placenta accreta: mitigating risk with cns lead
TRANSCRIPT
Placenta accreta, increta and percreta cause a significant risk for
hemorrhage, maternal morbidity and mortality. Care coordination
and advance planning, availability of blood products, and
interdisciplinary resources are essential to mitigate this risk.
Statement of the Problem
Background
The Society of Maternal Fetal Medicine states that “the reported
incidence of accreta has increased from 0.8 per 1000 deliveries in
the 1980s to 3 per 1000 deliveries in the past decade.”
Placenta previa in the presence of prior cesarean section or uterine
scare is a significant risk factor for development of placenta
accreta.
The FIGO Placenta Accreta Diagnosis and Management Expert
Consensus Panel state that the increase in placenta accreta is a
consequence of the rise of cesarean sections over the last two
decades.
SMFM & ACOG Guidelines for Placenta Accreta
spectrum
Placenta Accreta: Mitigating Risk with CNS Lead Multidisciplinary Team Coordination
Jamie Vincent, APRN-CNS, RNC-OB, C-EFM, Perinatal Clinical Nurse Specialist
Strategy and Implementation
Evaluation
Quality & Process Improvement
References
Perinatal Morbidity and Mortality reviews
Quarterly auditing and quality & process improvement action plans
Hung, T.H., Shau, W.Y., Hsieh, C.C., Chiu, T.H., Hsu, J.J., and
Hsieh, T.T. Risk factors for placenta accreta. Obstet Gynecol. 1999;
93: 545–550 (Case-control level II-2)
Jauniaux, E., Chantraine, F., Silver, R.M., Langhoff-Roos, J. (2018).
FIGO consensus guidelines on placenta accreta spectrum
disorders: Epidemiology. International Journal of Gynecology and
Obstretrics.:140: 265-273.
Silver, R. M. & Branch, D. W. (2018). Placenta Accreta Spectrum.
New England Journal of Medicine. 378: 1529-1536.
Society of Maternal Fetal Medicine (SMFM). (2010). SMFM Clinical
Opinion Placenta Accreta. American Journal of Obstetrics and
Gynecology. November 2010. pp. 430-439.
Normal Placenta Placenta Accreta
https://www.nejm.org/doi/suppl/10.1056/NEJMcp1709324/suppl_file/nejmcp1709324_appendix.pdf
https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points
https://www.nejm.org/doi/full/10.1056/NEJMcp1709324#section_key_clinical_points
Uterus Post-hysterectomy:
Placenta In situ:
Classical Fundal incision is closed
Placenta is bulging the lower uterine segment
Increased vascularity is evident
The placenta is almost visible through the lower uterine segment, and there is evidence of increased vascularity.
The fetus has been delivered through a fundal uterine incision, which has been repaired.