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Mitchell MI, Khalil M, Ben-Dov IZ, Alverez-Perez J, Illsley NP, Zamudio S, Al-Khan A, Loudig O. Customizing EV-CATCHER to Purify Placental Extracellular Vesicles from Maternal Plasma to Detect Placental Pathologies. Int J Mol Sci 2024; 25:5102. [PMID: 38791142 PMCID: PMC11121217 DOI: 10.3390/ijms25105102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Placenta Accreta Spectrum (PAS) is a life-threatening condition in which placental trophoblastic cells abnormally invade the uterus, often up to the uterine serosa and, in extreme cases, tissues beyond the uterine wall. Currently, there is no clinical assay for the non-invasive detection of PAS, and only ultrasound and MRI can be used for its diagnosis. Considering the subjectivity of visual assessment, the detection of PAS necessitates a high degree of expertise and, in some instances, can lead to its misdiagnosis. In clinical practice, up to 50% of pregnancies with PAS remain undiagnosed until delivery, and it is associated with increased risk of morbidity/mortality. Although many studies have evaluated the potential of fetal biomarkers circulating in maternal blood, very few studies have evaluated the potential of circulating placental extracellular vesicles (EVs) and their miRNA contents for molecular detection of PAS. Thus, to purify placental EVs from maternal blood, we customized our robust ultra-sensitive immuno-purification assay, termed EV-CATCHER, with a monoclonal antibody targeting the membrane Placental Alkaline Phosphatase (PLAP) protein, which is unique to the placenta and present on the surface of placental EVs. Then, as a pilot evaluation, we compared the miRNA expression profiles of placental EVs purified from the maternal plasma of women diagnosed with placenta previa (controls, n = 16); placenta lying low in uterus but not invasive) to those of placental EVs purified from the plasma of women with placenta percreta (cases, n = 16), PAS with the highest level of invasiveness. Our analyses reveal that miRNA profiling of PLAP+ EVs purified from maternal plasma identified 40 differentially expressed miRNAs when comparing these two placental pathologies. Preliminary miRNA pathway enrichment and gene ontology analysis of the top 14 upregulated and top nine downregulated miRNAs in PLAP+ EVs, purified from the plasma of women diagnosed with placenta percreta versus those diagnosed with placenta previa, suggests a potential role in control of cellular invasion and motility that will require further investigation.
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Affiliation(s)
- Megan I. Mitchell
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
- Hackensack University Medical Center, Department of Pediatrics, Hackensack Meridian Health, Hackensack, NJ 07601, USA;
- Hackensack Meridian School of Medicine (HMHSOM), Nutley, NJ 07110, USA; (J.A.-P.); (A.A.-K.)
| | - Marwa Khalil
- Hackensack University Medical Center, Department of Pediatrics, Hackensack Meridian Health, Hackensack, NJ 07601, USA;
- Hackensack Meridian School of Medicine (HMHSOM), Nutley, NJ 07110, USA; (J.A.-P.); (A.A.-K.)
| | - Iddo Z. Ben-Dov
- Laboratory of Medical Transcriptomics, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Jesus Alverez-Perez
- Hackensack Meridian School of Medicine (HMHSOM), Nutley, NJ 07110, USA; (J.A.-P.); (A.A.-K.)
- Hackensack University Medical Center, Department of Maternal and Fetal Medicine, Hackensack Meridian Health, Hackensack, NJ 07601, USA; (N.P.I.)
| | - Nicholas P. Illsley
- Hackensack University Medical Center, Department of Maternal and Fetal Medicine, Hackensack Meridian Health, Hackensack, NJ 07601, USA; (N.P.I.)
| | - Stacy Zamudio
- Hackensack University Medical Center, Department of Maternal and Fetal Medicine, Hackensack Meridian Health, Hackensack, NJ 07601, USA; (N.P.I.)
| | - Abdulla Al-Khan
- Hackensack Meridian School of Medicine (HMHSOM), Nutley, NJ 07110, USA; (J.A.-P.); (A.A.-K.)
