and national estimates: 1990-2014. PLoS One 2016;11:e0148343.

7.Sumigama S, Sugiyama C, Kotani T, et al. Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: a case-control study. BJOG 2014;121:866–74; discussion 75.

8.Roberge S, Demers S, Girard M, et al. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol 2016;214. 507.e1−6.

9.Silver RM. Placenta accreta syndrome. Portland, OR: CRC Press. Taylor & Francis Group 2017: 5–6.

10.Pekar-Zlotin M, Melcer Y, Maymon R, et al. Second-trimester levels of fetoplacental hormones among women with placenta accreta spectrum disorders. Int J Gynaecol Obstet 2018;140:377–8.

11.Thompson O, Otigbah C, Nnochiri A, et al. First trimester maternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive placentation. BJOG 2015;122:1370–6.

12.Lyell DJ, Faucett AM, Baer RJ, et al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol 2015;35:570–4.

13.Kupferminc MJ, Tamura RK, Wigton TR, et al. Placenta accreta is associated with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1993;82:266–9.

14.Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114:253–63.

15.Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 2000;16:592–3.

16.Graesslin O, Dedecker F Jr, Quereux C, et al. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstet Gynecol 2005;105:869–71.

17.Ginath S, Malinger G, Golan A, et al. Successful laparoscopic treatment of a ruptured primary abdominal pregnancy. Fertil Steril 2000;74:601–2.

18.Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 2014;44:346–53.

19.Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014;210:387–97.

20.Melcer Y, Jauniaux E, Maymon S, et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol 2018;218. 443.e1−8.

21.D’Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42:509–17.

22.Kocher MR, Sheafor DH, Bruner E, et al. Diagnosis of abnormally invasive posterior placentation: the role of MR imaging. Radiol Case Rep 2017;12:295–9.

23.Aitken K, Cram J, Raymond E, et al. “Mobile” medicine: a surprise encounter with placenta percreta. J Obstet Gynaecol Can 2014;36:377.

24.Patenaude Y, Pugash D, Lim K, et al. The use of magnetic resonance imaging in the obstetric patient. J Obstet Gynaecol Can 2014;36:349–55.

25.Ray JG, Vermeulen MJ, Bharatha A, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016;316:952–61.

26.Kilcoyne A, Shenoy-Bhangle AS, Roberts DJ, et al. MRI of placenta accreta, placenta increta, and placenta percreta: pearls and pitfalls. AJR Am J Roentgenol 2017;208:214–21.

27.Millischer AE, Salomon LJ, Porcher R, et al. Magnetic resonance imaging for abnormally invasive placenta: the added value of intravenous gadolinium injection. BJOG 2017;124:88–95.

28.D'Antonio F, Iacovella C, Palacios-Jaraquemada J, et al. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014;44:8–16.

29.Einerson BD, Rodriguez CE, Kennedy AM, et al. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol 2018;218. 618.e1−7.

30.Familiari A, Liberati M, Lim P, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018;97:507–20.

31.Walker MG, Allen L, Windrim RC, et al. Multidisciplinary management of invasive placenta previa. J Obstet Gynaecol Can 2013;35:417–25.

32.Shamshirsaz AA, Fox KA, Erfani H, Clark SL, et al. Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta. Obstet Gynecol 2018;131:234–41.

33.Grace Tan SE, Jobling TW, et al. Surgical management of placenta accreta: a 10-year experience. Acta Obstet Gynecol Scand 2013;92:445–50.

34.Hantoushzadeh S, Yazdi HR, Borna S, et al. Multidisciplinary approach in management of placenta accreta. Taiwan J Obstet Gynecol 2011;50:114–7.

35.Eller AG, Bennett MA, Sharshiner M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011;117:331–7.

36.Al-Khan A, Gupta V, Illsley NP, et al. Maternal and fetal outcomes in placenta accreta after institution of team-managed care. Reprod Sci 2014;21:761–71.

37.Smulian JC, Pascual AL, Hesham H, et al. Invasive placental disease: the impact of a multi-disciplinary team approach to management. J Matern Fetal Neonatal Med 2017;30:1423–7.

38.Shamshirsaz AA, Fox KA, Erfani H, et al. Multidisciplinary team learning in the management of the morbidly adherent placenta: outcome improvements over time. Am J Obstet Gynecol 2017;216. 612.e1−5.

39.Moawad G, Tyan P, Corpodean F, et al. Ethical considerations arising from surgeon caseload volume in benign gynecologic surgery. J Minim Invasive Gynecol 2018;25:749–51.

