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      Elective robotic hysterectomy for placenta accreta spectrum in the second trimester: Case report

      case-report

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          Highlights

          • •

            Early diagnosis of placenta accreta spectrum allows effective surgical planning.

          • •

            Elective robot-assisted laparoscopic hysterectomy for placenta accreta spectrum diagnosed before viability is an option for women that have completed fertility.

          • •

            We propose a technique for the safe performance of minimally invasive hysterectomy with pregnancy in situ for early diagnosed placenta accreta spectrum.

          Abstract

          Background

          A scheduled pre-viable hysterectomy is a treatment option for women with early diagnosed placenta accreta spectrum who do not wish future fertility. A minimally invasive hysterectomy with pregnancy in situ for placenta accreta spectrum has not been previously reported.

          Case

          A patient with evidence of placenta accreta spectrum on prenatal imaging underwent an elective robot-assisted laparoscopic hysterectomy at 16 weeks of gestation. The procedure was uncomplicated and she was discharged on postoperative day 1. Pathology was consistent with placenta percreta.

          Conclusion

          Robot-assisted laparoscopic hysterectomy with pregnancy in situ is feasible in a patient with placenta accreta spectrum in the second trimester.

          Teaching points

          1. Early diagnosis of placenta accreta spectrum is important for surgical planning and management. 2. We present a technique for minimally invasive hysterectomy in a patient with placenta accreta spectrum diagnosed before viability.

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          Most cited references9

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          Clinical risk factors for placenta previa-placenta accreta.

          David Miller, Janet A Chollet, T.Murphy Goodwin (1997)
          Our purpose was to define the clinical risk factors associated with placenta previa-placenta accreta. Hospital records were reviewed of all cases of placenta accreta confirmed histologically between January 1985 and December 1994. Additionally, we reviewed the records of all women with placenta previa and all those undergoing cesarean hysterectomy during the same period. Multiple logistic regression analysis was used to identify independent clinical risk factors for placenta accreta. Among 155,670 deliveries, 62 (1/2510) were complicated by histologically confirmed placenta accreta. Placenta accreta occurred in 55 of 590 (9.3%) women with placenta previa and in 7 of 155,080 (1/22,154) without placenta previa (relative risk 2065, 95% confidence interval 944 to 4516, p or = 35 years) and previous cesarean delivery were independent risk factors for placenta accreta. Placenta accreta was present in 36 of 124 (29%) cases in which the placenta was implanted over the uterine scar and in 4 of 62 (6.5%) cases in which it was not (relative risk 4.5, 95% confidence interval 1.68 to 12.07). Among women with placenta previa, the risk of placenta accreta ranged from 2% in women < 35 years old with no previous cesarean deliveries to almost 39% in women with two or more previous cesarean deliveries and an anterior or central placenta previa. Placenta accreta occurs in approximately 1 of 2500 deliveries. Among women with placenta previa, the incidence is nearly 10%. In this high-risk group advanced maternal age and previous cesarean section are independent risk factors.
          Article 0 comments Cited 169 times – based on 0 reviews     Review now
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            Obstetric Care Consensus No. 7

            (2018)
            Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. The most favored hypothesis regarding the etiology of placenta accreta spectrum is that a defect of the endometrial-myometrial interface leads to a failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. Maternal morbidity and mortality can occur because of severe and sometimes life-threatening hemorrhage, which often requires blood transfusion. Although ultrasound evaluation is important, the absence of ultrasound findings does not preclude a diagnosis of placenta accreta spectrum; thus, clinical risk factors remain equally important as predictors of placenta accreta spectrum by ultrasound findings. There are several risk factors for placenta accreta spectrum. The most common is a previous cesarean delivery, with the incidence of placenta accreta spectrum increasing with the number of prior cesarean deliveries. Antenatal diagnosis of placenta accreta spectrum is highly desirable because outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption. The most generally accepted approach to placenta accreta spectrum is cesarean hysterectomy with the placenta left in situ after delivery of the fetus (attempts at placental removal are associated with significant risk of hemorrhage). Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum. In addition, established infrastructure and strong nursing leadership accustomed to managing high-level postpartum hemorrhage should be in place, and access to a blood bank capable of employing massive transfusion protocols should help guide decisions about delivery location.
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              Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis

              Eric Jauniaux, Catey Bunce, Lene Grønbeck … (2019)
              Article 0 comments Cited 83 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ioannis Alagkiozidis
                Journal
                Journal ID (nlm-ta): Int J Surg Case Rep
                Journal ID (iso-abbrev): Int J Surg Case Rep
                Title: International Journal of Surgery Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2210-2612
                Publication date PMC-release: 12 June 2020
                Publication date Collection: 2020
                Publication date (Electronic): 12 June 2020
                Volume: 72
                Pages: 361-364
                Affiliations
                [0005]Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11219, United States
                Author notes
                [* ]Corresponding author at: Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, United States. alagkiozidis@ 123456gmail.com
                Article
                Publisher ID: S2210-2612(20)30425-9
                DOI: 10.1016/j.ijscr.2020.06.024
                PMC ID: 7306544
                PubMed ID: 32563821
                SO-VID: 3de9b227-22d3-47f4-8144-fc5633239fc6
                Copyright © © 2020 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 23 April 2020
                Date revision received : 26 May 2020
                Date accepted : 5 June 2020
                Categories
                Subject: Article

                Keywords: placenta accreta spectrum,minimal invasive hysterectomy,second trimester,case report
                Data availability:
                Keywords: placenta accreta spectrum, minimal invasive hysterectomy, second trimester, case report

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