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Wu Q, Xi F, Luo P, Dong T, Jiang H, Luo Q. Development and validation of a nomogram for predicting placenta accreta spectrum in pregnancies with one previous cesarean delivery. Int J Gynaecol Obstet 2024. [PMID: 38832362 DOI: 10.1002/ijgo.15702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/27/2024] [Accepted: 05/11/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a prenatal nomogram to predict the risk of placenta accreta spectrum (PAS) in women with one previous cesarean delivery. METHODS This retrospective study enrolled 5157 pregnant women with one previous cesarean delivery in China from January 2021 to January 2023. The nomogram was developed from a training cohort of 3612 pregnant women and tested on a validation cohort of 1545 pregnant women. Multivariate regression analysis was performed using the minimum value of the Akaike information criterion to select prognostic factors that can be included in the nomogram. We evaluated the nomogram by the area under the receiver operating characteristic (ROC) curve, calibration curves, and the decision curve analysis (DCA). RESULTS PAS occurred in 199 (5.51%) and 80 (5.18%) patients in the training and validation cohorts, respectively. Backward stepwise algorithms in the multivariable logistic regression model determined abortion, hypertensive disorders complicating pregnancy, fetal position, and placenta previa as relevant PAS predictors. The area under the ROC curve for the nomogram was 0.770 (95% confidence interval [CI] 0.733-0.807) and 0.791 (95% CI 0.730-0.853) for the training and validation cohorts, respectively. The calibration curves indicated that the nomogram's prediction probability was consistent with the actual probability. The DCA curve revealed that the nomogram has potential clinical benefit. CONCLUSION A prenatal nomogram was developed for PAS in our study, which helped obstetricians determine potential patients with PAS and make sufficient preoperative preparation to reduce maternal and neonatal complications.
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Affiliation(s)
- Qianqian Wu
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Fangfang Xi
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Peiying Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
- Department of Obstetrics, Taizhou Women and Children's Hospital, Taizhou, China
| | - Tian Dong
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Hangjin Jiang
- Center for Data Science, Zhejiang University, Hangzhou, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University, School of Medicine, Hangzhou, China
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Adu-Bredu TK, Aryananda RA, Arkorful J, Matthewlynn S, Collins SL. Differentiating placenta accreta spectrum from scar dehiscence with underlying, non-adherent placenta: A systematic review of scoring systems and primary data analysis. Acta Obstet Gynecol Scand 2024. [PMID: 38819580 DOI: 10.1111/aogs.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes. MATERIAL AND METHODS A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case. RESULTS The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high-grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71-0.92) to 0.87 (95% CI 0.79-0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low-grade PAS and scar dehiscence on all scoring systems. CONCLUSIONS Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non-adherent placenta from high-grade PAS with excellent diagnostic accuracy, but not for low-grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.
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Affiliation(s)
- Theophilus K Adu-Bredu
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Rozi Aditya Aryananda
- Obstetrics and Gynecology Department, Maternal Fetal Medicine, Dr Soetomo Academic General Hospital, Universitas Airlangga, Surabaya, Indonesia
| | - Joseph Arkorful
- Department of Medical Imaging, University of Cape Coast, Cape Coast, Ghana
| | - Sam Matthewlynn
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Sally L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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Seoud M, Chahine R, Arab W, Jaafar I, Moubarak M, El Kassis N, Abdallah R, Ramadan MK, Nassar M, Nassar A, Ayoub EN, Atallah D. The Lebanese percreta group: A retrospective cohort study of both radical and conservative management outcomes of abnormally invasive placenta. Int J Gynaecol Obstet 2024. [PMID: 38798144 DOI: 10.1002/ijgo.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon. METHODS We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death). RESULTS The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively. CONCLUSION Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed.
