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Greenwood L, Mastrobattista J, Mack L, Fox K, Lee W, Donepudi R. Impact of Pelvic Rest Recommendations on Follow-Up and Resolution of Placenta Previa and Low-Lying Placenta. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2023-2030. [PMID: 36928922 DOI: 10.1002/jum.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine the rate of resolution of placenta previa and low-lying placenta (LLP) and the effect of pelvic rest recommendations on the timing of follow-up imaging. METHODS Retrospective review of pregnancies with previa/LLP detected on mid-trimester exam at our ultrasound unit from 2019 to 2021. LLP was defined as the lower edge of placenta located within 2 cm of the internal cervical os. Previa was defined as any portion of the placenta touching with the internal os. Demographics, placental location, activity restrictions, and delivery outcomes were analyzed. Timing of follow-up imaging was stratified by individuals advised and not advised pelvic rest. RESULTS Exactly 144 patients had previa and 266 had LLP on the mid-trimester exam with complete records. Previa resolution happened in 51.4% (74/144) of cases. Exactly 62% (46/74) of previa resolutions occurred by the 28-week ultrasound. Exactly 45% (65/144) of previa patients were advised pelvic rest. Most pelvic rest and non-pelvic rest patients had a 28-week scan. Even when clearance occurred, most patients in both groups had a repeat ultrasound at 32 weeks. Exactly 75% of LLP resolved by the 28-week scan, and the remainder by delivery. Exactly 12% (32/259) of LLP patients were advised pelvic rest. CONCLUSION Most societies recommend follow-up imaging at 32 weeks; however, our results suggest this may be done sooner and closer to 28 weeks. Pelvic rest did not affect timing of repeat imaging or delivery.
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Affiliation(s)
- Lauren Greenwood
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Joan Mastrobattista
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Lauren Mack
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Karin Fox
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
| | - Roopali Donepudi
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
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Schwartz A, Chen D, Shinar S, Agrawal S, Yogev Y. Timing of cesarean delivery in women with uncomplicated placenta previa. J Matern Fetal Neonatal Med 2022; 35:10559-10564. [PMID: 36261133 DOI: 10.1080/14767058.2022.2134772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The optimal timing of an elective cesarean delivery for uncomplicated placenta previa remains controversial. Although the present guidelines recommend an elective cesarean delivery between 360/7 and 376/7 weeks of gestation, data supporting this recommendation does not differentiate in outcomes between elective and emergent delivery, or between women with and without ante-partum hemorrhage. Recommendations regarding optimal timing of delivery are based on the risks and benefits associated with delivery at a certain gestational week, compared with a reference of 38 weeks. Therefore, the aim of this paper was to assess the maternal and neonatal adverse outcomes associated with elective delivery at different gestational weeks from 360/7 to 386/7 weeks compared with expectant management in women with uncomplicated placenta previa. METHODS A retrospective cohort study in a single tertiary medical center of 251 women with a diagnosis of uncomplicated placenta previa, who delivered between 360/7 and 386/7 weeks of gestation, who delivered at our center between Jan 2011 and Dec 2019. Maternal and neonatal outcomes at each gestational week were compared with expectant management. RESULTS At 360/7-366/7 weeks, the rate of composite maternal adverse outcome was similar for elective delivery and expectant management (10.5% vs 7.7%, p = .68). Similarly, at 370/7-376/7 the rate of composite maternal adverse outcome was comparable for elective cesarean delivery and expectant management (7.2% vs 6.4%, p = .54). Maternal bleeding was the main indication of an urgent cesarean delivery, and account for 86% of urgent cesarean delivery at 360/7-366/7, 76.4% of urgent cesarean delivery at 370/7-376/7, and for 70.6% of all urgent cesarean delivery at 380/7-386/7 weeks. This group of women who were delivered due to maternal bleeding had a history of maternal bleeding during 2nd and/or 3rd trimester in 75-92.3% of cases. Composite adverse neonatal outcome was similar for elective cesarean delivery at each gestational age compared with expectant management. The risk for lower 5-min APGAR score and hypoglycemia was higher for newborns that were delivered electively a 36th weeks of gestation compared with expectant management. CONCLUSION Our study suggests that the optimal time of delivery for women with an uncomplicated placenta previa is between 380/7 and 386/7 weeks of gestation, especially in women without ante-partum bleeding.
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Affiliation(s)
- Anat Schwartz
- Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel-Aviv, Israel
| | - Daniela Chen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Swati Agrawal
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Yariv Yogev
- Lis Hospital for Women, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel-Aviv, Israel
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Alhubaishi F, Mahmood N. Prevalence and Fetomaternal Outcome of Placenta Previa at Salmaniya Medical Complex, Bahrain. Cureus 2022; 14:e27873. [PMID: 36110476 PMCID: PMC9463607 DOI: 10.7759/cureus.27873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
Abstract
Background Placenta previa is a condition which occurs when the placenta implants in the lower uterine segment, thus obstructing delivery. It is considered a grave pregnancy complication as it is associated with massive maternal hemorrhage. The condition is associated with previous cesarean delivery, multiple gestations, and increased maternal age. The placental villi may abnormally adhere, invade, or penetrate the myometrium causing accreta, increta, or percreta, respectively. It is the most common indication of peripartum hysterectomy. The gold standard for diagnosis of placenta previa is transvaginal ultrasound. Objective This study aims to calculate the prevalence of placenta previa in relation to the known risk factors and to determine the fetomaternal outcome which will aid in improving the obstetric care of patients with placenta previa. Methods A total of 216 placenta previa cases diagnosed between October 2014 and December 2018 were evaluated in a retrospective cross-sectional study. Analysis of the data was conducted using SPSS software, version 20 (IBM Corp., Armonk, NY). Results The total number of deliveries during the study period was 25,693 out of which 216 were diagnosed with placenta previa. Thus, the prevalence of placenta previa is 0.84%. The mean age at diagnosis was 32.8 years. At diagnosis, 23.1% of the cases were primiparous. Of the 216 patients, 1.9% were diagnosed with placenta percreta, of which 5.1% received a hysterectomy; 59.7% had uncomplicated elective cesarean delivery at 37-38 weeks of gestation. The mean gestational age at emergency delivery was 35.97 (+-3.1). Conclusion The study highlights that although risk factors increase the likelihood of placenta previa, it is necessary to rule it out in women with no known risk factors.
