C Biele1, L Kaufner2, A Schwickert1, A Nonnenmacher1, K von Weizsäcker1, M Z Muallem3, W Henrich1, T Braun4,5. 1. Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. 2. Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. 3. Department of Gynecology With Center of Oncological Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. 4. Department of Obstetrics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. Thorsten.braun@charite.de. 5. Department of 'Experimental Obstetrics' and Study Group 'Perinatal Programming', Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. Thorsten.braun@charite.de.
Abstract
INTRODUCTION: Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead to high perioperative maternal blood loss. A conservative treatment by leaving the placenta in utero after caesarean delivery of the baby is an option to preserve fertility and to reduce peripartum hysterectomy-related morbidity. Nevertheless, due to increased placental coagulation activity as well as consumption of clotting factors, a disseminated intravascular coagulation (DIC)-like state with secondary late postpartum bleeding can occur. PURPOSE: Systematic review after the presentation of a case of conservative management of placenta percreta with secondary partial uterine wall resection due to vaginal bleeding, complicated by local hyperfibrinolysis and consecutive systemic decrease in fibrinogen levels. METHODS: Systematic PubMed database search was done until August 2019 without any restriction of publication date or journal RESULTS: Among 58 publications, a total of 11 reported on DIC-like symptoms in the conservative management of AIP, in the median on day 59 postpartum. In most cases, emergency hysterectomy was performed, which led to an almost immediate normalization of coagulation status but was accompanied with high maternal blood loss. In two cases, fertility-preserving conservative management could be continued after successful medical therapy. CONCLUSION: Based on these results, we suggest routinely monitoring of the coagulation parameters next to signs of infection in the postpartum check-ups during conservative management of AIP. Postpartum tranexamic acid oral dosage should be discussed when fibrinogen levels are decreasing and D-Dimers are increasing.
INTRODUCTION: Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead to high perioperative maternal blood loss. A conservative treatment by leaving the placenta in utero after caesarean delivery of the baby is an option to preserve fertility and to reduce peripartum hysterectomy-related morbidity. Nevertheless, due to increased placental coagulation activity as well as consumption of clotting factors, a disseminated intravascular coagulation (DIC)-like state with secondary late postpartum bleeding can occur. PURPOSE: Systematic review after the presentation of a case of conservative management of placenta percreta with secondary partial uterine wall resection due to vaginal bleeding, complicated by local hyperfibrinolysis and consecutive systemic decrease in fibrinogen levels. METHODS: Systematic PubMed database search was done until August 2019 without any restriction of publication date or journal RESULTS: Among 58 publications, a total of 11 reported on DIC-like symptoms in the conservative management of AIP, in the median on day 59 postpartum. In most cases, emergency hysterectomy was performed, which led to an almost immediate normalization of coagulation status but was accompanied with high maternal blood loss. In two cases, fertility-preserving conservative management could be continued after successful medical therapy. CONCLUSION: Based on these results, we suggest routinely monitoring of the coagulation parameters next to signs of infection in the postpartum check-ups during conservative management of AIP. Postpartum tranexamic acid oral dosage should be discussed when fibrinogen levels are decreasing and D-Dimers are increasing.
Authors: Sally L Collins; Bahrin Alemdar; Heleen J van Beekhuizen; Charline Bertholdt; Thorsten Braun; Pavel Calda; Pierre Delorme; Johannes J Duvekot; Lene Gronbeck; Gilles Kayem; Jens Langhoff-Roos; Louis Marcellin; Pasquale Martinelli; Olivier Morel; Mina Mhallem; Maddalena Morlando; Lone N Noergaard; Andreas Nonnenmacher; Petra Pateisky; Philippe Petit; Marcus J Rijken; Mariola Ropacka-Lesiak; Dietmar Schlembach; Loïc Sentilhes; Vedran Stefanovic; Gita Strindfors; Boris Tutschek; Siri Vangen; Alexander Weichert; Katharina Weizsäcker; Frederic Chantraine Journal: Am J Obstet Gynecol Date: 2019-03-05 Impact factor: 8.661
Authors: A Al-Khan; I L Aye; I Barsoum; A Borbely; E Cebral; G Cerchi; V L Clifton; S Collins; T Cotechini; A Davey; J Flores-Martin; T Fournier; A M Franchi; R E Fretes; C H Graham; G Godbole; S R Hansson; P L Headley; C Ibarra; A Jawerbaum; U Kemmerling; Y Kudo; P K Lala; L Lassance; R M Lewis; E Menkhorst; C Morris; T Nobuzane; G Ramos; N Rote; R Saffery; C Salafia; D Sarr; H Schneider; C Sibley; A T Singh; T S Sivasubramaniyam; M J Soares; O Vaughan; S Zamudio; G E Lash Journal: Placenta Date: 2011-01-13 Impact factor: 3.481
Authors: Thorsten Braun; Katharina Weizsäcker; Mustafa Zelal Muallem; Janina Tillinger; Larry Hinkson; Frederic Chantraine; Wolfgang Henrich Journal: J Perinat Med Date: 2018-12-19 Impact factor: 1.901
Authors: C Biele; L Kaufner; A Nonnenmacher; K von Weizsäcker; M Z Muallem; W Henrich; Thorsten Braun Journal: Arch Gynecol Obstet Date: 2021-02-05 Impact factor: 2.344