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Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium (the middle layer of the uterine wall). There are three forms of placenta accreta, distinguishable by the depth of penetration.

The placenta usually detaches from the uterine wall relatively easily, but women who encounter placenta accreta during childbirth are at great risk of haemorrhage during its removal. This commonly requires surgery to stem the bleeding and fully remove the placenta, and in severe forms can often lead to a hysterectomy or be fatal.

Placenta accreta affects approximately 1 in 533 pregnancies.

Variants

There are multiple variants, defined by the depth of their attachment to uterine wall:

Type Description Percent
placenta accreta An invasion of the myometrium which does not penetrate the entire thickness of the muscle. This form of the condition accounts for around 75% of all cases. 75-78%
placenta increta Occurs when the placenta further extends into the myometrium, penetrating the muscle. 17%
placenta percreta The worst form of the condition is when the placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall). This variant can lead to the placenta attaching to other organs such as the rectum or bladder[2]. 5-7%

Diagnosis

Placenta accreta is very rarely recognised before birth, and is very difficult to diagnose. A Doppler ultrasound can lead to the diagnosis of a suspected accreta and an MRI will give more detail leading to further suspicion of such an abnormal placenta. However, both the ultrasound and the MRI rarely confirm an accreta with certainty. While it can lead to some vaginal bleeding during the third trimester, this is more commonly associated with the factors leading to the condition. In some cases the second trimester can see elevated maternal serum alpha-fetoprotein levels, though this is also an indicator of many other conditions[3].

During birth, placenta accreta is suspected if the placenta has not been delivered within 30 minutes of the birth. Usually in this case, manual blunt dissection or placenta traction is attempted but can cause haemorrhage in accreta.

Risk factors

The condition affects around 10% of cases of placenta praevia, and is increased in incidence by the presence of scar tissue i.e. Asherman’s syndrome usually from past uterine surgery, especially from a past Dilation and curettage,[4] (which is used for many indications including miscarriage, termination, and postpartum hemorrhaging), myomectomy,[5] or caesarean section. A thin decidua can also be a contributing factor to such trophoblastic invasion. Some studies suggest that the rate of incidence is higher when the fetus is female.[6]

Treatment

The safest treatment is a planned caesarean section and abdominal hysterectomy if placenta accreta is diagnosed before birth.[7][8]

If it is important to save the woman’s uterus (for future pregnancies) then resection around the placenta may be successful.

Conservative treatment can also be uterus sparing but may not be as successful and has a higher risk of complications.[8] Techniques include

  • leaving the placenta in the uterus
  • intrauterine balloon catheterisation to compress blood vessels
  • embolisation of pelvic vessels

If the woman decides to proceed with a vaginal delivery, blood products for transfusion should be prepared.[9]

References

  1. ^ Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005 May;192(5):1458-61.
  2. ^ Miller, David A. (2 November 2004). ‘Accreta Obstetric HemorrhageHigh Risk Pregnancy Directory at ObFocus. Accessed 25 January 2006
  3. ^ Mayes, M., Sweet, B. R. & Tiran, D. (1997). Mayes’ Midwifery – A Textbook for Midwives 12th Edition, pp. 524, 709. Baillière Tindall. ISBN 0-7020-1757-4
  4. ^ Capella-Allouc, S.; Morsad, F; Rongières-Bertrand, C; Taylor, S; Fernandez, H (1999). “Hysteroscopic treatment of severe Asherman’s syndrome and subsequent fertility”. Human Reproduction 14 (5): 1230–3. doi:10.1093/humrep/14.5.1230. PMID 10325268.
  5. ^ Al-Serehi, A; Mhoyan, A; Brown, M; Benirschke, K; Hull, A; Pretorius, DH (2008). “Placenta accreta: An association with fibroids and Asherman syndrome”. Journal of ultrasound in medicine 27 (11): 1623–8. PMID 18946102.
  6. ^ American Pregnancy Association (January 2004) ‘Placenta Accreta‘. Accessed 16 October 2006
  7. ^ Johnston, T A; Paterson-Brown, S (January 2011). Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. Royal College of Obstetricians and Gynecologists.[page needed]
  8. ^ a b Oyelese, Yinka; Smulian, John C. (2006). “Placenta Previa, Placenta Accreta, and Vasa Previa”. Obstetrics & Gynecology 107 (4): 927–41. doi:10.1097/01.AOG.0000207559.15715.98. PMID 16582134.
  9. ^ Committee On Obstetric, Practice (2002). “Placenta accreta Number 266, January 2002 Committee on Obstetric Practice”. International Journal of Gynecology & Obstetrics 77 (1): 77–8. doi:10.1016/S0020-7292(02)80003-0. PMID 12053897.

