Palacios Jaraquemada Placental Adhesive Disorders

1. Auflage 2012
ISBN: 978-3-11-028238-2
Verlag: De Gruyter
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, Band 1, 171 Seiten

Reihe: Hot Topics in Perinatal MedicineISSN

Abnormal placental adhesive disorders are associated to massive hemorrhage and high maternal morbidity and mortality. The main risk factor for abnormal invasive placentation is the repeated cesarean, although other factors were identified. There are specific techniques to provide a high confidence diagnosis. However, precise skills must be acquired to recognize detailed diagnostic signs, to avoid common technical mistakes, and also to know when, how and why it is necessary to use each of them. Presurgical study provides diagnosis, extension and compromise of neighboring structures such as the bladder or the parametrium. Knowledge of placental invasion extension is needed to plan any resective surgery such as hysterectomy or one-step conservative surgery. Due to the fact that topography of the invaded area has direct relation with the specific arterial pedicles, a map of the invasion is required to know which type of proximal vascular control can be more effective. Leaving the placenta in situ seems to be the best option when resources or a skilled team are not available, but it requires intensive postoperative controls to detect infection, bleeding or coagulation disorders. Hysterectomy can be an easy solution for non-experimented operators; however, it is usually a very complicated procedure with demonstrated morbidity and mortality due to hemodynamic and hemostatic problems.

This book gathers the latest knowledge in relation with the etiology, diagnosis, treatment and also the authors personal experience in more than 500 cases. All aspects of this condition have been analyzed to provide an accurate management, which includes vascular control, urology, anesthesia and hemodynamic management among others.

Zielgruppe

Gynecologists, Clinicians; Obstetrics Departments, High-Risk Department Areas; Advanced Students, Graduates, Lecturers; Academic Libraries

Autoren/Hrsg.

Palacios Jaraquemada, José Miguel

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Gynäkologie, Geburtshilfe

Inhaltsverzeichnis

1;Preface;5
2;Acknowledgements;7
3;1 General knowledge;11
3.1;1.1 Introduction;11
3.2;1.2 Epidemiology;13
3.3;1.3 Risk factors;14
3.4;1.4 Terminology;17
3.5;1.5 Types of placental invasion;18
3.6;1.6 Etiology;24
3.7;1.7 Intrinsic problems;25
4;2 Diagnosis;27
4.1;2.1 Presurgical stage;27
4.2;2.2 Clinical suspicion;27
4.3;2.3 Auxiliary diagnosis;28
4.3.1;2.3.1 Ultrasound, Doppler, Three-dimensional Doppler;30
4.3.2;2.3.2 Placental magnetic resonance imaging (pMRI);40
4.3.3;2.3.3 Placental magnetic resonance imaging (pMRI) gallery;42
4.3.4;2.3.4 Serologic diagnosis;42
5;3 Surgical anatomy;53
5.1;3.1 Anatomic and surgical problems;53
5.2;3.2 Uterine blood supply;56
5.3;3.3 Induced vascular neoformation;61
5.4;3.4 Bladder dissection;63
5.5;3.5 Ureteral dissection;68
5.6;3.6 Pelvic access spaces;73
5.7;3.7 Proximal vascular control;76
5.7.1;3.7.1 Aortic;76
5.7.2;3.7.2 Common iliac;80
5.7.3;3.7.3 Internal iliac;82
5.7.4;3.7.4 Uterine;86
6;4 Tactics and strategy;89
6.1;4.1 Alternative management in different settings;89
6.2;4.2 Scheduled surgery;95
6.3;4.3 Emergency;96
6.4;4.4 Additional resources;97
6.5;4.5 Training;98
7;5 Clinical problems;101
7.1;5.1 Hemostatic problems;101
7.2;5.2 Hemodynamic management;103
7.3;5.3 Anesthesia;104
8;6 Surgical alternatives;105
8.1;6.1 Surgical approach;105
8.2;6.2 Resective procedure (hysterectomy);111
8.3;6.3 Conservative procedures;117
8.3.1;6.3.1 In situ placenta;117
8.3.2;6.3.2 One-step conservative surgery;124
8.3.3;6.3.3 Two-step conservative surgery;133
8.3.4;6.3.4 Cesarean scar pregnancy;134
8.4;6.4 Surgical hemostasis;137
8.4.1;6.4.1 Arterial ligatures and compression methods;137
8.4.2;6.4.2 Embolization;139
8.5;6.5 Postoperative care;147
8.5.1;6.5.1 Thromboprophylaxis;147
8.5.2;6.5.2 Analgesia;148
9;7 Results;149
9.1;7.1 General overview;149
9.2;7.2 Maternal outcomes;151
9.3;7.3 Reproductive outcome;152
10;8 Summary;153
10.1;8.1 Quick guide;153
10.1.1;8.1.1 Clinical risk;153
10.1.2;8.1.2 Ultrasound;153
10.1.3;8.1.3 Placental magnetic resonance imaging (pMRI);155
10.1.4;8.1.4 Doppler;155
10.1.5;8.1.5 Surgery;155
10.1.6;8.1.6 Interventional radiologist’s assistance;156
10.1.7;8.1.7 Hemodynamic and hemostatic status;157
10.1.8;8.1.8 Reproductive outcome;157
10.2;8.2 Conclusions;158
11;References;159
12;Index;171

Über Autor(innen)

Palacios Jaraquemada, José Miguel
José Miguel Palacios Jaraquemada, Centre for Medical Education and Clinical Research (CEMIC), Buenos Aires, Argentina; Scientific South Foundation, Lomas de Zamora, Argentina; University of Buenos Aires, Argentina.