- Hackensack University Medical Center, Department of Maternal and Fetal Medicine, Hackensack Meridian Health, Hackensack, NJ 07601, USA; (N.P.I.)
| | - Olivier Loudig
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
- Hackensack University Medical Center, Department of Pediatrics, Hackensack Meridian Health, Hackensack, NJ 07601, USA;
- Hackensack Meridian School of Medicine (HMHSOM), Nutley, NJ 07110, USA; (J.A.-P.); (A.A.-K.)
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Arakaza A, Zou L, Zhu J. Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review. Int J Womens Health 2023; 15:635-654. [PMID: 37101719 PMCID: PMC10124567 DOI: 10.2147/ijwh.s395271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
Background Placenta accreta spectrum (PAS) is the most common obstetric complication in current obstetrics in which the placenta is fully or partially attached to the uterine myometrial layer at delivery. This is commonly due to the deficiency of the uterine interface between the uterine endometrial and myometrial layers leading to abnormal decidualization at the uterine scar area, which permits the abnormally placental anchoring villous and trophoblasts, deeply invade the myometrium. The prevalence of PAS is globally at rising trends every day in modern obstetrics originally due to the high increasing rate of cesarean sections, placenta previa, and assisted reproductive technology (ART). Thus, the early and precise diagnosis of PAS is imperative to prevent maternal intrapartum or postpartum bleeding complications. Objective The main aim of this review is to debate the current challenges and controversies in the routine diagnosis of PAS diseases in obstetrics. Data Source We retrospectively reviewed the recent articles on different methods of diagnosing PAS in PubMed, Google Scholar, Web of Science, Medline, Embase, and other website databases. Results Despite that, the standard ultrasound is a reliable and key tool for the diagnosis of PAS, the lack of ultrasound features does not exclude the diagnosis of PAS. Therefore, clinical assessment of risk factors, MRI tests, serological markers, and placental histopathological tests are also indispensable for the prediction of PAS. Previously, limited studies reached a high sensitivity rate of diagnosis PAS in appropriate cases, while many studies recommended the inclusion of different diagnosis methods to improve the diagnosis accuracy. Conclusion A multidisciplinary squad with well-experienced obstetricians, radiologists, and histopathologists should be involved in the establishment of the early and conclusive diagnosis of PAS.
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Affiliation(s)
- Arcade Arakaza
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Zou
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Correspondence: Li Zou, Email
| | - Jianwen Zhu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Cai SN, Wu YT, Zeng L, Ding YQ. Value of 3D ultrasound flow imaging combined with serum AFP, β-hCG, sFlt-1 and CK in the diagnosis of placenta accreta. BMC Womens Health 2022; 22:556. [PMID: 36581918 PMCID: PMC9798680 DOI: 10.1186/s12905-022-02107-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To analyze the diagnostic value of placenta three-dimensional (3D) energy blood flow parameters combined with maternal serum AFP, β-hCG, sFlt-1 and CK levels for PA. METHODS 30 pregnant women with PA and 30 pregnant women with normal placenta were randomly selected in the Affiliated Maternal and Child Health Hospital of Nantong University from January 2021 to December 2021. Thereafter, the 3D energy ultrasound was applied to detect the placenta VI, FI and VFI. Moreover, the diagnostic value of different parameters combined with serum AFP, β-hCG, sFlt-1 and CK levels for PA was analyzed. RESULTS Multivariate analysis results indicated that, gravidity > 2 and with/without placenta previa were the independent risk factors for PA (P < 0.05). In PA group, the AFP, β-hCG, CK, placenta VI, FI and VFI values were higher than those in non-PA group, while sFlt-1 was apparently lower than that in non-PA group. With the increase in PA degree, the serum AFP, β-hCG and CK levels increased. Meanwhile, serum sFlt-1 level was negatively correlated with PA degree. Serum AFP, β-hCG, sFlt-1, CK and placenta VFI showed prediction potency for PA, and their combined detection attained the optimal diagnostic value for predicting PA. ROC curve analysis suggested that, serum AFP, β-hCG, sFlt-1, CK and 3D ultrasound VFI value had the greatest AUC values in predicting PA, which might provide reference for the clinical diagnosis and disease evaluation of PA. Conclusion Serum AFP, β-hCG, sFlt-1, CK and placental VFI can increase the consistency in the diagnosis of PA. Serum markers combined with 3D ultrasound blood flow imaging can improve the sensitivity and specificity of prenatal diagnosis of PA, which provides an important reference for clinical diagnosis and treatment.