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It has been a while since I have logged in to write. Reason being I had a very difficult pregnancy and a near death delivery. I have come away with three

life lessons:

1. Trust your instincts

2. Know your body and never be afraid to call your OB over something that others think is trivial

3. Trust in the creator or God whoever he may be to you as when all things fail he will see you through

My pregnancy from the beginning was painful. But my doctor sent me to do a ultra sound which showed nothing. I had done a previous  c section so they thought the  pain from that was due to that c section cut.  But in my mind I knew something was wrong. I kept feeling this pain in my left side that as time went along got worse. Still no explanation after two ultra sounds. So I thought maybe I am just overreacting. But I noticed signs along the way that everything was not ok.

Based on past experience and what was happening I registered at UWI just in case something went wrong I had an option. Let me tell you the hours spent waiting to see on OB on your app.t day was crazy. I would have a 3pm appt and had to go at 12pm just ensure I saw the doc early to get back home in time to pick up my son from school. After three appts. and less than satisfactory care and concern I gave up and returned to my private doctor who answered my every call and concern during the entire process even though I was registered elsewhere. Let me tell you that was the single most best decision I ever made as it was life saving.

36 Weeks on from the night before I started having pains I waited a while but by the next morning I knew something was wrong and rushed to the hospital. Long and short I had my son via c section but then found out during surgery what the issue was, placenta accreta which led to further complications and an additional surgery and time spent in intensive care and after many efforts the docs telling me they had done all they could do, there is nothing more that can be done. But thanks to my doc he tried everything and thanks to alot of prayers I am alive to tell the tale.

I seriously want to say a big thank you to all the nurses on the maternity ward at Andrews Memorial. In the last moments when everyone thought the end was near she held my hand and prayed with me, I just felt a calm come over me. Also to Dr. Walcott my OB and Dr Murray my anesthesiologist and Pediatrician Dr. Miller for taking care of my son all the days he spent in the hospital and to all the assistant surgeons and to my 2 ICQ nurses . They stuck with me to the end and back. Spending countless hours at the hospital with me through the days. I would never be here without them.

I am happy to say my 5 pound baby boy is now 10 pounds at 7 weeks.

Below are some pics of the joys of my life:

               

My son at the hospital waiting on during one hospital visit. He was such a trooper

  • In: Pregnancy
  • Comments Off on How to get pregnant faster

By NADINE WILSON All Woman writer wilsonn@jamaicaobserver.com

Monday, December 05, 2011

THE dream of hearing the pitter patter of little feet on the floor, changing diapers and nursing cuddly babies, continues to elude some women who would love for nothing else than to become pregnant. But despite changing positions, investing in ovulation kits and going through various fertility tests, some are still unable to conceive. This has proven quite frustrating, especially when one considers the fact that other women, it would appear, just need to be touched by their partners to reproduce.

If you are one of these women who are just watching while your biological clock ticks away, don’t lose hope, there might just be something you can do to up your chances of becoming a mother. Trying the following tips might be a start to getting you to realise this dream.

1. Increase sex before ovulation. Pregnancy rates peak two days before ovulation so try to have sex on these days plus the two days after. Since an egg can survive for only 12 to 48 hours in the uterus, you stand a greater chance of becoming pregnant on these days. Ovulation usually occurs 14 days into a woman’s menstrual cycle — that’s 14 days after the period. If you can map out your most fertile period on a calendar, you can determine when is the best time to have sex.

2. Go in for family counselling with your partner. Checking in with your health care provider before you start having children is not a bad idea. By doing so, you can get to go over each other’s medical history, review your current list of medications to see if they impact on fertility, conduct a gynaecological exam, and test for sexually transmitted diseases. “Chlamydia and gonorrhoea are the two main causes of infertility because they cause damage or blockage to the fallopian tubes so that sperm can’t move through,” explained obstetrician/gynaecologist Dr Leslie Meade, who further noted that something as simple as chicken pox could impact fertility since a man who gets it over 40 years old could have a reduction in his sperm count.

3. Stop taking birth control in advance. Some birth control methods like Depo-Provera, for example, might impact your ability to become pregnant even after you’ve discontinued using them. “So if you are planning to get pregnant, you should try to come off this a couple months before,” explain Dr Meade. You can use a barrier method such as a condom while you try to wean yourself off other contraceptives and then stop using the condom the minute you want to start trying to have a child.

4. Do it without the lube. Lubricants can reduce your chances of becoming pregnant because they are toxic to sperm and interfere with the role of cervical mucous. The alkalinity of the vaginal mucous usually protects the sperm before ovulation, so store bought, artificial and even home-made lubricants create a problem for those wanting to become pregnant. “That’s why we recommend water-based lubricants which tend to be better,” said Dr Meade. But if you plan on becoming a mommy soon, increasing foreplay is the best choice.