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Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa. Abdom Radiol (NY) 2021; 46:2722-2728. [PMID: 33388802 DOI: 10.1007/s00261-020-02894-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the association of placental thickness with placenta accreta spectrum disorder in placenta previa. METHODS In this IRB-approved, retrospective study, ultrasound (US) reports were retrospectively queried for keyword previa. US performed closest to mid-gestation were included. Three measurements were performed at the thickest portion of the placenta on longitudinal transabdominal images. Operative reports and surgical pathology were used as the reference standard. Statistical analysis was performed using unpaired T-tests and receiver operating curve (ROC) analysis. RESULTS Sixty-five patients with placenta previa were included: 38 with PAS disorder and 27 without PAS disorder, clinically or pathologically. 38/38 (100%) patients of PAS group and 16/27 (59.3%) patients of non-PAS group had history of prior cesarean section. The average placental thickness was 4.3 cm (range 1.8 cm to 7.8 cm) for PAS group and 3.0 cm (range 0.6 cm to 5.3 cm) for non-PAS group (p < 0.001). Placental thickness in patients without PAS disorder and history of prior cesarean section was 3.1 (± 1.1) cm. This was statistically different from patients who had history of prior cesarean section with PAS diagnosis (4.3 cm, P<0.01). Using ROC analysis, a threshold measurement of 4.5 cm leads to sensitivity of 50% and specificity of 96%. CONCLUSION Our results demonstrate that among women with placenta previa, increased placental thickness at lower uterine segment correlates with placenta accreta spectrum disorder. A threshold of 4.5 cm can be useful for screening patients with placenta previa and risks factors for PAS.
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Alsammani MA, Nasralla K. Fetal and Maternal Outcomes in Women With Major Placenta Previa Among Sudanese Women: A Prospective Cross-Sectional Study. Cureus 2021; 13:e14467. [PMID: 33996326 PMCID: PMC8118616 DOI: 10.7759/cureus.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Placenta previa is a major obstetric problem with high rates of fetomaternal mortality and morbidity. This study aimed to determine the prevalence and fetal and maternal outcomes of major degree placenta previa among Sudanese women. Method This is a prospective descriptive study conducted in the period from January 1 to June 30, 2109, at Omdurman Maternity Hospital, Khartoum, Sudan. Fetal and maternal complications associated with major degree placenta were analyzed using descriptive statistics. Results The total number of deliveries was 22,000, of which 87 cases were of major degree placenta previa, giving a prevalence rate of 0.4%, the hysterectomies rate was 23% (n= 20), and the total maternal deaths were 6.9% (n= 6). Intraoperative interventions used to control the bleeding were multiple hemostatic sutures in 34.5% (n=30) of cases, followed by uterine backing (20.7%; n= 18), and uterine artery ligation (12.6%; n=11). The common reported maternal complications were bladder injuries (28.7%; n= 25) followed by bowel injuries (4.6%; n=5). Of all mothers, 48.27% (n=42) were admitted to the intensive care unit (ICU). Of all deliveries, 26.4% (n=23) were preterm, and 38% (n=33) of neonates were admitted to the newborn intensive care unit (NICU), and 9.2% (n=8) were fresh stillbirth (FSB). Conclusion Neonatal complications were comparable to other studies but maternal deaths were relatively high. The study indicated the need for effective management protocols and more training of the medical staff in order to overcome the problem.
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Affiliation(s)
- Mohamed Alkhatim Alsammani
- Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraidah, SAU.,Department of Obstetrics and Gynecology, College of Medicine, University of Bahri, Khartoum, SDN
| | - Khalid Nasralla
- Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Buraidah, SAU
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Levin G, Rottenstreich A, Ilan H, Cahan T, Tsur A, Meyer R. Predictors of adverse neonatal outcome in pregnancies complicated by placenta previa. Placenta 2020; 104:119-123. [PMID: 33316721 DOI: 10.1016/j.placenta.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We aimed to underline the determinants of adverse neonatal outcome in gestations complicated by placenta previa (PP). METHODS A retrospective study including all women diagnosed with placenta previa carrying a singleton gestation who delivered between 2011 and June 2019. Gestations with adverse neonatal outcomes were compared to those without. In a secondary analysis, we further studied the rate of Placenta accreta spectrum (PAS) in relation to number of previous cesarean deliveries. RESULTS Overall, 548/84,558 (0.6%) singleton deliveries were complicated by PP (0.6%). PAS was noted in 105 (19.2%) cases. After exclusion of PAS cases, adverse neonatal outcome occurred in 149/443 (33.6%), median gestational age of delivery was 37 0/7 with a median birthweight of 2780 g. In a univariate analysis, adverse neonatal outcome was associated with emergent delivery and general anesthesia [56.8% vs. 20.8%, OR 5.00 (95% CI) 3.24-7.72, p < 0.001 and 54.4% vs. 24.8%, OR 3.60 (95% CI) 2.37-5.47, p < 0.001, respectively]. Gestational age at delivery was lower in the adverse outcome group (mean 35 1/7 vs. 37 3/7, p < 0.001). In a multivariate regression analysis, general anesthesia and gestational age at delivery were independently associated with adverse neonatal outcome [adjusted odds ratio (aOR) 2.26 (95% CI) 1.18-4.31, p = 0.01, aOR 1.10 (95% CI) 1.05-1.16, p < 0.001. Analysis of the rate of PAS among women with previous cesarean delivery and PP revealed that no cases of PAS were noted when no prior cesarean delivery was present. The rate of PAS for previous 1, 2, 3, 4 and 5 cesarean deliveries was 26.7%, 43.5%, 65.5%, 55.6% and 66.7% respectively. DISCUSSION Efforts should be made to avoid general anesthesia in deliveries of PP.