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Affiliation(s)
- Sheng-nan Cai
- grid.260483.b0000 0000 9530 8833Department of Gynecology, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, 226000 Jiangsu China
| | - Yan-ting Wu
- grid.260483.b0000 0000 9530 8833Department of Gynecology, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, 226000 Jiangsu China
| | - Li Zeng
- grid.260483.b0000 0000 9530 8833Department of Gynecology, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, 226000 Jiangsu China
| | - Yi-qian Ding
- grid.260483.b0000 0000 9530 8833Department of Gynecology, Affiliated Matern&Child Care Hospital of Nantong University, 399 Century Avenue, Chongchuan District, Nantong, 226000 Jiangsu China
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Abstract
INTRODUCTION Abnormally invasive placenta (AIP, aka placenta accreta spectrum; PAS) is an increasingly common pregnancy pathology, which, despite significant morbidity risk to the mother, is often undiagnosed prior to delivery. We tested several potential biomarkers in plasma from PAS mothers to determine whether any were sufficiently robust for a formal, diagnostic accuracy study. METHODS We examined hyperglycosylated hCG (h-hCG), decorin and IL-8, based on biological plausibility and literature indications that they might be altered in PAS. These analytes were assayed by ELISA in maternal plasma from five groups, comprising (1) normal term controls, (2) placenta previa controls, and cases of (3) placenta increta/percreta without placenta previa, (4) placenta previa increta/percreta and (5) placenta previa accreta. RESULTS There were no differences in h-hCG, ß-hCG or the h-hCG/ß-hCG ratio between the groups. Mean decorin levels were increased in previa controls (Group 2) compared to the other groups, but there was substantial overlap between the individual values. While an initial multiplex assay showed a greater value for IL-8 in the placenta previa increta/percreta group (Group 4) compared to placenta previa controls (Group 2), the subsequent validation ELISA for IL-8 showed no differences between the groups. DISCUSSION We conclude that the absence of differences and the extent of overlap between cases and controls does not justify further assessment of these biomarkers.
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Li J, Zhang N, Zhang Y, Hu X, Gao G, Ye Y, Peng W, Zhou J. Human placental lactogen mRNA in maternal plasma play a role in prenatal diagnosis of abnormally invasive placenta: yes or no? Gynecol Endocrinol 2019; 35:631-634. [PMID: 30784325 DOI: 10.1080/09513590.2019.1576607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To determine whether maternal plasma human placental lactogen (hPL) mRNA levels can predict abnormally invasive placenta. Study design: Sixty-eight singleton pregnant women with prior Cesarean deliveries were classified into three groups: 35 with normal placentation (control group); 21 with placenta previa alone (placenta previa group); 12 with placenta previa and placenta accreta (placenta accreta group). Maternal plasma hPL mRNA concentrations were measured by real-time reverse-transcription polymerase chain reaction Result: The multiple of the median (median, range) for hPL mRNA was significantly higher for the placenta accreta group (2.78, 1.09-4.56) than the control (1.00, 0.29-2.98) or placenta previa (1.12, 0.33-3.25) groups (Steel-Dwass test, p < .001 and p = .005, respectively), was not significantly different between the women with placenta accreta who underwent hysterectomies (2.96, 1.38-4.56) and the women whose deliveries did not result in hysterectomy (2.36, 1.09-3.25) in the placenta accreta group (Mann-Whitney U test, p = .372). Conclusion: hPL mRNA in maternal plasma may indicate abnormally invasive placenta but cannot predict whether abnormally invasive placenta will result in hysterectomy.