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Affiliation(s)
- Muhieddine Seoud
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Rabih Chahine
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital (RHUH), Beirut, Lebanon
| | - Wissam Arab
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Iman Jaafar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Malak Moubarak
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Nadine El Kassis
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Reem Abdallah
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Mohamad K Ramadan
- Department of Obstetrics and Gynecology, Rafic Hariri University Hospital (RHUH), Beirut, Lebanon
| | - Malek Nassar
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Anwar Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Eliane Nasser Ayoub
- Intensive Care and Anesthesiology Department, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
| | - David Atallah
- Department of Obstetrics and Gynecology, Hotel-Dieu de France (HDF) University Hospital, Saint-Joseph University, Beirut, Lebanon
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Hamel C, Amir B, Avard B, Fung-Kee-Fung K, Furey B, Garel J, Ghandehari H. Canadian Association of Radiologists Obstetrics and Gynecology Diagnostic Imaging Referral Guideline. Can Assoc Radiol J 2024; 75:261-268. [PMID: 37624360 DOI: 10.1177/08465371231185292] [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] [Indexed: 08/26/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Obstetrics and Gynecology Expert Panel consists of radiologists specializing in obstetrics and gynecology, obstetrics and gynecology physicians, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 12 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 46 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for guidelines framework were used to develop 68 recommendation statements across the 12 scenarios related to the evaluation of obstetrics and gynecology clinical and diagnostic scenarios. This guideline presents the methods of development and the imaging recommendations for a variety of obstetrical and gynecological conditions including pregnancy assessment, recurrent first trimester pregnancy loss, post-partum indications, disorders of menstruation, localization of intra-uterine contraceptive device, infertility assessment, assessment of adnexal mass, pelvic pain of presumed gynecological origin, and pelvic floor evaluation.
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Affiliation(s)
- Candyce Hamel
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | | | - Barb Avard
- North York General Hospital, Toronto, ON, Canada
| | | | - Beth Furey
- Dalhousie University, Halifax, NS, Canada
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Hu C, Zhang W, Pu H, Fei K, Li Q, Huang J. Quality evaluation of clinical practice guidelines for placenta accreta spectrum disorders. Heliyon 2024; 10:e28390. [PMID: 38571606 PMCID: PMC10988008 DOI: 10.1016/j.heliyon.2024.e28390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction We evaluated the quality of the published clinical practice guidelines on placenta accreta spectrum (PAS) disorders to provide reference for the development of high-quality PAS guidelines. Methods China National Knowledge Infrastructure (CNKI), Wan Fang, PubMed, Embase, Web of Science, and Cochrane Library were systematically searched. Quality assessments were conducted using the appraisal of guidelines for research and evaluation (AGREE) II framework and Reporting Items for practice Guidelines in Healthcare (RIGHT) checklist. Intraclass correlation coefficients (ICCs) were used to measure the agreement among reviewers. Results In total, 13 guidelines from different countries, published between 2015 and 2021 were included. There included 9 official guidelines, 3 consensuses, and 1 standard reference and covered subjects including epidemiology, diagnosis and treatment. The mean standardized scores across 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence) were 53.63%, 27.35%, 33.57%, 72.01%, 19.39% and 41.02%, respectively. Of the 13 guidelines, 11 were classified as grade B, whereas 2 as grade C. According to the RIGHT checklist, the overall reporting rate of the 13 guidelines ranged from 28.57% to 54.29%. Conclusion The current guidelines for PAS demonstrate commendable methodological and reporting qualities. However, the methodological and reporting quality of PAS CPGs still need to be further improved, particularly in stakeholder involvement, the rigor of development, applicability, and editorial independence domains.
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Affiliation(s)
- Caihong Hu
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
- Hunan Engineering Research Center of Early Life Development and Disease Prevention, Changsha, China
| | - Heyang Pu
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Kuilin Fei
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
| | - Qi Li
- Reproductive Medicine Center, Xiangya Hospital Central South University, Changsha, China
| | - Jingrui Huang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, China
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Farisoğullari N, Tanaçan A, Sakcak B, Denizli R, Baştemur AG, Başaran E, Kara Ö, Yazihan N, Şahin D. Evaluation of maternal serum VEGF, TNF-alpha, IL-4, and IL-10 levels in differentiating placenta accreta spectrum from isolated placenta previa. Cytokine 2024; 176:156513. [PMID: 38262117 DOI: 10.1016/j.cyto.2024.156513] [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: 11/17/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Our study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) using maternal serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin-4 (IL-4), and IL-10. METHODS The case group consisted of 77 patients with placenta previa, and the control group consisted of 90 non-previa pregnant women. Of the pregnant women in the case group, 40 were diagnosed with PAS in addition to placenta previa and 37 had placenta previa with no invasion. The maternal serum VEGF, TNF-alpha, IL-4, and IL-10 levels were compared between the case and control groups. Then the success of these markers in differentiating between PP and PAS was evaluated. RESULTS We found the VEGF, TNF-alpha, and IL-4 levels to be higher and the IL-10 level to be lower in the case group compared to the control group (p < 0.001). We observed a statistically significantly lower IL-10 level in the patients with PAS than those with PP (p = 0.029). In the receiver operating characteristic analysis, the optimal cut-off of IL-10 in the detection of PAS was 0.42 ng/mL). In multivariate analysis, the risk of PAS was significant for IL-10 (odds ratio (OR) 0.45, 95 % confidence interval (CI) 0.25-0.79, p = 0.006) and previous cesarean section (OR 2.50, 95 % Cl 1.34-4.66, p = 0.004). The model's diagnostic sensitivity and specificity, including previous cesarean section, preoperative hemoglobin (Hb), TNF-alpha, and IL-10 were 75 % and 72.9 %, respectively. CONCLUSION The study showed that the IL-10 level was lower in patients with PAS than in those with PP. A statistical model combining risk factors including previous cesarean section, preoperative Hb, TNF-alpha, and IL-10 may improve clinical diagnosis of PAS in placenta previa cases. Cytokines may be used as additional biomarkers to the clinical risk factors in the diagnosis of PAS.