5. Quit smoking. There are so many reasons to stop smoking and infertility is one of them. Smoking has been shown to harm a woman’s ovaries, leading to an increased risk of miscarriage also. Regardless of whether you have been exposed to first-hand or second-hand smoking, you are at risk for infertility or might put your child in danger if you do become pregnant. If your partner is the one who smokes, he might make it difficult for you to create that family you’ve always dreamed about, since smoking affects a man’s sperm count. “When we evaluate people, we usually ask them about smoking, whether it is ganja or cigarette, because both can lead to so many different things,” Dr Meade said.

6. Improve your diet. Having well-balanced meals is not a bad idea if you are trying to become pregnant. A proper diet helps with the production of hormones in both males and females. Imbalanced hormones can cause a man to have a low sperm count and can lead to increased oestrogen levels in women, thereby making it more difficult to conceive. You would be well advised to stay away from foods with a high mercury content as too much of this in the blood is believed to cause infertility.

7. Just have fun. Although you are trying to get pregnant, sex shouldn’t be a chore. Stressing yourself won’t make you get pregnant any sooner, so try new moves while in the bedroom. Some researchers argue that spasmatic movement brought on by an orgasm helps to pull the sperm into the uterus and it can also increase the man’s sperm count. Instead of becoming frustrated, relax yourself by trying yoga or sticking to some other exercise regime.

8. Visit a specialist. You can visit a fertility clinic, such as the one located at the University Hospital of the West Indies, to view your options to have the family you have been longing for. The visit might just be worth your while, since many women have been able to have babies through in vitro fertilisation.

9. Monitor your cervical mucous. The consistency of your cervical mucous is a great indicator of when you are most fertile, if you don’t mind examining your bodily fluid. Before ovulation, you will notice a sticky, cloudy-looking mucous which usually turns into a clear and slippery secretion. You are considered most fertile when the mucous is clear, thick and slippery. “When the ovulation time is near, it tends to be watery so the sperm can penetrate through the cervical mucous,” said Dr Meade.

Read more: http://www.jamaicaobserver.com/magazines/allwoman/How-to-get-pregnant-faster_10295994#ixzz1flYd0v00

By DONNA HUSSEY-WHYTE All Woman writer husseyd@jamaicaobserver.com

Monday, December 05, 2011

BEING pregnant can be an exciting prospect for a first time mother, and the thought of the little bundle at the end of nine months outweighs any issues doctors and previously pregnant friends can warn you about.

But there are certain things that don’t come in the ‘bigger boobs and morning sickness and swollen feet’ talk — things no one really includes in the pregnancy advice; things even some pregnancy books shy away from.

Below we list some of them — 10 things you may never have known about pregnancy, as confirmed by gynaecologist at the Winchester Surgical and Medical Centre, Dr Lloyd Goldson.

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1/1

 

1 You may need to be stitched after childbirth. Childbirth can be very traumatic for some mothers. In fact, many mothers receive a tear in the area between the vagina and the anus and have to be stitched up afterwards. While getting a tear may sound horrible, mothers have confessed to not knowing exactly when this took place as the force of pushing out the child takes precedence over any other pain. In fact, it is believed that nine out of 10 women have some type of vaginal tearing after birth.

2 Your sense of smell gets better. Dr Goldson said during pregnancy, it is possible that a woman’s sense of smell increases as does her sense of taste as a result of the increased level of blood flow to the nostrils. Scientists theorise that this is to help pregnant mothers avoid eating small levels of toxins that might not be dangerous to an adult, but could be deadly to a foetus.

3 You still have contractions after childbirth. Dr Goldson said contractions will continue after childbirth while the mother breastfeeds. “Breastfeeding produces oxytocins which make the uterus contracts,” he said. As a result the new mother will feel the pains as this takes place. Research says these muscle cramps are also the body’s way of stopping excess blood loss.

4 You don’t need to eat for two. We’ve all heard the old wives’ tale that when you are pregnant you need to eat for two as mothers need to pack on the pounds. This, Dr Goldson said, is not true. He said once women are taking vitamins and eating properly then they are OK. Most women only need to gain about 25 pounds throughout their entire pregnancy.

5 Your feet can grow one shoe size more. Dr Goldson said during pregnancy the body retains water so the ring gets tight and the feet get big. “This normally goes down afterwards depending on if she loses weight and loses the water. But the thing is that a lot of women retain the weight afterwards,” he said. The excess pressure on the feet, the added pounds gained, along with relaxed ligaments in the body can cause the feet to grow up to one shoe size more. It has also been found that as pregnancy matures, the body starts to release the tightness of its ligaments to help with the birthing process; this also means that your feet will lose their arch and stretch out on the sides. The flatter, wider shape of your feet will probably be temporary, but if they grew too much, the change could end up being permanent.