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Affiliation(s)
- Jing Li
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Ning Zhang
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yan Zhang
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Xiaoyu Hu
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Guoqiang Gao
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yuanhua Ye
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Wei Peng
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Jun Zhou
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
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Ersoy AO, Oztas E, Ozler S, Ersoy E, Erkenekli K, Uygur D, Caglar AT, Danisman N. Can venous ProBNP levels predict placenta accreta? J Matern Fetal Neonatal Med 2016; 29:4020-4. [PMID: 26864469 DOI: 10.3109/14767058.2016.1152576] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Placenta previa (PP) is a potential life-threatening pregnancy complication. Pro-brain natriuretic peptide (ProBNP), creatine kinase (CK), cardiac form of CK (CK-MB) and Troponin I are circulatory biomarkers related to cardiac functions. We aimed to determine whether these biomarkers are related to PP and placenta accreta. METHODS In this case-control study, fifty-four pregnant women who attended our tertiary care center for perinatology with the diagnosis of PP totalis, and of them, 14 patients with placenta accreta were recruited as the study groups. Forty-six uncomplicated control patients who were matched for age, BMI were also included. Maternal venous ProBNP, CK, CK-MB and Troponin I levels were compared between the three groups. RESULTS Obstetric history characteristics were comparable among groups, generally. CK and CK-MB levels were similar among three groups. Troponin I levels in the previa and accreta groups were significantly higher than the controls. ProBNP levels in the accreta group were significantly higher than other two groups. The multivariate regression model revealed that ProBNP could predict placental adhesion anomalies. CONCLUSIONS Troponin I and ProBNP levels in PP cases were higher than controls and ProBNP could predict placenta accreta.
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Affiliation(s)
- Ali Ozgur Ersoy
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Efser Oztas
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Sibel Ozler
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Ebru Ersoy
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Kudret Erkenekli
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Dilek Uygur
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Ali Turhan Caglar
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
| | - Nuri Danisman
- a Department of Obstetrics and Gynecology , Zekai Tahir Burak Women's Health Care Training and Research Hospital , Ankara , Turkey
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Pal R, Prasad D, Jain S. Placenta Percreta Causing Rupture of Uterus in Second Trimester of Pregnancy in Non Scarred Uterus with an Unusual Presentation: A Case Report and Review of Literature. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojog.2014.411096] [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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Kawashima A, Sekizawa A, Ventura W, Koide K, Hori K, Okai T, Masashi Y, Furuya K, Mizumoto Y. Increased levels of cell-free human placental lactogen mRNA at 28-32 gestational weeks in plasma of pregnant women with placenta previa and invasive placenta. Reprod Sci 2013; 21:215-20. [PMID: 23744883 DOI: 10.1177/1933719113492209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the levels of cell-free human placental lactogen (hPL) messenger RNA (mRNA) in maternal plasma at 28 to 32 weeks of gestation between women with diagnosis of placenta previa or invasive placenta and women with an uneventful pregnancy. Sensitivity and specificity of hPL mRNA for the prediction of invasive placenta were further explored. Plasma hPL mRNA were quantified by real-time reverse-transcriptase polymerase chain reaction in women with placenta previa (n = 13), invasive placenta (n = 5), and normal pregnancies (n = 92). Median (range) hPL mRNA was significantly higher in women with placenta previa, 782 (10-2301) copies/mL of plasma, and in those with invasive placenta, 615 (522-2102) copies/mL of plasma, when compared to normal pregnancies, 90 (4-4407) copies/mL of plasma, P < .01 and P < .05, respectively. We found a sensitivity of 100% and a specificity of 61.5% for the prediction of invasive placenta among women with placenta previa. In conclusion, expression of hPL mRNA is increased in plasma of women with placenta previa and invasive placenta at 28 to 32 weeks of gestation.
