BMC pregnancy and childbirth · 2026
The quintessential high-risk profile: advanced management strategies for placenta accreta spectrum in patients with advanced maternal age and IVF conception.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Waseem Shanza, Zeng Siyuan, Xiao Xue, Han Liujie, Zhao Hu, Zhan Jun, Bai Peng
Аннотация
BACKGROUND: The convergence of Advanced Maternal Age (AMA ≥ 35), In Vitro Fertilization (IVF) conception, and Placenta Accreta Spectrum (PAS) represents a clinical nexus of potentially elevated obstetric risk, hypothetically associated with a high probability of massive peripartum hemorrhage (MPH). Based on limited observational evidence, this case-based narrative review hypothesizes that this risk profile warrants protocol-driven management considerations, which are presented as hypothesis-generating rather than definitive.
CASE PRESENTATION: A 54-year-old gravida 4, para 2 (2 living children) with an IVF-conceived twin pregnancy and two prior cesarean deliveries presented at 34 1/7 weeks with catastrophic hemorrhage. Prenatal MRI confirmed placenta percreta. During a planned, coordinated admission for delivery, the patient experienced acute hemorrhage, prompting an emergency classical cesarean hysterectomy with partial cystectomy. This was performed by a multidisciplinary team employing a comprehensive hemostatic strategy including prophylactic arterial balloon occlusion, tranexamic acid, intraoperative cell salvage, and a massive transfusion protocol. Estimated blood loss was 4,500 mL. Both neonates required NICU admission but were discharged in stable condition.
CONCLUSIONS: Based on this single case and the available observational literature (summarized in Supplementary Tables S1-S7), we hypothesize that this case exemplifies a potential the compounded pathophysiology that may amplify morbidity in the AMA/IVF/prior uterine scar risk profile. While the management principles discussed are derived from limited evidence and should be considered hypothesis-generating, they may inform care for similar high-risk patients. We suggest that effective management may include: 1)Aggressive prenatal diagnosis with early MRI where available; 2) Consideration of delivery at a Level IV center with a multidisciplinary team; and 3) Implementation of a proactive Patient Blood Management plan. These suggestions derive from limited evidence and require prospective validation.
CASE PRESENTATION: A 54-year-old gravida 4, para 2 (2 living children) with an IVF-conceived twin pregnancy and two prior cesarean deliveries presented at 34 1/7 weeks with catastrophic hemorrhage. Prenatal MRI confirmed placenta percreta. During a planned, coordinated admission for delivery, the patient experienced acute hemorrhage, prompting an emergency classical cesarean hysterectomy with partial cystectomy. This was performed by a multidisciplinary team employing a comprehensive hemostatic strategy including prophylactic arterial balloon occlusion, tranexamic acid, intraoperative cell salvage, and a massive transfusion protocol. Estimated blood loss was 4,500 mL. Both neonates required NICU admission but were discharged in stable condition.
CONCLUSIONS: Based on this single case and the available observational literature (summarized in Supplementary Tables S1-S7), we hypothesize that this case exemplifies a potential the compounded pathophysiology that may amplify morbidity in the AMA/IVF/prior uterine scar risk profile. While the management principles discussed are derived from limited evidence and should be considered hypothesis-generating, they may inform care for similar high-risk patients. We suggest that effective management may include: 1)Aggressive prenatal diagnosis with early MRI where available; 2) Consideration of delivery at a Level IV center with a multidisciplinary team; and 3) Implementation of a proactive Patient Blood Management plan. These suggestions derive from limited evidence and require prospective validation.