6 A male foetus can get erections in the womb. While this may be hard to believe, in fact it is believed that this is sometimes how doctors are able to tell through ultrasound the sex of your baby. Dr Goldson said an erection in the womb is possible especially since males usually wake up with an erection in the morning. “This may be something that started from in the womb, but it has never been something we have discussed medically,” he said.

7 You will poop. Because the muscles used to push the baby out are the same ones used during a bowel movement, women giving birth often defecate in the delivery room during the process. Another contributing factor is that the baby pushes directly on the rectum as it makes its exit, helping to squeeze out anything near that exit. In fact, many doctors/nurses warn women in labour not sit on the toilet if they feel like going because this could be the baby making its way out.

8 Fathers sometimes show symptoms of pregnancy. Thirty-four-year-old Leon W said while his girlfriend was pregnant, she never got sick once. Yet every morning he woke up nauseous or vomiting. Dr Goldson explained that while there is no scientific explanation, the number of incidences seen leaves one to believe this is true. He said some fathers even feel the symptoms and are the ones who let their partners know that they are pregnant. There are also some fathers who gain the weight and even feel cramps in their lower abdomen.

9 Sleeping can be very uncomfortable. As the tummy gets larger, mothers-to-be will find it very hard to sleep comfortably in any position. Tossing and turning can result in many sleepless nights. Dr Goldson said if the woman lies on her back she will feel as if she is suffocating, while if she lies on her right side, the baby presses on the vein that carries the blood to the heart preventing enough blood from flowing to the placenta. It is recommended that women lie on their left side.

10 It hurt! Because of the increase in the size of the tummy there is a lot of stretching which results in the woman feeling pain. “A lot of patients have backaches because the ligament stretches ,” Dr Goldson said. He said if the woman has fibroids there will be even more pain as a result of the stretching.

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  • In: Pregnancy
  • Comments Off on Beyonce On Pregnancy

From people.com

Beyoncé: I’m Not Pigging Out During Pregnancy

Landov

Beyoncé‘s baby bump is growing right on schedule – but she’s working hard to make sure the rest of her body doesn’t expand right along with it.

“I’ve been really conscious and I’ve been trying my best not to lose control,” she says of her pregnancy eating habits on Friday night’s 20/20.

“Because I’ve met so many people that say, ‘My second baby, my third baby, I’ve learned my lesson.’ So I haven’t been going crazy.”

She added, “It’s important that I don’t lose myself … I believe that life doesn’t stop.”

She also dismissed rumors of wacky cravings involving ketchup, hot sauce and ice cream, saying her desires don’t involve “anything crazy.”

“I was on a plane and the flight attendant came and was like, ‘I have your hot sauce and pickles and bananas.’ And I’m like, ‘That is absolutely disgusting, what are you doing?’ He’s like, ‘I read it on the Internet,’” she says.

The expectant first-time mom admits she knows things won’t be perfect, but says she can handle whatever comes her way.

“It’s exciting! I know it’s gonna be difficult at times,” she says. “I know that, like my mother, I’m gonna get on my child’s nerves [but] I’m just ready. I’m ready for the next chapter.”

Though she doesn’t exactly respond to reports to PEOPLE that she is having a girl, Knowles does share that she’s not picky about the child’s sex.

“I don’t care. I just want — I’m just like everyone else. And now I know why people say that, it’s true. I just want [a healthy baby],” she said.

 

  • In: Pregnancy
  • Comments Off on 5 Months Pregnant

Ok so I am now 5 months pregnant and its great to be this far despite the challenges. I have been having some health issue but I am taking it in stride with hopes that everything will eventually we ok. There were some scary, teary eyed moments but thank God my baby is still ok.

Apart from that I am happy and looking forward to delivery date. Things I am thinking about is my final hospital choice for delivery. Due to complications I have to think of which hospital can better handle my situation above all else. I am also thinking of baby names as I now know the sex of the baby and just generally getting things ready at home. I am also trying to rest as much as possible and am trying to stay as healthy as possible.

I am also focusing on getting my son ready for a new baby. He currently has everyone’s attention as an only child so it will be a change for him so I am doing my best to get him ready.

That’s it so far.

  • In: Pregnancy
  • Comments Off on Being 4 months pregnant

After 3 months of being sick all day everyday despite other issue there is a sigh of relief and I am saying thank you Jesus. It was horrible I would not wish it on my worse enemy. It was hard being sick and also dealing with a two-year old toddler.  Having your children close together is by no means an easy cake walk so far. My sister and I were 6 years apart and it was hell having an annoying little sister. So even though I wasnt ready I was happy that my children will be this close in age.

So far so good though. Having lost a baby before at birth afer a c section, then delivering my son successfully through another c section you cant help but being nervous about doing another surgery but I have been here before and I hope for the best and try to do everything to stay healthy.

As I am writing this I have my son beside me whining for more attention. But I just do the best you can, there is nothing else I can do.


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