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Affiliation(s)
- Akihiro Kawashima
- 1Department of Obstetrics and Gynecology, Self-Defense Forces Central Hospital, Tokyo, Japan
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Héquet D, Ricbourg A, Sebbag D, Rossignol M, Lubrano S, Barranger E. [Placenta accreta: screening, management and complications]. ACTA ACUST UNITED AC 2013; 41:31-7. [PMID: 23291052 DOI: 10.1016/j.gyobfe.2012.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/15/2022]
Abstract
Abnormal placental invasion can result in major obstetric haemorrhage during delivery. The most important risk factors are the following: previous caesarean delivery, placenta praevia maternal age over 35, smoking, previous myomectomy, dilatation and curettage. When placenta accreta is suspected on ultrasound, an RMI can complete the diagnostic. Therefore, patients must be managed, as far as possible, in a reference centre, by a trained medical team. Birth must be planned in order to decrease complications rate. Treatment can consist in radical management (caesarean-hysterectomy) or conservative management (preservation of both uterus and placenta). Conservative management allows patients to keep fertility but can also decrease blood loss during delivery. Side effects of this therapy are secondary haemorrhage, sepsis, long-term follow-up and vaginal loss. There are few studies describing fertility after conservative management, but it seems to be a secure treatment for future pregnancies. Embolization can be a very useful, already demonstrated, help when massive haemorrhage occurs. Management of placenta accreta is multidisciplinary and patients must be informed of all options. Treatment is decided regarding history of the patients, operative findings and peri-partum blood loss.
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Affiliation(s)
- D Héquet
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, Paris, 2 rue Ambroise-Paré, Paris, France.
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Abstract
OBJECTIVE We sought to review the risks of placenta accreta, increta, and percreta, and provide guidance regarding interventions to improve maternal outcomes when abnormal placental implantation occurs. METHODS Relevant documents were identified through a search of the English-language literature for publications including ≥1 of the key words "accreta" or "increta" or "percreta" using PubMed (US National Library of Medicine; January 1990 through January 2010); with results limited to studies involving human beings. Additional information was obtained from references identified within selected articles; from additional review articles; and from guidelines by organizations including the American College of Obstetricians and Gynecologists. Each included article was evaluated according to study design and quality in accordance with the scheme outlined by the US Preventative Services Task Force. RESULTS AND RECOMMENDATIONS Abnormal placentation--encompassing placenta accreta, increta, and percreta--is increasingly common. While randomized controlled trials and large observational cohort studies that can be used to define best practice are lacking, strategies to enhance early diagnosis, enhance preparation, and coordinate peripartum management can be undertaken. Women with a placenta previa overlying a uterine scar should be evaluated for the potential diagnosis of placenta accreta. Women with a placenta previa or "low-lying placenta" overlying a uterine scar early in pregnancy should be reevaluated in the third trimester with attention to the potential presence of placenta accreta. When the diagnosis of placenta accreta is made remote from delivery, the need for hysterectomy should be anticipated and arrangements made for delivery in a center with adequate resources, including those for massive transfusion. Intraoperatively, attention should be paid to abdominal and vaginal blood loss. Early blood product replacement, with consideration of volume, oxygen-carrying capacity, and coagulation factors, can reduce perioperative complications.
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Abstract
Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta. The diagnosis is typically made by gray-scale ultrasound and confirmed with magnetic resonance imaging, which may better delineate the extent of placental invasion. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta. Aggressive management of hemorrhage through the use of uterotonics, fluid resuscitation, blood products, planned hysterectomy, and surgical hemostatic agents can be life-saving for these patients. Conservative management, including the use of uterine and placental preservation and subsequent methotrexate therapy or pelvic artery embolization, may be considered when a focal accreta is suspected; however, surgical management remains the current standard of care.