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Affiliation(s)
- Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Amihai Rottenstreich
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hadas Ilan
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Cahan
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Tsur
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Jansen CHJR, Kleinrouweler CE, Kastelein AW, Ruiter L, van Leeuwen E, Mol BW, Pajkrt E. Follow-up ultrasound in second-trimester low-positioned anterior and posterior placentae: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:725-731. [PMID: 31671480 PMCID: PMC7702149 DOI: 10.1002/uog.21903] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/09/2019] [Accepted: 10/19/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The majority of cases of placenta previa or a low-lying placenta in the second trimester will have a normal placental position in the third trimester. The aim of this study was to assess the accuracy of the distance between the placenta and the internal os of the cervix (IOD) in the second trimester for the prediction of third-trimester low-positioned placenta, and to define a cut-off value at which all cases of third-trimester low-positioned placenta are identified. METHODS This was a prospective cohort study including women undergoing a transvaginal ultrasound examination between 18 and 24 weeks' gestation who had a low-positioned placenta, defined as an IOD of < 20 mm. Low-positioned placenta included placenta previa, defined as a placenta covering the internal os of the cervix, and a low-lying placenta, defined as a placenta lying near to (within 20 mm) but not overlying the internal os. All women were re-evaluated in the third trimester. Relative risks for a low-positioned placenta in the third trimester were calculated for women with placenta previa vs a low-lying placenta, posterior vs anterior placenta and positive vs negative history of Cesarean section. Multilevel likelihood ratios for ranges of IOD in the prediction of a low-positioned placenta in the third trimester were calculated separately for anteriorly and posteriorly located placentae. Corresponding receiver-operating-characteristics curves were constructed. RESULTS In total, 958 women were included in the study. In the second trimester, placentae were more frequently located on the posterior side (62.0%) than on the anterior side (38.0%). In the third trimester, 48/958 (5.0%) placentae persisted as a low-positioned placenta. Women with placenta previa in the second trimester had a higher risk of a low-positioned placenta in the third trimester than did those with a low-lying placenta in the second trimester (37/181 (20.4%) vs 11/777 (1.4%); relative risk (RR), 17.9 (95% CI, 8.9-36.0)). Women with a posterior placenta had a higher risk of a low-positioned placenta in the third trimester than did those with an anterior placenta (38/594 (6.4%) vs 10/364 (2.7%); RR, 2.4 (95% CI, 1.2-4.9)), as did women with a history of Cesarean section compared with those without such a history (14/105 (13.3%) vs 34/853 (4.0%); RR, 3.7 (95% CI, 1.9-7.2)). The cut-off value of IOD in the second trimester to identify all cases of an abnormally located placenta in the third trimester was 15.5 mm for posteriorly located placentae, while for anteriorly located placentae the IOD cut-off was lower, namely -4.5 mm, representing a 4.5-mm overlap of the placental edge over the internal os of the cervix. CONCLUSIONS With incorporation of a safety margin of 5 mm and ensuring that all women with placenta previa undergo a follow-up scan, we recommend lowering the IOD cut-off value for follow-up in cases of an anterior low-positioned placenta from 20 to 5 mm, which would decrease the number of unnecessary follow-up ultrasound examinations without missing any high-risk women. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. H. J. R. Jansen
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
| | - C. E. Kleinrouweler
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
| | - A. W. Kastelein
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
| | - L. Ruiter
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
| | - E. van Leeuwen
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
| | - B. W. Mol
- Monash University, Department of Obstetrics and GynaecologyClaytonVictoriaAustralia
| | - E. Pajkrt
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and GynaecologyAmsterdamThe Netherlands
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8
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King LJ, Dhanya Mackeen A, Nordberg C, Paglia MJ. Maternal risk factors associated with persistent placenta previa. Placenta 2020; 99:189-192. [PMID: 32854040 DOI: 10.1016/j.placenta.2020.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Maternal risk factors associated with placenta previa are well documented in the literature. However, there are limited studies identifying maternal characteristics associated with the persistence of placenta previa. The objective of the study was to determine maternal characteristics associated with the persistent placenta previa. METHODS A retrospective cohort study was conducted in which 705 pregnant women diagnosed with low-lying placenta or placenta previa between 17 and 24 weeks gestation were identified from a single institution between 2003 and 2017. The primary outcome included persistent placenta previa (i.e., persistent placental tissue within 2 cm of the internal os) at or after 36 weeks 0 days. Those with abnormal placentation (e.g., vasa previa, placenta accreta) or delivery prior to 36 weeks 0 days were excluded. Multivariable logistic regression modeling was utilized to determine significant maternal characteristics associated with persistent placenta previa among women diagnosed with either placenta previa or low-lying placenta. RESULTS Women with a prior cesarean delivery were seven times more likely to have persistent placenta previa (odds ratio, 7.0, 95% confidence interval, 3.7-13.1). A history of intrauterine curettage or evacuation in the setting of placenta previa increases the likelihood of persistent placenta previa almost 3-fold (odds ratio, 2.5, 95% confidence interval, 1.3-5.0). DISCUSSION To date, our study is the largest, retrospective cohort study assessing maternal risk factors associated with persistent placenta previa; and is the first to detect a statistically significant correlation between a history of intrauterine surgeries and persistent placenta previa.
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Affiliation(s)
- Luke J King
- Department of Obstetrics and Gynecology, Geisinger Health System, Danville, USA.
| | - A Dhanya Mackeen
- Department of Obstetrics and Gynecology, Geisinger Health System, Danville, USA
| | - Cara Nordberg
- Henry Hood Division of Biostatistics, Geisinger Health System, Danville, USA
| | - Michael J Paglia
- Department of Obstetrics and Gynecology, Geisinger Health System, Danville, USA
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9
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Retrospective Evaluation of Patients with Placenta Previa. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.591664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Stafford IA, Garite TJ, Maurel K, Combs CA, Heyborne K, Porreco R, Nageotte M, Baker S, Gopalani S, Dola C, How H, Das AF. Cervical Pessary versus Expectant Management for the Prevention of Delivery Prior to 36 Weeks in Women with Placenta Previa: A Randomized Controlled Trial. AJP Rep 2019; 9:e160-e166. [PMID: 31044098 PMCID: PMC6491366 DOI: 10.1055/s-0039-1687871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/21/2019] [Indexed: 02/06/2023] Open
Abstract
Objective This multicenter randomized controlled trial compared cervical pessary (CP) versus expectant management (EM) in women with placenta previa between 22.0 and 32.0 in prolonging gestation until ≥ 36.0 weeks' gestation. Study Design This study took place from November 2016 to June 2018. Women were randomized to receive either the Bioteque CP or EM. The pessary was removed at ≥ 36.0 weeks unless indicated. The primary outcome was gestational age (GA) at delivery, with secondary outcomes including need for transfusion, number and duration of antepartum admissions, type of delivery, and neonatal outcomes. A total of 140 patients were needed to show a 3-week prolongation of pregnancy in the pessary group; however, the trial was stopped early due to budgetary issues. Results Of the 33 eligible women, 17 were enrolled. Although not statistically significant, the mean GA at delivery in the CP group was greater than women in the EM group (36.5 ± 1.23 vs. 36.0 ± 2.0; p = 0.1673). The number and duration of antepartum admissions was greater in the EM group (2.7 ± 0.58 vs. 16.0 ± 22.76 days; p = 0.1264) as well. Conclusion Although the study was underpowered to determine the primary outcome, safety and feasibility of CP in pregnancies complicated with previa were demonstrated.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.,Touro Infirmary, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Thomas J Garite
- University of California, Irvine, Orange, California.,The Center for Research, Education, Quality and Safety, Mednax, Inc., Sunrise, Florida
| | - Kimberly Maurel
- The Center for Research, Education, Quality and Safety, Mednax, Inc., Sunrise, Florida
| | - C Andrew Combs
- The Center for Research, Education, Quality and Safety, Mednax, Inc., Sunrise, Florida.,Obstetrix Medical Group, San Jose, California
| | - Kent Heyborne
- Denver Health and Hospital Authority, Denver, Colorado
| | | | | | - Susan Baker
- University of South Alabama Children's and Women's Hospital, Mobile, Alabama
| | | | - Chi Dola
- Tulane Lakeside Hospital for Women and Children, New Orleans, Louisiana
| | - Helen How
- Norton Hospital, Louisville, Kentucky
| | - Anita F Das
- Das Consulting Group, San Francisco, California
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Morfaw F, Fundoh M, Bartoszko J, Mbuagbaw L, Thabane L. Using tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal, perinatal, neonatal and maternal outcomes: a systematic review and meta-analysis. Syst Rev 2018; 7:249. [PMID: 30591076 PMCID: PMC6307312 DOI: 10.1186/s13643-018-0923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/18/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain. OBJECTIVES The primary objective is to determine the effects of tocolysis versus no tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of tocolysis versus no tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths. METHODS We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing tocolysis to no tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome. MAIN RESULTS There is no significant difference in pregnancy prolongation with the use of tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, - 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI - 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI - 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI - 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI - 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI - 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence). CONCLUSION In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018091513.