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Affiliation(s)
- Nihat Farisoğullari
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey.
| | - Atakan Tanaçan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ramazan Denizli
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ayşe Gülçin Baştemur
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ezgi Başaran
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Özgür Kara
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Nuray Yazihan
- Department of Pathophysiology, Internal Medicine, Ankara University Medical School, Ankara, Turkey
| | - Dilek Şahin
- University of Health Sciences, Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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Barinov SV, Di Renzo GC. A new technique to preserve the uterus in patients with placenta accreta spectrum disorders. Am J Obstet Gynecol 2024; 230:S1107-S1115. [PMID: 37661498 DOI: 10.1016/j.ajog.2023.07.012] [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: 08/23/2022] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. OBJECTIVE This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014. STUDY DESIGN This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. RESULTS The volume of blood loss was 1.5-fold lower (P=.0010), the number of blood transfusions was 5.1-fold lower (P=.026), and the rate of bladder injuries was 19-fold lower (P=.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P=.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P=.023). The study groups did not differ in terms of placenta accreta spectrum type. CONCLUSION The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders.
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Affiliation(s)
- Sergey V Barinov
- Department of Obstetrics and Gynecology No.2, Omsk State Medical University, Omsk, Russia
| | - Gian Carlo Di Renzo
- Department of Medicine, Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.
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Walsh CA, Lees N. Prevalence of anomalies on the routine mid-trimester ultrasound: 3172 consecutive cases by a single maternal-fetal medicine specialist. Australas J Ultrasound Med 2024; 27:12-18. [PMID: 38434547 PMCID: PMC10902829 DOI: 10.1002/ajum.12369] [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: 03/05/2024] Open
Abstract
Introduction/Purpose The routine mid-trimester fetal anatomy ultrasound (FAS) is offered to every pregnant woman and remains critical in the detection of structural fetal anomalies. Our study aimed to determine the prevalence of abnormalities on routine FAS performed by a single operator, who is an experienced sub-specialist in maternal-fetal medicine. Methods A retrospective analysis of all routine FAS performed a tertiary private obstetric ultrasound practice in metropolitan Sydney over a 7-year period, August 2015-July 2022. An advanced ultrasound protocol including detailed cardiac views was used in every case. Second opinion scans for suspected abnormalities were excluded. Fetal anomalies were classified into major and minor, based on the likely need for neonatal intervention. Results Among 14,908 obstetric ultrasound examinations, routine FAS were performed on 3172 fetuses by a single operator. More than 99% of women had screened low-risk for fetal aneuploidy. Structural anomalies were identified in 5% (157/3172) of fetuses; the prevalence of major anomalies was 1% (30/3172). Almost 60% of total anomalies were either cardiac or renal. No differences were identified in anomaly rates for singletons compared with twins (5.0% vs. 4.2%; P = 0.75). The prevalence of placenta previa and vasa previa was 10% and 0.1%, respectively. Discussion The prevalence of fetal anomalies on routine FAS by a single operator using a standardised protocol was higher in our practice (5%) than in previously published studies. Although most anomalies were minor, the rate of major abnormality was 1%. Conclusion The routine mid-trimester FAS remains an integral component of prenatal ultrasound screening.