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Affiliation(s)
- Samuel T Bauer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol 2008; 35:519-29, x. [PMID: 18952019 DOI: 10.1016/j.clp.2008.07.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An unintended consequence of the rising cesarean section rate is abnormal placentation in subsequent pregnancies, leading to the clinical complications of placenta accreta and cesarean scar pregnancies. Both of these clinical entities are associated with high rates of maternal morbidity and mortality. This article reviews the potential mechanisms by which uterine scarring may lead to abnormal trophoblast invasion, the association of cesarean section with placenta accreta and scar pregnancies, current management, and suggestions for future research to reduce the incidence of these potentially devastating complications of pregnancy.
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Affiliation(s)
- Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, 622 West 168th Street, PH 16-66, Columbia University, New York, NY 10032, USA.
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Mazouni C, Gorincour G, Juhan V, Bretelle F. Placenta Accreta: A Review of Current Advances in Prenatal Diagnosis. Placenta 2007; 28:599-603. [PMID: 16959315 DOI: 10.1016/j.placenta.2006.06.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 06/29/2006] [Accepted: 06/29/2006] [Indexed: 10/24/2022]
Abstract
Placenta accreta is a life-threatening obstetrical condition requiring a multidisciplinary approach. Despite identified obstetrical risk factors, the diagnosis is often made at the time of delivery. Recent advances in biology could allow a prenatal screening of placenta accreta with the identification of biological markers in maternal blood including cell-free fetal DNA, placental mRNA, and DNA microarray. These promising technologies can detect the presence of anomalies and should play a future role in developing a better understanding of placental invasion. Ultrasound imaging is popular due to its low cost and accessibility and widely used for the screening of placenta location and potential abnormal development. This exam is associated with high sensitivity and specificity for diagnosis of placenta accreta when specific defined criteria are used for the diagnosis. A placental MRI provides a morphological description, as well as recently demonstrated topographical information that optimizes diagnosis and surgical management. The screening of placenta accreta should be improved with the use of a combination of these diagnostic techniques and benefit high-risk populations with a reduction in morbidity.
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Affiliation(s)
- C Mazouni
- Department of Obstetrics and Gynecology, Conception Hospital, Marseille Public Hospital System, 147 boulevard Baille, 13385 Marseille, France.
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Placenta percreta, rotura uterina e histerectomía obstétrica. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77346-3] [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]
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Lapresta Moros M, Conte Martín P, Pérez Pérez P, Azúa Romeo J, Oro Fraile J, Lapresta Ferrández C. Postabortal haemorrhage and disseminated intravascular coagulation due to placenta accreta. Arch Gynecol Obstet 2003; 268:329-30. [PMID: 14504880 DOI: 10.1007/s00404-002-0403-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2002] [Accepted: 08/02/2002] [Indexed: 11/24/2022]
Abstract
We describe the case of a second trimester placenta accreta presenting as postabortal haemorrhage complicated by disseminated intravascular coagulation, requiring hysterectomy.
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Jimbo M, Sekizawa A, Sugito Y, Matsuoka R, Ichizuka K, Saito H, Okai T. Placenta increta: Postpartum monitoring of plasma cell-free fetal DNA. Clin Chem 2003; 49:1540-1. [PMID: 12928242 DOI: 10.1373/49.9.1540] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masatoshi Jimbo
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo 142-8666, Japan
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Esler MD, Douglas MJ. Planning for hemorrhage. Steps an anesthesiologist can take to limit and treat hemorrhage in the obstetric patient. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:127-44, vii. [PMID: 12698837 DOI: 10.1016/s0889-8537(02)00027-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obstetric hemorrhage continues to be a significant cause of maternal mortality and morbidity. Blood transfusion in such circumstances may be life saving but involves exposing the patient to additional risks. Limiting blood transfusion and using autologous blood when possible may reduce some of these risks. This article outlines the techniques that may be used to limit and more effectively treat hemorrhage in the obstetric patient, with particular attention paid to reducing the use of allogeneic blood transfusion.
