Placenta accreta is currently the most common indication for peripartum hysterectomy. It occurs when the placenta invades and attaches abnormally to the myometrium. The risk and incidence of placenta accreta has increased significantly in recent decades due to rising cesarean delivery rates. Prenatal diagnosis using ultrasound and MRI is important to identify high-risk women and allow planning with a multidisciplinary team. Optimal management involves scheduled cesarean hysterectomy between 34-35 weeks gestation. Conservative management can be considered but is associated with higher risks of hemorrhage, infection and need for emergency hysterectomy.
- Decompression of the abdominal compartment by
opening the abdomen and leaving it open with a
temporary abdominal closure device.
- Aggressive fluid resuscitation should be avoided to prevent dilutional coagulopathy and increased intra-abdominal pressures. Early administration of platelets and fresh frozen plasma in a 1:1:1 ratio with packed red blood cells can help achieve hemostasis earlier.
- Cesarean hysterectomy is usually required for placenta accreta, though in select stable cases a conservative approach retaining the placenta may be attempted with strict follow up given high morbidity.
The document discusses placenta accreta, a condition where the placenta invades and attaches abnormally to the uterine wall. It has increased in incidence 10-fold over the past 50 years due to rising cesarean delivery rates. Risk factors include placenta previa, prior uterine surgery, and increasing maternal age and parity. Ultrasound and MRI can be used to diagnose placenta accreta prenatally based on signs like lack of a hypoechoic zone between the placenta and uterus. Management options for severe postpartum hemorrhage from placenta accreta include uterine packing, arterial ligation, hysterectomy, and the B-Lynch compression suture
La placenta es un órgano efímero presente en los mamíferos placentarios que relaciona al feto con su madre. Se forma a partir de la segunda semana y evoluciona hasta el tercer-cuarto mes, resultando de la asociación de dos placas unidas por sus bordes, la corionica aportada por el feto y la decidual aportada por la madre. La placenta cumple funciones respiratorias, digestivas, urinarias, protectoras, metabólicas y endocrinas para el feto.
D’après les nouvelles recommandations de l’InCa (novembre 2010)
Classifications des types histologiques.
le TYPE 1 : ADENOCARCINOME ENDOMETRIOIDE (avec 3 grades : 1, 2 et 3 en fonction du contingent indifférencié)
le TYPE 2 : CARCINOME A CELLULES CLAIRES, CARCINOMES PAPILLAIRES SEREUX, CARCINOSARCOME
Les traitements diffèrent selon le niveau de risque de la maladie :
Risque bas :
Stade IA + grade 1 ou 2 du TYPE 1 histologique
Risque intermédiaire :
Stade IA + grade 3 du TYPE 1 histo
Stade IB + grade 1 ou 2 du TYPE 1 histo
Risque élevé :
Stade IB + grade 3 du TYPE 1 histo
Et TOUS LES TYPES 2, quel que soit le stade
Et tous les stades I + emboles lymphatiquesa
Le traitement chirurgical en général :
De l’hystérectomie totale + annexectomie à l’hystérectomie totale + annexectomie + curage pelvien + curage lombo-aortique et iliaque commun + omentectomie infracolique + cytologie + biopsies péritonéales
reseauprosante.fr
présentation du Dr Harlicot Jean philippe dans le cadre des journée nationales de médecine générales à Paris au CNIT la défense dans le cadre du DPC organisé par le CHEM