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Affiliation(s)
- Frederick Morfaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Mercy Fundoh
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Jessica Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, Ontario Canada
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Saad AF, Kirsch N, Saade GR, Hankins GDV. Progressive Devascularization: A Novel Surgical Approach for Placenta Previa. AJP Rep 2018; 8:e223-e226. [PMID: 30345158 PMCID: PMC6188885 DOI: 10.1055/s-0038-1673373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
Background The gold standard for antenatal diagnosis of placenta previa is the transvaginal ultrasonography. In placenta previa cases, separation of placental and uterine tissues is challenging even for the most experienced surgeons. Life-threatening obstetrical complications from cesarean deliveries with placenta previa include peripartum hemorrhage, coagulopathy, blood transfusion, peripartum hysterectomy, and multiple organ failure. Cases We detailed the 3 cases of placenta previa that underwent bilateral uterine artery ligation; if hemostasis was not achieved, horizontal mattress sutures were placed in the lower uterine segment. All patients were discharged with minimal morbidity. Conclusion For patients with placenta previa and low risk for placenta creta, counseling should include the risk for maternal morbidity and criteria for pursuing peripartum hysterectomy. Our devascularization, a stepwise surgical approach, shows promising outcomes in placenta previa cases. Précis We propose a novel surgical approach, using a progressive devascularization surgical technique, for management of women with placenta previa, undergoing cesarean delivery.
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Affiliation(s)
- Antonio F Saad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Nathan Kirsch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - George R Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Gary D V Hankins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, Texas
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13
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Jeon H, Min J, Kim DK, Seo H, Kim S, Kim YS. Women with Endometriosis, Especially Those Who Conceived with Assisted Reproductive Technology, Have Increased Risk of Placenta Previa: Meta-analyses. J Korean Med Sci 2018; 33:e234. [PMID: 30127709 PMCID: PMC6097069 DOI: 10.3346/jkms.2018.33.e234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/18/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many women with endometriosis have become pregnant through assisted reproductive technology (ART), and have often experienced placenta previa (PP) during pregnancy. The objective of this study was to assess the association between women with endometriosis, especially those who conceived with ART, and the risk of PP. METHODS Two reviewers independently determined studies that were considered suitable for meta-analyses published in various medicine-related databases from March 1, 2004 through July 31, 2017 without language restrictions. Eight studies met the inclusion criteria, with a combined sample size of 21,930 women. Of these 21,930 pregnancies, 6,256 had endometriosis (endometriosis) and 15,674 had no endometriosis. Four of these studies included 8,161 women who conceived with ART, 1,640 of whom had endometriosis (endometriosis + ART), and 6,521 of whom did not have endometriosis. Meta-analyses were estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using random effect analysis according to heterogeneity of studies. RESULTS These meta-analyses showed women with endometriosis (endometriosis) have an increased risk of PP (OR, 4.038; 95% CI, 2.291-7.116; P = 0.000). These results showed women who conceived with ART (endometriosis + ART), have a substantially increased risk of PP (OR, 5.543; 95% CI, 1.659-18.523; P = 0.005). CONCLUSION These meta-analyses demonstrate women with endometriosis have an increased risk of PP.
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Affiliation(s)
- Hyeji Jeon
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jiwon Min
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Deok Kyeong Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Heekyung Seo
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sunkyung Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yun-Sook Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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14
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Roustaei Z, Vehviläinen-Julkunen K, Tuomainen TP, Lamminpää R, Heinonen S. The effect of advanced maternal age on maternal and neonatal outcomes of placenta previa: A register-based cohort study. Eur J Obstet Gynecol Reprod Biol 2018; 227:1-7. [PMID: 29859374 DOI: 10.1016/j.ejogrb.2018.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Advanced maternal age (AMA) at the time of delivery generally worsens obstetric outcomes, but its effects on specific pregnancy problems, such as placenta previa, have not been adequately assessed. Therefore, the objective of the study was to explore the effect of AMA on adverse maternal and neonatal outcomes among pregnancies complicated by placenta previa. STUDY DESIGN The study was a register-based cohort study using data of three Finnish health registries, including information of 283 324 women and their newborns. Separate multivariable logistic regression modeling was performed for women under age 35 and women aged 35 or older to assess the association between placenta previa and adverse maternal and neonatal outcomes. Furthermore, interactions between maternal age and placenta previa were tested. RESULTS A total of 283 324 deliveries of which 714 (0.3%) were complicated by placenta previa. Adverse maternal and neonatal outcomes increased in women with placenta previa, with different patterns across age groups. The adjusted odds ratios and 95% confidence intervals for AMA and young women with previa were 7.3 (5.0-10.6) and 6.8 (5.2-8.9) in blood transfusion, 11.3 (5.4-23.3) and 10.9 (6.1-19.6) in placental abruption. In neonatal outcomes the adjusted odds ratios for AMA and young women with placenta previa were 8.8 (6.6-11.6) and 11.7 (9.7-14.1) in preterm birth <37 weeks, 4.0 (3.0-5.3) and 4.9 (4.1-5.9) in neonatal intensive care unit (NICU) admission, 4.0 (2.8-5.7) and 5.9 (4.7-7.4) low birth weight <2500 g, 2.7 (1.5-4.9) and 3.3 (2.2-5.0) in low Apgar score at 5 min. The joint effects of maternal age and placenta previa on the risk of adverse maternal and neonatal outcomes were non-significant. CONCLUSIONS The risk of adverse maternal and neonatal outcomes for women with placenta previa was not substantially affected by maternal age if their different risk profiles were taken into account.