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Affiliation(s)
- Mark D Esler
- Department of Anesthesia, Division of Obstetric Anesthesia, University of British Columbia, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada.
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Affiliation(s)
- Gary A Dildy
- Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
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Höpker M, Fleckenstein G, Heyl W, Sattler B, Emons G. Placenta percreta in week 10 of pregnancy with consecutive hysterectomy: case report. Hum Reprod 2002; 17:817-20. [PMID: 11870142 DOI: 10.1093/humrep/17.3.817] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Placenta percreta in early pregnancy is rare and has been documented in only a few cases. We report on a patient with abdominal pain in week 10 of pregnancy. Sonography revealed a defective embryonic development and the absence of a border line between trophoblast and myometrium, as well as invasive growth in the region of isthmocervical transition, so curettage was performed. Heavy bleeding at this stage made a hysterectomy necessary. Histological examination revealed a placenta percreta. Because of possible complications, the therapy of choice for a placenta percreta is a hysterectomy, as was performed in this case.
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Affiliation(s)
- Martin Höpker
- Department of Obstetrics and Gynecology, Georg August University, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany
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Sekizawa A, Jimbo M, Saito H, Iwasaki M, Sugito Y, Yukimoto Y, Otsuka J, Okai T. Increased Cell-free Fetal DNA in Plasma of Two Women with Invasive Placenta. Clin Chem 2002. [DOI: 10.1093/clinchem/48.2.353] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Masatoshi Jimbo
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Hiroshi Saito
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Mariko Iwasaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Yumi Sugito
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Yasuo Yukimoto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Junko Otsuka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Takashi Okai
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Affiliation(s)
- Manish Singh
- Department of Obstetrics and Gynaecology, Townsville Hospital, Queensland, Australia
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Morken NH, Henriksen H. Placenta percreta--two cases and review of the literature. Eur J Obstet Gynecol Reprod Biol 2001; 100:112-5. [PMID: 11728672 DOI: 10.1016/s0301-2115(01)00422-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two cases of placenta pecreta confirmed histologically were treated conservatively with retention of the uterus. Both later went on to have successful pregnancies.
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Affiliation(s)
- N H Morken
- Department of Obstetrics and Gynaecology, Telemark Central Hospital, Ulefossveien 52-56, 3710 Skien, Norway.
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Descargues G, Douvrin F, Degré S, Lemoine JP, Marpeau L, Clavier E. Abnormal placentation and selective embolization of the uterine arteries. Eur J Obstet Gynecol Reprod Biol 2001; 99:47-52. [PMID: 11604185 DOI: 10.1016/s0301-2115(01)00355-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Abnormal placentation accounts for more than 50% of uterine artery embolization failure. The authors report their experience in this situation. STUDY DESIGN Seven women presented with abnormal placentation. Uterine artery embolization was carried out in emergency or prophylactic control of postpartum bleeding. RESULTS In five patients, control of postpartum hemorrhage was obtained without hysterectomy. In two cases with no placental removal and prophylactic procedures, hysterectomy and blood transfusion were not necessary. The manual removal of the placenta was achieved secondarily, respectively on the 25th and the 12th day. CONCLUSIONS The success rate of uterine artery embolization for postpartum bleeding appears to be lower with abnormal placentation. In none of the cases with the placenta present was it possible to leave the residual placenta in place. However, embolization may permit a safe waiting period and spontaneous migration of the placenta. When the diagnosis is made before delivery, prophylactic uterine artery embolization without placental removal should be considered to reduce blood transfusion and preserve fertility.
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Affiliation(s)
- G Descargues
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
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