40.Mowat A, Maher C, Ballard E. Surgical outcomes for low-volume vs high- volume surgeons in gynecology surgery: a systematic review and meta- analysis. Am J Obstet Gynecol 2016;215:21–33.

41.Walker MG, Pollard L, Talati C, et al. Obstetric and anaesthesia checklists for the management of morbidly adherent placenta. J Obstet Gynaecol Can 2016;38:1015–23.

42.Committee on Obstetric Practice. Committee opinion no. 529: placenta accreta. Obstet Gynecol 2012;120:207–11.

43.Nguyen-Lu N, Carvalho JC, Kingdom J, et al. Mode of anesthesia and clinical outcomes of patients undergoing Cesarean delivery for invasive placentation: a retrospective cohort study of 50 consecutive cases. Can J Anaesth 2016;63:1233–44.

44.Taylor NJ, Russell R. Anaesthesia for abnormally invasive placenta: a single- institution case series. Int J Obstet Anesth 2017;30:10–5.

45.Chandraharan E, Rao S, Belli AM, et al. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet 2012;117:191–4.

46.Eller AG, Porter TF, Soisson P, et al. Optimal management strategies for placenta accreta. BJOG 2009;116:648–54.

47.Seoud MA, Nasr R, Berjawi GA, et al. Placenta accreta: elective versus emergent delivery as a major predictor of blood loss. J Neonatal Perinatal Med 2017;10:9–15.

48.Bowman ZS, Manuck TA, Eller AG, et al. Risk factors for unscheduled delivery in patients with placenta accreta. Am J Obstet Gynecol 2014;210. 241.e1−6.

49.Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015;212. 218.e1−9.

50.Skoll A, Boutin A, Bujold E, et al. No. 364-antenatal corticosteroid therapy for improving neonatal outcomes. J Obstet Gynaecol Can 2018;40:1219– 39.

51.Rac MW, Wells CE, Twickler DM, et al. Placenta accreta and vaginal bleeding according to gestational age at delivery. Obstet Gynecol 2015;125:808–13.

52.Robinson BK, Grobman WA. Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol 2010;116:835–42.

53.Singh SS, Mehra N, Hopkins L. No. 286-surgical safety checklist in obstetrics and gynaecology. J Obstet Gynaecol Can 2018;40:e237–42.

54.Committee on Practice Bulletins—Gynecology, American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 84: prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 2007;110:429–40.

55.Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195– 283.

56.Shakur H, Beaumont D, Pavord S, et al. Antifibrinolytic drugs for treating primary postpartum haemorrhage. Cochrane Database Syst Rev 2018(2): CD012964.

57.Allen L, Jauniaux E, Hobson S, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Nonconservative surgical management. Int J Gynaecol Obstet 2018;140:281–90.

58.Norris BL, Everaerts W, Posma E, et al. The urologist's role in multidisciplinary management of placenta percreta. BJU Int 2016;117:961–5.

59.Elagamy A, Abdelaziz A, Ellaithy M. The use of cell salvage in women undergoing cesarean hysterectomy for abnormal placentation. Int J Obstet Anesth 2013;22:289–93.

60.Hussein AM, Dakhly DMR, Raslan AN, et al. The role of prophylactic internal iliac artery ligation in abnormally invasive placenta undergoing caesarean hysterectomy: a randomized control trial. J Matern Fetal Neonatal Med 2018:1−7.

61.Salim R, Chulski A, Romano S, et al. Precesarean prophylactic balloon catheters for suspected placenta accreta: a randomized controlled trial. Obstet Gynecol 2015;126:1022–8.

62.Petrov DA, Karlberg B, Singh K, et al. Perioperative internal iliac artery balloon occlusion, in the setting of placenta accreta and its variants: the role of the interventional radiologist. Curr Probl Diagn Radiol 2018;47:445–51.

63.Iwata A, Murayama Y, Itakura A, et al. Limitations of internal iliac artery ligation for the reduction of intraoperative hemorrhage during cesarean hysterectomy in cases of placenta previa accreta. J Obstet Gynaecol Res 2010;36:254–9.

64.Shrivastava V, Nageotte M, Major C, et al. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am J Obstet Gynecol 2007;197:402.e1−5.

65.Duan XH, Wang YL, Han XW, et al. Caesarean section combined with temporary aortic balloon occlusion followed by uterine artery embolisation for the management of placenta accreta. Clin Radiol 2015;70:932–7.

