Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa
Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named “stepwise treatmen...
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doaj-5504cc96ed2f4eef9266c020ab97625a2021-09-30T22:46:07ZengThieme Medical Publishers, Inc.The Surgery Journal2378-51282378-51362021-09-0110.1055/s-0041-1728748Stepwise Treatment for Abnormally Invasive Placenta with Placenta PreviaSeiji Sumigama0Tomomi Kotani1Hiromi Hayakawa2Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, JapanDepartment of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, JapanDepartment of Obstetrics, Aichi Children's Health and Medical Center, Obu, Aichi, JapanPlacenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named “stepwise treatment” was introduced in 2003. At a cesarean section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter angiographic UAE is performed on the operation day, followed by the total hysterectomy on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy and the amount of bleeding can be reduced by the added effect of the blood flow interruption by UAE and the uterine involution. Although there are not many indication cases, this is the prudent operation that should be considered for the most severe PAS case such as total placenta increta/percreta with placenta previa. In this article, the practical procedures and tips of stepwise treatment are described.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728748placenta accreta spectrumabnormally invasive placentaplacenta previamodified cesarean hysterectomystepwise treatmentuterine arterial embolizationcatheter occlusion |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Seiji Sumigama Tomomi Kotani Hiromi Hayakawa |
spellingShingle |
Seiji Sumigama Tomomi Kotani Hiromi Hayakawa Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa The Surgery Journal placenta accreta spectrum abnormally invasive placenta placenta previa modified cesarean hysterectomy stepwise treatment uterine arterial embolization catheter occlusion |
author_facet |
Seiji Sumigama Tomomi Kotani Hiromi Hayakawa |
author_sort |
Seiji Sumigama |
title |
Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa |
title_short |
Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa |
title_full |
Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa |
title_fullStr |
Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa |
title_full_unstemmed |
Stepwise Treatment for Abnormally Invasive Placenta with Placenta Previa |
title_sort |
stepwise treatment for abnormally invasive placenta with placenta previa |
publisher |
Thieme Medical Publishers, Inc. |
series |
The Surgery Journal |
issn |
2378-5128 2378-5136 |
publishDate |
2021-09-01 |
description |
Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named “stepwise treatment” was introduced in 2003. At a cesarean section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter angiographic UAE is performed on the operation day, followed by the total hysterectomy on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy and the amount of bleeding can be reduced by the added effect of the blood flow interruption by UAE and the uterine involution. Although there are not many indication cases, this is the prudent operation that should be considered for the most severe PAS case such as total placenta increta/percreta with placenta previa. In this article, the practical procedures and tips of stepwise treatment are described. |
topic |
placenta accreta spectrum abnormally invasive placenta placenta previa modified cesarean hysterectomy stepwise treatment uterine arterial embolization catheter occlusion |
url |
http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1728748 |
work_keys_str_mv |
AT seijisumigama stepwisetreatmentforabnormallyinvasiveplacentawithplacentaprevia AT tomomikotani stepwisetreatmentforabnormallyinvasiveplacentawithplacentaprevia AT hiromihayakawa stepwisetreatmentforabnormallyinvasiveplacentawithplacentaprevia |
_version_ |
1716862700064079872 |