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Affiliation(s)
- Zahra Roustaei
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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15
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Audette MC, Levytska K, Lye SJ, Melamed N, Kingdom JC. Parental ethnicity and placental maternal vascular malperfusion pathology in healthy nulliparous women. Placenta 2018; 66:40-46. [PMID: 29884301 DOI: 10.1016/j.placenta.2018.04.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/02/2018] [Accepted: 04/25/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Rates of some placental-associated pregnancy complications vary by ethnicity, though the strength of association with underlying placental pathology is presently unknown. Our objective was to determine whether an association between ethnicity and placental pathology occurs in low-risk pregnancies. METHODS 829 low-risk nulliparous pregnant women were prospectively studied. Data were obtained from standardized obstetrical appointments (clinical history, serum biomarkers, placental ultrasound) and hospital delivery records (pregnancy complications, delivery details and perinatal outcomes). Placental pathology was performed in all subjects using standard criteria. RESULTS In our cohort, 72% of women were Caucasian, 14% East Asian, 8% South Asian, 4% Afro-Caribbean and 3% Hispanic women. 81% of couples were concordant (same ethnic background) and 19% discordant (mixed ethnicities). South Asian women had the highest rate of small for gestational age (SGA) birth (customized birthweight <10th percentile) (24.2%), which was associated with the placental features of uteroplacental vascular insufficiency (placental weight <10th percentile with decidual vasculopathy, focal infarction, and/or syncytial knot formation) (p = 0.05). Placental efficiency varied significantly by ethnicity; Caucasian women had the highest efficiency (7.1 ± 1.2) and Afro-Caribbean women the lowest (6.5 ± 0.9) (p < 0.003). Afro-Caribbean women had the highest rate of marginal cord insertion. Placental efficiency, was higher in concordant vs. discordant couples (7.0 ± 1.2 vs. 6.8 ± 1.1; p < 0.05). Placental histopathology was not affected by parental ethnic discordance. DISCUSSION Maternal ethnicity influences placental efficiency and relationship between uteroplacental vascular insufficiency and SGA birth, but was not associated with other placental pathologies. Discordant parental ethnicity did not affect the development of placental pathologies or adverse pregnancy outcomes.
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Affiliation(s)
- Melanie C Audette
- The Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Faculty of Medicine - University of Toronto, Toronto, Ontario, Canada.
| | - Khrystyna Levytska
- Department of Obstetrics and Gynaecology (Maternal Fetal Medicine), University of Toronto, Toronto, Ontario, Canada.
| | - Stephen J Lye
- The Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Faculty of Medicine - University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology (Maternal Fetal Medicine), University of Toronto, Toronto, Ontario, Canada.
| | - Nir Melamed
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Canada.
| | - John C Kingdom
- The Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Faculty of Medicine - University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology (Maternal Fetal Medicine), University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.
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16
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Wortman AC, Schaefer SL, McIntire DD, Sheffield JS, Twickler DM. Complete Placenta Previa: Ultrasound Biometry and Surgical Outcomes. AJP Rep 2018; 8:e74-e78. [PMID: 29686936 PMCID: PMC5910059 DOI: 10.1055/s-0038-1641163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/23/2018] [Indexed: 11/01/2022] Open
Abstract
Objective To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa. Study Design This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge. If morbidly adherent placentation was suspected, women were excluded. Receiver operating characteristic (ROC) curves were developed for pertinent surgical outcomes, and multivariate analysis was performed to determine the placental extension with the best predictive discriminatory zone. Results In total, 157 women had placenta previa, ultrasound, and delivery data: 86 (55%) had a placental extension of <40 mm, and 71 (45%) had a placental extension of ≥40 mm. Women with placental extension of ≥40 mm had increased surgical time, blood loss > 2,000 mL, blood transfusion, and rate of peripartum hysterectomy. After multivariate analysis, only peripartum hysterectomy and surgical time > 90 minutes remained significant, p ≤ 0.05 and p ≤ 0.01, respectively. Conclusion In women with placenta previa, the placental extension ultrasound measurement of ≥40 mm is a predictor of adverse surgical outcomes.
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Affiliation(s)
- Alison C Wortman
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephanie L Schaefer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Donald D McIntire
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeanne S Sheffield
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Diane M Twickler
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
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M M, A V, Gn G, E N, Ae P, I M. Association of Placenta Previa with a History of Previous Cesarian Deliveries and Indications for a Possible Role of a Genetic Component. Balkan J Med Genet 2017; 20:5-10. [PMID: 29876227 PMCID: PMC5972497 DOI: 10.1515/bjmg-2017-0022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A prior Cesaria section (C-section) is an important risk factor that leads to endometrial damage and abnormal implantation of the placenta. Our retrospective study aims to correlate the frequency of placenta previa to previous C-sections, to determine the effect of male gender in this condition and to evaluate further the maternal outcome. Seventy-six cases with placenta previa were selected out of 5200 live births. Diagnosis was confirmed by ultrasound and in the operating theater. In the 76 women examined, we found 50 cases with a history of a previous C-section (66.0%) and 49 male offspring (65.0%) (p <0.001), with a mean birth weight of 2635 ± 740 g. Of all these patients, six (8.0%) cases developed placenta percreta, seven (9.0%) were transferred to the intensive care unit (ICU), 14 (18.0%) women needed blood transfusion and eight (11.0%) underwent hysterectomy. The results of our series show a strong correlation of placenta previa to a history of previous C-sections and a predominance of male fetuses. Early recognition and proper monitoring could minimize the possibility of a poor outcome.