66.Panici PB, Anceschi M, Borgia ML, et al. Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/ increta. J Matern Fetal Neonatal Med 2012;25:2512–6.

67.Wu Q, Liu Z, Zhao X, et al. Outcome of pregnancies after balloon occlusion of the infrarenal abdominal aorta during caesarean in 230 patients with placenta praevia accreta. Cardiovasc Intervent Radiol 2016;39:1573–9.

68.Zhu B, Yang K, Cai L. Discussion on the timing of balloon occlusion of the abdominal aorta during a caesarean section in patients with pernicious placenta previa complicated with placenta accreta. Biomed Res Int 2017;2017:8604849.

69.Luo F, Xie L, Xie P, et al. Intraoperative aortic balloon occlusion in patients with placenta previa and/or placenta accreta: a retrospective study. Taiwan J Obstet Gynecol 2017;56:147–52.

70.Ordonez CA, Manzano-Nunez R, Parra MW, et al. Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: a systematic review, meta-analysis, and case series. J Trauma Acute Care Surg 2018;84:809–18.

71.Palacios Jaraquemada JM, Pesaresi M, et al. Anterior placenta percreta: surgical approach, hemostasis and uterine repair. Acta Obstet Gynecol Scand 2004;83:738–44.

72.Aitken K, Allen L, Pantazi S, et al. MRI significantly improves disease staging to direct surgical planning for abnormal invasive placentation: a single centre experience. J Obstet Gynaecol Can 2016;38:246–51.

73.Tskhay VB. The use of modified triple-p method with adherent placenta long-term results. Womens Health 2017;4:30–2.

74.Sentilhes L, Kayem G, Chandraharan E, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet 2018;140:291–8.

75.Amsalem H, Kingdom JCP, Farine D, et al. Planned caesarean hysterectomy versus "conserving" caesarean section in patients with placenta accreta. J Obstet Gynaecol Can 2011;33:1005–10.

76.Pather S, Strockyj S, Richards A, et al. Maternal outcome after conservative management of placenta percreta at caesarean section: a report of three cases and a review of the literature. Aust N Z J Obstet Gynaecol 2014;54:84–7.

77.Legendre G, Zoulovits FJ, Kinn J, et al. Conservative management of placenta accreta: hysteroscopic resection of retained tissues. J Minim Invasive Gynecol 2014;21:910–3.

78.Arendas K, Lortie KJ, Singh SS. Delayed laparoscopic management of placenta increta. J Obstet Gynaecol Can 2012;34:186–9.

79.Rupley DM, Tergas AI, Palmerola KL, et al. Robotically assisted delayed total laparoscopic hysterectomy for placenta percreta. Gynecol Oncol Rep 2016;17:53–5.

80.El-Messidi A, Mallozzi A, Oppenheimer L. A multidisciplinary checklist for management of suspected placenta accreta. J Obstet Gynaecol Can 2012;34:320–4.

81.Sentilhes L, Kayem G, Ambroselli C, et al. Fertility and pregnancy outcomes following conservative treatment for placenta accreta. Hum Reprod 2010;25:2803–10.

82.Provansal M, Courbiere B, Agostini A, et al. Fertility and obstetric outcome after conservative management of placenta accreta. Int J Gynaecol Obstet 2010;109:147–50.

83.Kabiri D, Hants Y, Shanwetter N, et al. Outcomes of subsequent pregnancies after conservative treatment for placenta accreta. Int J Gynaecol Obstet 2014;127:206–10.

84.Cauldwell M, Chandraharan E, Pinas Carillo A, et al. Successful pregnancy outcome in woman with history of triple-P procedure for placenta percreta. Ultrasound Obstet Gynecol 2018;51:696–7.

85.Papillon-Smith J, Sobel ML, Niles KM, et al. Surgical management algorithm for caesarean scar pregnancy. J Obstet Gynaecol Can 2017;39:619–26.

86.Hunt SP, Talmor A, Vollenhoven B. Management of non-tubal ectopic pregnancies at a large tertiary hospital. Reprod Biomed Online 2016;33:79–84.

87.Cali G, Timor-Tritsch IE, Palacios-Jaraquemada J, et al. Outcome of Cesarean scar pregnancy managed expectantly: systematic review and meta- analysis. Ultrasound Obstet Gynecol 2018;51:169–75.

88.Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019;53(1):101–6. https://doi.org/10.1002/uog.20104. Epub 2018 Sep 10.


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