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Affiliation(s)
| | - Nicole Lees
- Shore for WomenSt LeonardsNew South WalesAustralia
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Lee SU, Jo JH, Lee H, Na Y, Park IY. A Multicenter, Retrospective Comparison Study of Pregnancy Outcomes According to Placental Location in Placenta Previa. J Clin Med 2024; 13:675. [PMID: 38337369 PMCID: PMC10856070 DOI: 10.3390/jcm13030675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: We investigated the association between placental location and pregnancy outcomes in placenta previa. Methods: This multi-center retrospective study enrolled 781 women who delivered between May 1999 and February 2020. We divided the dataset into anterior (n = 209) and posterior (n = 572) groups and compared the baseline characteristics and obstetric and neonatal outcomes. The adverse obstetric outcomes associated with placenta location were evaluated using a multivariate logistic analysis. Results: Gestational age at delivery in the anterior group (253.0 ± 21.6) was significantly lower than that in the posterior group (257.6 ± 19.1) (p = 0.008). The anterior group showed significantly higher parity, rates of previous cesarean section, non-vertex fetal positions, admissions for bleeding, emergency cesarean sections, transfusions, estimated blood loss, and combined placenta accrete spectrum (p < 0.05). In the multivariate analysis, the anterior group had higher rates of transfusion (OR 2.23; 95% CI 1.50-3.30), placenta accreta spectrum (OR 2.16; 95% CI 1.21-3.97), and non-vertex fetal positions (OR 2.47; 95% CI 1.09-5.88). Conclusions: These findings suggest that more caution is required in the treatment of patients with anterior placenta previa. Therefore, if placenta previa is diagnosed prenatally, it is important to determine the location of the body and prepare for massive bleeding in the anterior group.
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Affiliation(s)
- Seon Ui Lee
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Ji Hye Jo
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Haein Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yoojin Na
- Department of Obstetrics and Gynecology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Takahashi J, Orisaka M, Inoue D, Kawamura H, Takahashi N, Tsuyoshi H, Shinagawa A, Kurokawa T, Yoshida Y. Evaluation of the holding-up uterus technique for placenta accreta spectrum cesarean hysterectomy in shocked patients with a high shock index: a case series study. BMC Surg 2024; 24:23. [PMID: 38218800 PMCID: PMC10787967 DOI: 10.1186/s12893-024-02311-8] [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: 08/29/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) cesarean hysterectomy is performed under conditions of shock and can result in serious complications. This study aimed to evaluate the usefulness of the "Holding-up uterus" surgical technique with a shock index (S.I.) > 1.5. METHODS Twelve patients who underwent PAS cesarean hysterectomy were included in the study. RESULTS Group I had S.I. > 1.5, and group II had S.I. ≤ 1.5. Group I had more complications, but none were above Grade 3 or fatal. Preoperative scheduled uterine artery embolization did not result in serious complications, but three patients who had emergency common iliac artery balloon occlusion (CIABO) and a primary total hysterectomy with S.I. > 1.5 had postoperative Grade 2 thrombosis. Two patients underwent manual ablation of the placenta under CIABO to preserve the uterus, both with S.I. > 1.5. CONCLUSIONS The study found that the "Holding-up uterus" technique was safe, even in critical situations with S.I. > 1.5. CIABO had no intervention effect. The study also identified assisted reproductive technology pregnancies with a uterine cavity length of less than 5 cm before conception as a critical factor.
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Affiliation(s)
- Jin Takahashi
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
- Department of Obstetrics and Gynecology, Fukui Prefectural Hospital, Fukui, Japan
| | - Makoto Orisaka
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Hiroshi Kawamura
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Nozomu Takahashi
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Akiko Shinagawa
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan.
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Khalil A, Sotiriadis A, D'Antonio F, Da Silva Costa F, Odibo A, Prefumo F, Papageorghiou AT, Salomon LJ. ISUOG Practice Guidelines: performance of third-trimester obstetric ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:131-147. [PMID: 38166001 DOI: 10.1002/uog.27538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 01/04/2024]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece
| | - F D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - A Odibo
- Obstetrics and Gynecology Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK; Nuffield Department for Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - L J Salomon
- URP FETUS 7328 and LUMIERE platform, Maternité, Obstétrique, Médecine, Chirurgie et Imagerie Foetales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
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12
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Bonsen LR, Harskamp V, Feddouli S, Bloemenkamp KWM, Duvekot JJ, Pors A, van Roosmalen J, Zwart JJ, van Lith JMM, Hendriks J, Urlings TAJ, van den Akker T, van der Bom JG, Henriquez DDCA. Prophylactic radiologic interventions to reduce postpartum hemorrhage in women with risk factors for placenta accreta spectrum disorder: a nationwide cohort study. J Matern Fetal Neonatal Med 2023; 36:2251076. [PMID: 37673791 DOI: 10.1080/14767058.2023.2251076] [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: 03/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS). METHODS We conducted a retrospective nationwide cohort study of women with risk factors for placenta accreta spectrum disorder who underwent planned cesarean section in 69 Dutch hospitals between 2008 and 2013. All women had two risk factors for PAS: placenta previa/anterior low-lying placenta and a history of cesarean section(s). Women with and without ultrasonographic signs of PAS were studied as two separate groups. We compared