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Affiliation(s)
- Matalliotakis M
- Department of Obstetrics and Gynecology, Venizeleio General Hospital, Heraklion, Greece
| | - Velegrakis A
- Department of Obstetrics and Gynecology, Venizeleio General Hospital, Heraklion, Greece
| | - Goulielmos Gn
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Niraki E
- Department of Obstetrics and Gynecology, Venizeleio General Hospital, Heraklion, Greece
| | - Patelarou Ae
- Department of Nursing, Technological and Educational Institute of Crete, Heraklion, Greece
| | - Matalliotakis I
- Department of Obstetrics and Gynecology, Venizeleio General Hospital, Heraklion, Greece
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18
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Variations of placental migration in patients with early third trimester malposition. J Med Ultrason (2001) 2017; 45:99-102. [DOI: 10.1007/s10396-017-0791-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
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19
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Verspyck E, de Vienne C, Muszynski C, Bubenheim M, Chanavaz-Lacheray I, Dreyfus M, Deruelle P, Benichou J. Maintenance nifedipine therapy for preterm symptomatic placenta previa: A randomized, multicenter, double-blind, placebo-controlled trial. PLoS One 2017; 12:e0173717. [PMID: 28333939 PMCID: PMC5363821 DOI: 10.1371/journal.pone.0173717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the impact of maintenance nifedipine therapy on pregnancy duration in women with preterm placenta previa bleeding. Methods PPADAL was a randomized, double-blind, placebo-controlled trial conducted between 05/2008 and 05/2012 in five French hospitals. The trial included 109 women, aged ≥ 18 years, with at least one episode of placenta previa bleeding, intact membranes and no other pregnancy complication, at gestational age 24 to 34 weeks and after 48 hours of complete acute tocolysis. Women were randomly allocated to receive either 20 mg of slow-release nifedipine three times daily (n = 54) or placebo (n = 55) until 36 + 6 weeks of gestation. The primary outcome for the trial was length of pregnancy measured in days after enrolment. Main secondary outcomes were rates of recurrent bleeding, cesarean delivery due to hemorrhage, blood transfusion, maternal side effects, gestational age at delivery and adverse perinatal outcomes (perinatal death, chronic lung disease, neonatal sepsis, intraventricular hemorrhage > grade 2, perventricular leukomalacia > grade 1, or necrotizing enterocolitis). Analysis was by intention to treat. Results Mean (SD) prolongation of pregnancy was not different between the nifedipine (n = 54) and the placebo (n = 55) group; 42.5 days ± 23.8 versus 44.2 days ± 24.5, p = 0.70. Cesarean due to hemorrhage performed before 37 weeks occurred more frequently in the nifedipine group in comparison with the placebo group (RR, 1.66; 95% confidence interval, 1.05–2.72). Adverse perinatal outcomes were comparable between groups; 3.8% for nifedipine versus 5.5% for placebo (relative risk, 0.52; 95% confidence interval 0.10–2.61). No maternal mortality or perinatal death occurred. Conclusion Maintenance oral nifedipine neither prolongs duration of pregnancy nor improves maternal or perinatal outcomes. Trial registration ClinicalTrials.gov NCT00620724
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Affiliation(s)
- Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
- * E-mail:
| | - Claire de Vienne
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Charles Muszynski
- Department of Obstetrics and Gynecology, Amiens University Hospital, Amiens, France
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | | | - Michel Dreyfus
- Department of Obstetrics and Gynecology, Caen University Hospital, Caen, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Lille University, EA 4489—Environnement Périnatal et Santé, Lille, France
| | - Jacques Benichou
- Inserm U657, University of Rouen and Biostatistics, Rouen, France
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Abstract
Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period. Obstetric-specific hemorrhage protocols, facilitating the integration and timely escalation of pharmacologic, radiological, surgical, and transfusion interventions, are critical to the successful management of peripartum bleeding.
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Affiliation(s)
- Emily J Baird
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mailcode UH2, Portland, OR 97239, USA.
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Coskun B, Akkurt I, Dur R, Akkurt MO, Ergani SY, Turan OT, Coskun B. Prediction of maternal near-miss in placenta previa: a retrospective analysis from a tertiary center in Ankara, Turkey. J Matern Fetal Neonatal Med 2017; 31:370-375. [DOI: 10.1080/14767058.2017.1285896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bora Coskun
- Department of Obstetrics and Gynecology, Polatlı State Hospital, Ankara, Turkey
| | - Iltac Akkurt
- Department of Obstetrics and Gynecology, Isparta Maternity and Children’s Hospital, Isparta, Turkey
| | - Rıza Dur
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Mehmet O. Akkurt
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Perinatology, Suleyman Demirel University, Isparta, Turkey
| | - Seval Y. Ergani
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Maternity and Women’s Health Teaching and Research Hospital, Ankara, Turkey
| | - Ozerk T. Turan
- College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - Bugra Coskun
- Department of Obstetrics and Gynecology, Sincan State Hospital, Ankara, Turkey
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22
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Charoenraj P, Charuluxananan S, Chatrkaw P, Tunprasit C, Wangdumrongwong P, Phupong V. Brief communication (Original). Anesthesia for cesarean section in parturients diagnosed with placenta previa in a Thai university hospital: a retrospective analysis of 562 consecutive cases. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Anesthesia for cesarean delivery in parturients diagnosed with placenta previa remains controversial.
Objectives: To investigate factors correlated with choice of anesthesia in these parturients and their outcomes.
Methods: Retrospective analysis of patients with placenta previa and cesarean delivery at King Chulalongkorn Memorial Hospital. Peri operative anesthetic and complication data were collected using a structured collection form. Univariate analysis and multivariate logistic regression were used. P < 0.05 was considered significant.
Results: Among 50,237 deliveries from July 1, 2005 to June 30, 2011, there were 562 cesarean sections in diagnosed cases of placenta previa. Cesarean deliveries (479) were performed under spinal anesthesia (81%), epidural anesthesia (1.8%), and if the effects spinal anesthesia dissipated, general anesthesia (2.3%). Among 46 cases of cesarean hysterectomy, 27 patients (58.7%) received regional anesthesia. However, 6 of 10 patients with planned cesarean hysterectomy underwent general anesthesia, while 1 of 4 of a group with regional anesthesia needed conversion to general anesthesia. There was no serious anesthesia-related complication. Factors related to general anesthesia were: a higher American Society of Anesthesiologists (ASA) physical status OR 2.7 (95% CI 1.7-4.3) P < 0.001; presentation with bleeding OR 1.8(95% CI 1.0-3.1) P = 0.033; anterior site of placenta OR 1.8 (95% CI 1.1-3.2) P = 0.025; heart rate >125 bpm OR 5.6 (95% CI 1.5-214) P = 0.01; and pack red cell transfusion OR 3.4 (95% CI 2.0-5.7) P < 0.001.
Conclusions: Most parturients received regional anesthesia. Neuroaxial anesthesia and general anesthesia are safe.
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Affiliation(s)
- Pornarun Charoenraj
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Somrat Charuluxananan
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Phornlert Chatrkaw
- Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chooksak Tunprasit
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Parinya Wangdumrongwong
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Vorapong Phupong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Hong DH, Kim E, Kyeong KS, Hong SH, Jeong EH. Safety of cesarean delivery through placental incision in patients with anterior placenta previa. Obstet Gynecol Sci 2016; 59:103-9. [PMID: 27004200 PMCID: PMC4796079 DOI: 10.5468/ogs.2016.59.2.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To demonstrate the safety of fetal delivery through placental incision in a placenta previa pregnancy. METHODS We examined the medical records of 80 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between May 2010 and May 2015 at the Department of Obstetrics and Gynecology, Chungbuk National University Hospital. Among the women with placenta previa, those who did not have the placenta in the uterine incision site gave birth via conventional uterine incision, while those with anterior placenta previa or had placenta attached to the uterine incision site gave birth via uterine incision plus placental incision. We compared the postoperative hemoglobin level and duration of hospital stay for the mother and newborn of the two groups. RESULTS There was no difference between the placental incision group and non-incision group in terms of preoperative and postoperative hemoglobin change, the amount of blood transfusions required by the mother, newborns with 1-min or 5-min Apgar scores below 7 points or showing signs of acidosis on umbilical cord blood gas analysis result of pH below 7.20. Moreover, neonatal hemoglobin levels did not differ between the two groups. CONCLUSION Fetal delivery through placental incision during cesarean section for placenta previa pregnancy does not negatively influence the prognosis of the mother or the newborn, and therefore, is considered a safe surgical technique.
