TY - JOUR
T1 - Retrospective multicenter study of leaving the placenta in situ for patients with placenta previa on a cesarean scar
AU - the Perinatal Research Network Group in Japan
AU - Miyakoshi, Kei
AU - Otani, Toshimitsu
AU - Kondoh, Eiji
AU - Makino, Shintaro
AU - Tanaka, Mamoru
AU - Takeda, Satoru
N1 - Funding Information:
The authors express thanks to Shigeki Matsubara of the Department of Obstetrics and Gynecology, Jichi Medical University, Japan, for criD?-cal review of the manuscript. Rachel Roberts of the Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan, is thanked for providing helpful suggesD鸀oninspreparing the manuscript. Yoshihiko Murayama, Nerima Hikarigaoka Hospital, Tokyo, Japan, is thanked for his helpful comments on the study design. The present study was supported by a grant from the Perinatal Research Network Group in Japan.
Publisher Copyright:
© 2017 International Federation of Gynecology and Obstetrics
PY - 2018/3
Y1 - 2018/3
N2 - Objective: To investigate maternal outcomes after leaving the placenta in situ for placenta accreta spectrum (PAS) disorders in patients with placenta previa on a cesarean delivery scar. Methods: The present retrospective study reviewed medical records from women with placenta previa on a cesarean scar underwent perinatal care at secondary- or tertiary-level perinatal centers in Japan between January 1, 2010, and December 31, 2014. Perinatal management was conducted based on each leading obstetrician's discretion. The primary outcome was success of the leaving the placenta in situ approach for PAS disorders (defined as preserving the uterus without hysterectomy). Results: Of 178 eligible centers, 126 (71%) participated in this study; data from 613 patients were included. Of these, 41 had the placenta left in situ owing to PAS disorders and follow-up data were available for 36 women. Leaving the placenta in situ was successful in 25 (69%) patients, with placental resorption occurring postpartum (median 89 days; range 6–510). Hysterectomy was performed for 11 patients, primarily owing to hemorrhage and/or infection (median 30 days; range 0–95 days, postpartum). Conclusion: Leaving the placenta in situ, with close postpartum follow-up for at least several months, could be a uterus-preserving option for patient with PAS disorders.
AB - Objective: To investigate maternal outcomes after leaving the placenta in situ for placenta accreta spectrum (PAS) disorders in patients with placenta previa on a cesarean delivery scar. Methods: The present retrospective study reviewed medical records from women with placenta previa on a cesarean scar underwent perinatal care at secondary- or tertiary-level perinatal centers in Japan between January 1, 2010, and December 31, 2014. Perinatal management was conducted based on each leading obstetrician's discretion. The primary outcome was success of the leaving the placenta in situ approach for PAS disorders (defined as preserving the uterus without hysterectomy). Results: Of 178 eligible centers, 126 (71%) participated in this study; data from 613 patients were included. Of these, 41 had the placenta left in situ owing to PAS disorders and follow-up data were available for 36 women. Leaving the placenta in situ was successful in 25 (69%) patients, with placental resorption occurring postpartum (median 89 days; range 6–510). Hysterectomy was performed for 11 patients, primarily owing to hemorrhage and/or infection (median 30 days; range 0–95 days, postpartum). Conclusion: Leaving the placenta in situ, with close postpartum follow-up for at least several months, could be a uterus-preserving option for patient with PAS disorders.
KW - Cesarean scar
KW - Conservative management
KW - Leaving the placenta in situ
KW - Placenta accreta spectrum
KW - Placenta previa
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U2 - 10.1002/ijgo.12397
DO - 10.1002/ijgo.12397
M3 - Article
C2 - 29159943
AN - SCOPUS:85041168348
SN - 0020-7292
VL - 140
SP - 345
EP - 351
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 3
ER -