the total blood loss of women with prophylactic radiologic interventions, defined as preoperative placement of balloon catheters or sheaths in the internal iliac or uterine arteries, with that of a control group consisting of women without prophylactic radiologic interventions using multivariable regression. We evaluated maternal morbidity by the number of red blood cell (RBC) units transfused within 24 h following childbirth (categories: 0, 1-3, >4), duration of hospital admission, and need for intensive care unit (ICU) admission. RESULTS A total of 350 women with placenta previa/anterior low-lying placenta and history of cesarean section(s) were included: 289 with normal ultrasonography, of whom 21 received prophylactic radiologic intervention, and 61 had abnormal ultrasonography, of whom 22 received prophylactic intervention. Among women with normal ultrasonography without prophylactic intervention (n = 268), the median blood loss was 725 mL (interquartile range (IQR) 500-1500) vs. 1000 mL (IQR 550-1750) in women with intervention (n = 21); the adjusted difference in blood loss was 9 mL (95% confidence interval (CI) -315-513), p = .97). Among women with abnormal ultrasonography, those without prophylactic intervention (n = 39) had a median blood loss of 2500 mL (IQR 1200-5000) vs. 1750 mL (IQR 775-4000) in women with intervention (n = 22); the adjusted difference in blood loss was -1141 mL (95% CI -1694- -219, p = .02). Results of outcomes on maternal morbidity were comparable among women with and without prophylactic intervention. CONCLUSION These findings suggest that prophylactic radiologic interventions prior to planned cesarean section may help to limit perioperative blood loss in women with clear signs of placenta accreta spectrum disorder on ultrasonography, but there was no evidence of a difference within the subgroup without such ultrasonographic signs. The use of these interventions should be discussed in a multidisciplinary shared decision-making process, including discussions of potential benefits and possible complications. TRIAL REGISTRATION Netherlands Trial Registry, https://onderzoekmetmensen.nl/en/trial/28238, identifier NL4210 (NTR4363).
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Affiliation(s)
- Lisanne R Bonsen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Valerie Harskamp
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Sana Feddouli
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Wilhelmina's Children Hospital Birth Center, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aad Pors
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joris Hendriks
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Thijs A J Urlings
- Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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13
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Pinton A, Deneux-Tharaux C, Seco A, Sentilhes L, Kayem G. Incidence and risk factors for severe postpartum haemorrhage in women with anterior low-lying or praevia placenta and prior caesarean: Prospective population-based study. BJOG 2023; 130:1653-1661. [PMID: 37226308 DOI: 10.1111/1471-0528.17554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS). DESIGN Population-based study in 176 maternity units in France. POPULATION All women with anterior low-lying (0-19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS. METHODS Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth. MAIN OUTCOME MEASURES Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment. RESULTS Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2-30.4) overall, 27.5% (95% CI 21.8-33.3) in women with placenta praevia and 15.4% (95% CI 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8). CONCLUSION Severe PPH is frequent among women with anterior low-lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low-lying placenta.
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Affiliation(s)
- Anne Pinton
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Department of Obstetrics and Gynaecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Aurélien Seco
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Gilles Kayem
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Department of Obstetrics and Gynaecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
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14
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Barber E, Ganer Herman H, Kovo M, Tairy D, Schreiber L, Horowitz E, Weissman A, Weiner E, Raziel A. Placenta previa in in vitro fertilization and unassisted pregnancies-is there a difference in perinatal outcomes and placental histology? J Matern Fetal Neonatal Med 2023; 36:2221763. [PMID: 37286205 DOI: 10.1080/14767058.2023.2221763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In-vitro-fertilization (IVF) is an independent risk factor for placenta previa (PP). Our aim was to study this link by comparing the clinical characteristics and placental histology of pregnancies complicated by PP in IVF versus unassisted pregnancies. METHODS A retrospective-cohort study of deliveries with PP between 2008 and 2021. Placental histology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA) >24. RESULTS A total of 182 pregnancies were included - 23 IVF pregnancies (IVF group) and 159 unassisted pregnancies (Control group). The control group was characterized by higher gravidity (p = .007) and parity (p < .001) and a trend of more past cesarean deliveries, whereas the IVF group- by a higher rate of nulliparity (p < .001) and diabetes mellitus (p = .04). The control group was characterized by a higher rate of placental weight below the 10th percentile (47.8 versus 13.9%, p = .001) and by a trend of a lower overall placental weight. No differences were noted in maternal and fetal vascular lesions. DISCUSSION While PP in non-assisted pregnancies is probably associated with previous CDs, in IVF it is more "sporadic," and may complicate any index pregnancy. A lower placental weight was more prevalent in the control group, supporting the concept that pregnancies complicated by PP following IVF can be attributed to initial abnormal location of placentation, rather than an underlying pathological uterine segment of implantation. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.