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Affiliation(s)
- Deok-Ho Hong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Eugene Kim
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu-Sang Kyeong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seung Hwa Hong
- Department of Obstetrics and Gynecology, Chungbuk National University College of Medicine, Cheongju, Korea
- Chungbuk National University Medical Research Institute, Cheongju, Korea
| | - Eun-Hwan Jeong
- Department of Obstetrics and Gynecology, Chungbuk National University College of Medicine, Cheongju, Korea
- Chungbuk National University Medical Research Institute, Cheongju, Korea
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Mastrolia SA, Baumfeld Y, Loverro G, Yohai D, Hershkovitz R, Weintraub AY. Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study. J Matern Fetal Neonatal Med 2016; 29:3467-71. [PMID: 26653989 DOI: 10.3109/14767058.2015.1131264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The aim of our study was to compare maternal and neonatal outcomes in women with placenta previa complicated with severe bleeding leading to hospitalization until delivery versus those without severe bleeding episodes. METHODS This is a population-based retrospective cohort study including all pregnant women with placenta previa who delivered at our medical center in the study period, divided into the following groups: 1) women with severe bleeding leading to hospitalization resulting with delivery (n = 32); 2) patients with placenta previa without severe bleeding episodes (n = 1217). RESULTS Out of all women with placenta previa who delivered at our medical center, 2.6% (32/1249) had an episode of severe bleeding leading to hospitalization and resulting with delivery. The rate of anemia was lower (43.8% versus 63.7%, p = 0.02) while the need for blood transfusion higher (37.5% versus 21.1%, p = 0.03) in the study group. The rate of cesarean sections was significantly different between the groups, and a logistic regression model was constructed in order to find independent risk factors for cesarean section in our patients. CONCLUSION To the best of our knowledge, this is the first study to evaluate the impact of severe bleeding on the outcome of pregnancies complicated with placenta previa. Our study demonstrates that, in women with placenta previa, severe bleeding does not lead to increased adverse maternal or neonatal outcomes.
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Affiliation(s)
- Salvatore Andrea Mastrolia
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and.,b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - Yael Baumfeld
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Giuseppe Loverro
- b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico Di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy
| | - David Yohai
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Reli Hershkovitz
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
| | - Adi Yehuda Weintraub
- a Department of Obstetrics and Gynecology, Faculty of Health Sciences , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel and
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Abstract
Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology. The routine use of obstetric ultrasonography as well as improving ultrasonographic technology allows for the antenatal diagnosis of these conditions. In turn, antenatal diagnosis facilitates optimal obstetric management. This review emphasizes an evidence-based approach to the clinical management of pregnancies with these conditions as well as highlights important knowledge gaps.
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Ahmed SR, Aitallah A, Abdelghafar HM, Alsammani MA. Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study. J Clin Diagn Res 2015; 9:QC17-9. [PMID: 26674539 DOI: 10.7860/jcdr/2014/14930.6831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. AIM To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). MATERIALS AND METHODS A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. RESULTS The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. CONCLUSION The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services.
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Affiliation(s)
- Salah Roshdy Ahmed
- Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Abdusaeed Aitallah
- Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Hazem M Abdelghafar
- Assistant Professor, Department of Obstetrics and Gynecology, Sohag University , Egypt
| | - Mohamed Alkhatim Alsammani
- Associate Professor, Department of Obstetrics and Gynecology, College of Medicine, Qassim University, Saudi Arabia & University of Bahri , Sudan
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Cho HY, Park YW, Kim YH, Jung I, Kwon JY. Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients. PLoS One 2015; 10:e0134282. [PMID: 26263014 PMCID: PMC4532486 DOI: 10.1371/journal.pone.0134282] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/07/2015] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. METHODS We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. RESULTS Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01). CONCLUSION Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.
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Affiliation(s)
- Hee Young Cho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Yong Won Park
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Young Han Kim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Inkyung Jung
- Department of Biostatistics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Ja-Young Kwon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol 2015; 123:1070-1082. [PMID: 24785860 DOI: 10.1097/aog.0000000000000245] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Burgers M, Rengerink KO, Eschbach SJ, Muller MM, Pampus MGV, Mol BWJ, Graaf IMD. Predictors for Massive Haemorrhage during Caesarean Delivery Due to Placenta Praevia. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijcm.2015.62014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Broekman EA, Versteeg H, Vos LD, Dijksterhuis MG, Papatsonis DN. Temporary balloon occlusion of the internal iliac arteries to prevent massive hemorrhage during cesarean delivery among patients with placenta previa. Int J Gynaecol Obstet 2014; 128:118-21. [DOI: 10.1016/j.ijgo.2014.08.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/20/2014] [Accepted: 10/21/2014] [Indexed: 11/26/2022]
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Verspyck E, Douysset X, Roman H, Marret S, Marpeau L. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. Int J Gynaecol Obstet 2014; 128:44-7. [DOI: 10.1016/j.ijgo.2014.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/29/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
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Bereczky LK, Kiss SL, Szabó B. Increased frequency of gestational and delivery-related complications in women of 35 years of age and above. J OBSTET GYNAECOL 2014; 35:115-20. [DOI: 10.3109/01443615.2014.940294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rowe T. Placenta prævia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsuda H, Kotani T, Sumigama S, Mano Y, Hua L, Kikkawa F. Impact of warning bleeding on the cortisol level in the fetus and neonatal RDS/TTN in cases of placenta previa. J Matern Fetal Neonatal Med 2014; 28:1057-60. [DOI: 10.3109/14767058.2014.942632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210:387-97. [PMID: 24793721 DOI: 10.1016/j.ajog.2014.02.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 11/28/2022]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and magnetic resonance imaging in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost-effectiveness and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX.
| | - Alfred Z Abuhamad
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - Deborah Levine
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
| | - George R Saade
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Eastern Virginia Medical School, Norfolk, VA; Beth Israel Deaconess Medical Center, Boston, MA; University of Texas Medical Branch at Galveston, Galveston, TX
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Reddy UM, Abuhamad AZ, Levine D, Saade GR. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:745-757. [PMID: 24764329 DOI: 10.7863/ultra.33.5.745] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given that practice variation exists in the frequency and performance of ultrasound and magnetic resonance imaging (MRI) in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development hosted a workshop to address indications for ultrasound and MRI in pregnancy, to discuss when and how often these studies should be performed, to consider recommendations for optimizing yield and cost effectiveness, and to identify research opportunities. This article is the executive summary of the workshop.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd, Room 4B03F, Bethesda, MD 20892-7510 USA.
