Prof Yee Leung Obstetric's guest appearances

Prof Yee Leung Obstetric

Obsgynaecritcare

Mark Johnson

Chris Mitchell

Kevin Chan

Takotsubo Cardiomyopathy

Casey Parker

Matt Rucklidge

Nolan McDonnell

Mark Sharples

Sonya Ting

Cheryl Dane Stewart

Parvesh Verma

Dr Adam Mossenson

Katrina Calvert

Peter Garnett

Mike Paech

OwlTail

Hi everyone,Thanks for joining us again, this week I am joined by my colleague Prof Yee Leung, Head of Gynaecological Oncology in Western Australia, to discuss the obstetric and surgical aspects of managing the patient with an abnormally invasive placenta (accreta / increta / percreta). Please join us, listen to our conversation on the podcast and let us know if you have any comments or questions.Definitions:Accreta = the chorionic villi are in contact with the myometrium (78%)Increta =  the chorionic villi invade the myometrium. (17%)Percreta = the chorionic villi penetrate the uterine serosa. (5%)Risk factors: 	Previous caesarean delivery: The authors of one study found that in the presence of a placenta previa, the risk of placenta accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater repeat cesarean deliveries, respectively. 	Placenta previa (without previous uterine surgery): 1–5% risk of placenta accreta. 	Any condition resulting in myometrial tissue damage followed by a secondary collagen repair, eg myomectomy, vigorous curettage resulting in Asherman syndrome, submucous leiomyomas, thermal ablation , and uterine artery embolization.ACOGhttps://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-AccretaRANZCOGhttps://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Placenta-Accreta-(C-Obs-20)-Review-March-2014,-Amended-November-2015.pdf?ext=.pdfDiagnosis - Imaging Modalities:https://radiopaedia.org/articles/placenta-accretaUSS or MRISurgical managementSurgical management of placenta accreta: to leave or remove the placenta?A Perez-Delboy, JD Wright 2014Timing of DeliveryPlacenta Accreta: When is the optimal time to deliver?Manual Aortic OcclusionOur podcast discussion on this topicInterventional Radiology3) REBOA during unexpected uterine rupturehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628233/2) Comment urging caution before embracing interventional radiology techniques:http://www.obstetanesthesia.com/article/S0959-289X(16)30075-9/pdfCommunication and Having an Effective TeamFostering a culture of safety: The OR team huddleConservative ManagementLeaving the placenta in situ, Methotrexate, En bloc resection, Hysteroscopic resection

Hi everyone, Thanks for joining us again, this week I am joined by my colleague Prof Yee Leung, Head of Gynaecological Oncology in Western Australia, to discuss the obstetric and surgical aspects of managing the patient with an abnormally invasive placenta (accreta / increta / percreta). Please join us, listen to our conversation on the podcast and let us know if you have any comments or questions. Definitions: Accreta = the chorionic villi are in contact with the myometrium (78%) Increta =  the chorionic villi invade the myometrium. (17%) Percreta = the chorionic villi penetrate the uterine serosa. (5%) Risk factors: 	Previous caesarean delivery: The authors of one study found that in the presence of a placenta previa, the risk of placenta accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater repeat cesarean deliveries, respectively. 	Placenta previa (without previous uterine surgery): 1–5% risk of placenta accreta. 	Any condition resulting in myometrial tissue damage followed by a secondary collagen repair, eg myomectomy, vigorous curettage resulting in Asherman syndrome, submucous leiomyomas, thermal ablation , and uterine artery embolization. ACOG <a href="https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta" rel="nofollow" target="_blank">https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Placenta-Accreta</a> RANZCOG <a href="https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Placenta-Accreta-(C-Obs-20)-Review-March-2014,-Amended-November-2015.pdf?ext=.pdf" rel="nofollow" target="_blank">https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Placenta-Accreta-(C-Obs-20)-Review-March-2014,-Amended-November-2015.pdf?ext=.pdf</a> Diagnosis - Imaging Modalities: <a href="https://radiopaedia.org/articles/placenta-accreta" rel="nofollow" target="_blank">https://radiopaedia.org/articles/placenta-accreta</a> USS or MRI Surgical management Surgical management of placenta accreta: to leave or remove the placenta? A Perez-Delboy, JD Wright 2014 Timing of Delivery Placenta Accreta: When is the optimal time to deliver? Manual Aortic Occlusion Our podcast discussion on this topic Interventional Radiology 3) REBOA during unexpected uterine rupture <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628233/" rel="nofollow" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628233/</a> 2) Comment urging caution before embracing interventional radiology techniques: <a href="http://www.obstetanesthesia.com/article/S0959-289X(16)30075-9/pdf" rel="nofollow" target="_blank">http://www.obstetanesthesia.com/article/S0959-289X(16)30075-9/pdf</a> Communication and Having an Effective Team Fostering a culture of safety: The OR team huddle Conservative Management Leaving the placenta in situ, Methotrexate, En bloc resection, Hysteroscopic resection

017 – Prof Yee Leung Obstetric and surgical management of abnormally invasive placenta