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Affiliation(s)
- Elad Barber
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Horowitz
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Weissman
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Raziel
- In Vitro Fertilization Unit, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Farisoğullari N, Tanaçan A, Sakcak B, Denizli R, Özkavak OO, Turgut E, Kara Ö, Yazihan N, Şahin D. The Association of Serum Midkine Level with Invasion in Placenta Previa: A Case-Control Study from a Tertiary Reference Center. J Interferon Cytokine Res 2023; 43:557-564. [PMID: 38126935 DOI: 10.1089/jir.2023.0106] [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] [Indexed: 12/23/2023] Open
Abstract
We aimed to examine the relationship between serum midkine levels and placental invasion in pregnant women with placenta previa. The study group consisted of 43 pregnant women diagnosed with placenta previa, whereas the control group consisted of 60 healthy pregnant women. Serum midkine levels were compared between pregnant women with placenta previa and the control group in this study's first part. Thereafter, the utility of midkine in the prediction of the abnormally invasive placenta (AIP) was investigated and optimal cutoff values were calculated. Significantly higher serum midkine level was observed in placenta previa cases than in the controls (1.16 ng/mL vs. 0.18 ng/mL, P < 0.001). Serum midkine level was also significantly higher in the AIP group among the placenta previa cases (P = 0.004). In the receiver operating characteristic analysis, the cutoff value of the midkine level in predicting AIP was 1.19 ng/mL. This study revealed that the serum midkine level is higher in pregnant women with AIP. Maternal serum midkine level may be used as a complementary biomarker to the radiological and clinical findings for the prediction of the AIP in placenta previa cases.
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Affiliation(s)
- Nihat Farisoğullari
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Ramazan Denizli
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Osman Onur Özkavak
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Ezgi Turgut
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Özgür Kara
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Nuray Yazihan
- Department of Pathophysiology, Internal Medicine, Ankara University Medical School, Cankaya, Turkey
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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16
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de Mello PV, Bruns RF, Klas CF, Hammes LR. Re: Correspondence on "Expectant management of viable cesarean scar pregnancies: a systematic review". Arch Gynecol Obstet 2023; 308:1915-1916. [PMID: 36738317 DOI: 10.1007/s00404-023-06931-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Paula Vieira de Mello
- Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba-Paraná, Brazil.
| | - Rafael Frederico Bruns
- Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba-Paraná, Brazil
| | - Cynthia Fontoura Klas
- Obstetrics and Gynecology Program, Universidade Federal do Paraná, Curitiba-Paraná, Brazil
| | - Larissa Raso Hammes
- Obstetrics and Gynecology Program, Universidade Federal do Paraná, Curitiba-Paraná, Brazil
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17
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Topcu EG, McClenahan P, Pule K, Khattak H, Karsli SE, Cukelj M, Ubom AE, Algurjia E, Ozpinar K, Perez YR, Bunu R, Sanabria LS, Portilla FJR, Pumpure E, Roy P, Fogarty P. FIGO best practice guidance in surgical consent. Int J Gynaecol Obstet 2023; 163:795-812. [PMID: 37807812 DOI: 10.1002/ijgo.15174] [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] [Indexed: 10/10/2023]
Abstract
Obtaining medical consent preoperatively is one of the key steps in preparing for surgery, and is an important step in informed decision making with the patient. According to good medical practice guidelines, doctors are required to have the knowledge and skills to treat patients as well as inform them, respect their wishes, and establish trust between themselves and their patients. Valid consent includes elements of competence, disclosure, understanding, and voluntariness. Documentation of these elements is also very important. The International Federation of Gynecology and Obstetrics (FIGO) Education Communication and Advocacy Consortium (ECAC) has realized that the quality of consent varies considerably across the world and has developed simple guidelines regarding consent and procedure-specific checklists for the most common obstetric and gynecological procedures.
