Audience:
Obstetricians and surgeons

Supervisor:
Prof. Michael Corrin

Content Advisors:
John Kingdom and Ally Murji

Date:
April 2018

Media:
Adobe Photoshop, Adobe Illustrator, Savage Interactive Procreate

Format:
Textbook

Placenta percreta is a rare pregnancy complication where the placenta penetrates the wall of the uterus, invading adjacent organs. This complication can result in life-threatening hemorrhage, necessitating both a cesarean delivery of the infant and hysterectomy at time of delivery. I developed a series of illustrations for a mock gynecologic surgical atlas depicting the key steps in cesarean hysterectomy. My research included observation of cesarean hysterectomies performed by the Placenta Clinic team at Mt. Sinai Hospital in Toronto (led by Dr. John Kingdom). Drs Kingdom and Murji provided expert guidance, video resources and review of the illustration iterations. The refined digital sketches were rendered in Procreate (with select images digitally inked in Procreate) and arranged with text and labels in Illustrator. One page of the sequence was digitally inked using Procreate.

A selection of these illustrations was included in a recently accepted manuscript in the American Journal of Obstetrics and Gynecology:

Kingdom, JC, Hobson, SR, Murji A, Allen L, Windrim RC, Lockhart E, Collins SL, Majd HS, Alazzam M, Naasia F, Shamshirsaz AA, Belfort MA, and Fox KA. Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020. Am J Obstet Gynecol. 2020;223(3):322-329. PMID: 32007492

References:
1.  Agur, Anne, and Arthur F. Dalley. 2017. Grant’s Atlas of Anatomy (14th Edition). Philadelphia: Lippincott Williams & Wilkins.
2.  Frank H. Netter. Atlas of Human Anatomy. Summit, NJ: Ciba-Geigy, 1989.
3.  Clemente, Carmine. 1997. Anatomy: A Regional Atlas of the Human Body (4th Edition). Philadelphia: Williams Wilkins.
4.  Cunningham, F. Gary, Kenneth J. Leveno, Steven L. Bloom, Jodi S. Dashe, Barbara L. Hoffman, Brian M. Casey and Catherine Y. Spong. 2018. Williams Obstetrics (25th Edition). McGraw-Hill Education.
5.  Pervolaraki E., Holden A.V. (2012) Human Uterine Excitation Patterns Leading to Labour: Synchronization or Propagation? In: Lones M.A., Smith S.L., Teichmann S., Naef F., Walker J.A., Trefzer M.A. (eds) Information Processing in Cells and Tissues. IPCAT 2012. Lecture Notes in Computer Science, vol 7223. Springer, Berlin
6.  Frober, Rosemarie. “Surgical anatomy of the ureter.” British Journal of Urology International 100, issue 4 (October 2007): 949-965.
7.  Bamberg, Christian, Grit Rademacher, Felix Guttler, Ulf Teichgraber, Malte Cremer, Christoph Buhrer, Claudia Spies, Larry Hinkson, Wolfgang Henrich, Karim D Kalache, Joachim W. Dudenhausen. “Human birth observed in real-time open magnetic resonance imaging.” American Journal of Obstetrics & Gynecology 206, issue 6 (June 2012): 505.e1-505.e6.
8.  El Beialy, Mohammad A. “Placenta accreta: dark intraplacental T2 bands” https://radiopaedia.org/cases/placenta-accreta-dark-intraplacental-t2-bands?lang=us