Document Detail


Controversies in the management of placenta accreta.
MedLine Citation:
PMID:  21575803     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality worldwide, and abnormal placentation, including placenta accreta, is currently the most common indication for peripartum hysterectomy. Prenatal identification of these cases and early referral to centers with the capability to manage them will likely result in improved outcomes. Interventions that may limit transfusion requirements include normovolemic hemodilution, selective embolization of pelvic vessels by interventional radiology, conservative management of accretism in a few selected cases, and the use of the cell saver intraoperatively. Current understanding of the mechanisms of acute coagulopathy has questioned the current transfusion guidelines, leading to a tendency to apply massive transfusion protocols based on hemostatic resuscitation. Prospective trials are required to validate the efficacy of this approach. Obstetricians should be familiar with current transfusion protocols, as the incidence of placental accretism is expected to increase in the future.
Authors:
Luis D Pacheco; Alfredo F Gei
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology clinics of North America     Volume:  38     ISSN:  1558-0474     ISO Abbreviation:  Obstet. Gynecol. Clin. North Am.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8709551     Medline TA:  Obstet Gynecol Clin North Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  313-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, 3400 John Sealy Annexure, 301 University Boulevard, Galveston, TX 77555-0587, USA; Division of Surgical Critical Care, Department of Anesthesiology, The University of Texas Medical Branch at Galveston, 3400 John Sealy Annexure, 301 University Boulevard, Galveston, TX 77555-0587, USA.
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