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Affiliation(s)
- E Goknur Topcu
- Department of Obstetrics and Gynecology, Istanbul Health and Technology University, Istanbul, Turkey
| | - Phil McClenahan
- Department of Obstetrics and Gynecology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Koketso Pule
- Department of Obstetrics and Gynecology, Wits University, Johannesburg, South Africa
| | - Hajra Khattak
- Department of Obstetrics and Gynecology, UCL EGA Institute for Women's Health, London, UK
| | - S Eda Karsli
- Department of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Marijo Cukelj
- Department of Obstetrics and Gynecology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Akaninyene E Ubom
- Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Esraa Algurjia
- Department of Obstetrics and Gynecology, Al-Elwya Maternity Hospital, Baghdad, Iraq
| | - Kubra Ozpinar
- Department of Obstetrics and Gynecology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yotin Ramon Perez
- Department of Obstetrics and Gynecology, Hospital Central de las Fuerzas, Santo Domingo, Dominican Republic
| | - Rashid Bunu
- Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Leopoldo S Sanabria
- Department of Obstetrics and Gynecology, Unidad Medica de Alta Especialidad, Mexico City, Mexico
| | - Francisco J R Portilla
- Department of Obstetrics and Gynecology, Instituto Nacional de Perinatologia, Mexico City, Mexico
| | - Elizabete Pumpure
- Department of Obstetrics and Gynecology, Riga East Clinical University, Riga, Latvia
| | - Priyankur Roy
- Department of Obstetrics and Gynecology, Roy's Clinic, Siliguri, West Bengal, India
| | - Paul Fogarty
- International Federation of Gynecology and Obstetrics (FIGO), London, UK
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18
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Fazari A, Mohammed PB, Fahad A. Outcomes of the Expectant Management of 10 Cesarean Scar Pregnancy Cases in Patients Who Refused the Termination of Pregnancy. Cureus 2023; 15:e48921. [PMID: 38106794 PMCID: PMC10725518 DOI: 10.7759/cureus.48921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE Expectant management of cesarean scar pregnancy (CSP) in patients who refuse termination of pregnancy and continue with placenta accreta spectrum (PAS) is possible with multidisciplinary care and careful monitoring in a tertiary care center. Doctors with the relevant expertise in managing PAS use highly accurate ultrasound as a tool to diagnose, monitor, and manage this disorder, which enables them to determine appropriate surgical strategies and techniques to achieve optimum maternal and fetal outcomes with minimal blood loss and no major maternal mortality and morbidity. In this study, we aim to evaluate expectant management in such patients. MATERIALS AND METHODS This is a retrospective study of 10 patients with a previous history of a uterine scar. Diagnosed with CSP in the first trimester, they refused to terminate their pregnancy and continued with PAS. We studied them over a period of four years from 2018 to 2022 and managed them at Latifa Hospital, Dubai, UAE. RESULTS Of the 10 patients, nine delivered in the third trimester (around 34 weeks gestation), seven underwent elective surgery, and three underwent emergency surgery. Four patients were exogenous cases and six were endogenous cases at diagnosis during early gestation. Seven patients had a cesarean hysterectomy, and three (with focal placenta accreta) had uterine wall reconstruction surgery. Four patients needed blood transfusions. The average duration of surgery was between 2.5 and 5 hours. There were no miscarriages, no maternal and neonatal deaths, and no significant obstetric complications such as rupture of the uterus or major obstetric hemorrhage. CONCLUSION Even though CSP is a potentially life-threatening condition because of serious complications such as PAS if continued, expectant management is possible under multidisciplinary care where the team strictly adheres to clinical protocols and accurate surgery to reduce obstetric hemorrhage.
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Affiliation(s)
- Atif Fazari
- Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, SDN
- Obstetrics and Gynecology, Latifa Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | | | - Asma Fahad
- Obstetrics and Gynecology, Latifa Hospital, Dubai Academic Health Corporation, Dubai, ARE
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19
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Zabida A, Zahavi G, Bartoszko J, Otálora-Esteban M, Weinstein J, Frogel J, Miller L, Sivan E, Orkin D, Dolgoker I, Berkenstadt H. Improving blood product management in placenta accreta patients with severe bleeding: institutional experience. Int J Obstet Anesth 2023; 56:103904. [PMID: 37364347 DOI: 10.1016/j.ijoa.2023.103904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/10/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. METHODS A retrospective chart review of peri-operative demographic, anesthetic, and obstetric data was conducted for all patients with PAS undergoing CS between 2012 and 2018 at our center. To facilitate a practical evaluation of blood product management, we divided patients into two groups based on the severity of bleeding. RESULTS A total of 221 parturients with PAS underwent CS, with 133 in group 1 requiring excessive amounts of transfusion and 88 in group 2 requiring management similar to other uncomplicated CS cases. There were no deaths or instances of disseminated intravascular coagulation, and intensive care unit admission occurred in five cases (2.2%). Patients in group 1 had higher mean nadir values of intra-operative hemoglobin and platelet count. We observed a high rate of missing data for peri-operative measurement of lactate and fibrinogen, PAS grade documentation, and temperature monitoring. CONCLUSION Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.