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Asıcıoglu O, Şahbaz A, Güngördük K, Yildirim G, Asıcıoglu BB, Ülker V. Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey. J OBSTET GYNAECOL 2014; 34:462-6. [DOI: 10.3109/01443615.2014.902040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ueno Y, Kitajima K, Kawakami F, Maeda T, Suenaga Y, Takahashi S, Matsuoka S, Tanimura K, Yamada H, Ohno Y, Sugimura K. Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations. Eur Radiol 2013; 24:881-8. [DOI: 10.1007/s00330-013-3076-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/20/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
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Abstract
The diagnosis of placenta previa has shifted from clinical examination of the dilated cervix to sonographic assessment of the closed internal os, resulting in terminology confusion. If the cervix is closed, the distinction between a placental edge at the cervical margin and one partially covering the os is neither reliable nor clinically important. Cesarean delivery is recommended if the placenta reaches the cervical margin at time of delivery, and this entity may be grouped with placenta previa. Partial previa should probably be restricted to those with cervical dilatation. The terms marginal previa and low-lying placenta have been used interchangeably. However, if the placenta implants in the lower uterine segment but does not reach the cervix, low-lying placenta is preferred, and vaginal delivery may be achieved, depending on placental-os distance and presence of bleeding. Limited data suggest that if the placenta is within 2 cm of the os-low-lying placenta, cesarean delivery is performed for bleeding in one-third of cases.
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Affiliation(s)
- Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9032.
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Scholten BL, Page-Christiaens GCML, Franx A, Hukkelhoven CWPM, Koster MPH. The influence of pregnancy termination on the outcome of subsequent pregnancies: a retrospective cohort study. BMJ Open 2013; 3:bmjopen-2013-002803. [PMID: 23793655 PMCID: PMC3669713 DOI: 10.1136/bmjopen-2013-002803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare the incidences of preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems (ie, placenta praevia, placental abruption and retained placenta) and postpartum haemorrhage between women with and without a history of pregnancy termination. DESIGN A retrospective cohort study using aggregated data from a national perinatal registry. SETTING All midwifery practices and hospitals in the Netherlands. PARTICIPANTS All pregnant women with a singleton pregnancy without congenital malformations and a gestational age of ≥20 weeks who delivered between January 2000 and December 2007. MAIN OUTCOME MEASURES Preterm delivery, cervical incompetence treated by cerclage, placenta praevia, placental abruption, retained placenta and postpartum haemorrhage. RESULTS A previous pregnancy termination was reported in 16 000 (1.2%) deliveries. The vast majority of these (90-95%) were performed by surgical methods. The incidence of all outcome measures was significantly higher in women with a history of pregnancy termination. Adjusted ORs (95% CI) for cervical incompetence treated by cerclage, preterm delivery, placental implantation or retention problems and postpartum haemorrhage were 4.6 (2.9 to 7.2), 1.11 (1.02 to 1.20), 1.42 (1.29 to 1.55) and 1.16 (1.08 to 1.25), respectively. Associated numbers needed to harm were 1000, 167, 111 and 111, respectively. For any listed adverse outcome, the number needed to harm was 63. CONCLUSIONS In this large nationwide cohort study, we found a positive association between surgical termination of pregnancy and subsequent preterm delivery, cervical incompetence treated by cerclage, placental implantation or retention problems and postpartum haemorrhage in a subsequent pregnancy. Absolute risks for these outcomes, however, remain small. Medicinal termination might be considered first whenever there is a choice between both methods.
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Affiliation(s)
- Brenda L Scholten
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arie Franx
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Maria P H Koster
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
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Takemura Y, Osuga Y, Fujimoto A, Oi N, Tsutsumi R, Koizumi M, Yano T, Taketani Y. Increased risk of placenta previa is associated with endometriosis and tubal factor infertility in assisted reproductive technology pregnancy. Gynecol Endocrinol 2013; 29:113-5. [PMID: 22835092 DOI: 10.3109/09513590.2012.706669] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although assisted reproductive technology (ART) is suspected to increase the risk of placenta previa, a life-threatening complication of pregnancy, the reason is poorly understood. We recruited consecutive 318 pregnancies conceived by ART in our clinic and examined relation of ten variables, i.e. maternal age, gravidity, parity, male or female fetus, previous abortion, previous cesarean delivery, endometriosis, ovulatory disorder, tubal disease, and male infertility, to placenta previa, by logistic regression analysis. As a result, we found that endometriosis (odds ratio = 15.1; 95% CI = 7.6-500.0) and tubal disease (odds ratio = 4.4; 95% CI = 1.1-26.3) were significantly associated with placenta previa. It would be preferable to take the increased risk of placenta previa into account in treating ART pregnancy with endometriosis and tubal disease.
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Affiliation(s)
- Yuri Takemura
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
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Abstract
Complications of late pregnancy are managed infrequently in the emergency department and, thus, can pose a challenge when the emergency physician encounters acute presentations. An expert understanding of the anatomic and physiologic changes and possible complications of late pregnancy is vital to ensure proper evaluation and care for both mother and fetus. This article focuses on the late pregnancy issues that the emergency physician will face, from the bleeding and instability of abruptio placentae to the wide spectrum of complications and management strategies encountered with preterm labor.
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Silver RM. Implications of the first cesarean: perinatal and future reproductive health and subsequent cesareans, placentation issues, uterine rupture risk, morbidity, and mortality. Semin Perinatol 2012; 36:315-23. [PMID: 23009962 DOI: 10.1053/j.semperi.2012.04.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rates of cesarean delivery have substantially increased worldwide during the past 30 years. Indeed, almost one-third of deliveries in the United States are cesareans. Most cesareans are safe, and major complications are uncommon. However, there is a "concealed" downside to cesarean deliveries. There are rare but life-threatening morbidities that may occur, which are often overlooked because most cesareans go well. In addition, subsequent pregnancies are fraught with an increased risk of both maternal and fetal complications. The worst of these are associated with placental problems such as previa, abruption, and accreta. The risk dramatically worsens in patients with multiple repeat cesarean deliveries. This article will summarize and highlight the implications of the rising cesarean rate on maternal and fetal morbidity and mortality.
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Affiliation(s)
- Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
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Erez O, Novack L, Klaitman V, Erez-Weiss I, Beer-Weisel R, Dukler D, Mazor M. Early preterm delivery due to placenta previa is an independent risk factor for a subsequent spontaneous preterm birth. BMC Pregnancy Childbirth 2012; 12:82. [PMID: 22876799 PMCID: PMC3489587 DOI: 10.1186/1471-2393-12-82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 08/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. METHODS This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. RESULTS Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p < .001). Among patients with placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. CONCLUSIONS Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended.
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Affiliation(s)
- Offer Erez
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, P O Box 151, Beer Sheva, 84101, Israel.
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