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Affiliation(s)
- A Zabida
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel.
| | - G Zahavi
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Bartoszko
- Department of Anaesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto, Ontario, Canada
| | - M Otálora-Esteban
- Department of Anesthesiology, Hospital Universitario San Ignacio, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Weinstein
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - J Frogel
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - L Miller
- Blood Bank, Sheba Medical Centre, Tel-Hashomer, Israel
| | - E Sivan
- Josef Buchman Gynecology and Maternity Centre, Sheba Medical Centre, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - D Orkin
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - I Dolgoker
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
| | - H Berkenstadt
- Department of Anesthesiology, Chaim Sheba Medical Centre, Tel-Hashomer, Israel
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20
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Matsuo K, Sangara RN, Matsuzaki S, Ouzounian JG, Hanks SE, Matsushima K, Amaya R, Roman LD, Wright JD. Placenta previa percreta with surrounding organ involvement: a proposal for management. Int J Gynecol Cancer 2023; 33:1633-1644. [PMID: 37524496 DOI: 10.1136/ijgc-2023-004615] [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] [Indexed: 08/02/2023] Open
Abstract
Placenta accreta spectrum encompasses cases where the placenta is morbidly adherent to the myometrium. Placenta percreta, the most severe form of placenta accreta spectrum (grade 3E), occurs when the placenta invades through the myometrium and possibly into surrounding structures next to the uterine corpus. Maternal morbidity of placenta percreta is high, including severe maternal morbidity in 82.1% and mortality in 1.4% in the recent nationwide U.S. statistics. Although cesarean hysterectomy is commonly performed for patients with placenta accreta spectrum, conservative management is becoming more popular because of reduced morbidity in select cases. Treatment of grade 3E disease involving the urinary bladder, uterine cervix, or parametria is surgically complicated due to the location of the invasive placenta deep in the maternal pelvis. Cesarean hysterectomy in this setting has the potential for catastrophic hemorrhage and significant damage to surrounding organs. We propose a step-by-step schema to evaluate cases of grade 3E disease and determine whether immediate hysterectomy or conservative management, including planned delayed hysterectomy, is the most appropriate treatment option. The approach includes evaluation in the antenatal period with ultrasound and magnetic resonance imaging to determine suspicion for placenta previa percreta with surrounding organ involvement, planned cesarean delivery with a multidisciplinary team including experienced pelvic surgeons such as a gynecologic oncologist, intra-operative assessment including gross surgical field exposure and examination, cystoscopy, and consideration of careful intra-operative transvaginal ultrasound to determine the extent of placental invasion into surrounding organs. This evaluation helps decide the safety of primary cesarean hysterectomy. If safely resectable, additional considerations include intra-operative use of uterine artery embolization combined with tranexamic acid injection in cases at high risk for pelvic hemorrhage and ureteral stent placement. Availability of resuscitative endovascular balloon occlusion of the aorta is ideal. If safe resection is concerned, conservative management including planned delayed hysterectomy at around 4 weeks from cesarean delivery in stable patients is recommended.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Rauvynne N Sangara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Sue E Hanks
- Department of Radiology, University of Southern California, Los Angeles, California, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, California, USA
| | - Rodolfo Amaya
- Department of Anesthesiology, University of Southern California, Los Angeles, California, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
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Bailey HD, Adane AA, White SW, Farrant BM, Shepherd CCJ. Severe maternal morbidity following stillbirth in Western Australia 2000-2015: a population-based study. Arch Gynecol Obstet 2023; 308:1175-1187. [PMID: 36109376 PMCID: PMC10435652 DOI: 10.1007/s00404-022-06782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. METHODS In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks' gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. RESULTS This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. CONCLUSION In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted.
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Affiliation(s)
- Helen D Bailey
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia.
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia.
| | - Akilew A Adane
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Nedlands, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Brad M Farrant
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
| | - Carrington C J Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, GPO Box U1987, 6845, Australia
- Telethon Kids Institute, The University of Western Australia, West Perth 6872, P.O. Box 855, Nedlands, WA, Australia
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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22
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Bartels HC, O'Doherty J, Wolsztynski E, Brophy DP, MacDermott R, Atallah D, Saliba S, Young C, Downey P, Donnelly J, Geoghegan T, Brennan DJ, Curran KM. Radiomics-based prediction of FIGO grade for placenta accreta spectrum. Eur Radiol Exp 2023; 7:54. [PMID: 37726591 PMCID: PMC10509122 DOI: 10.1186/s41747-023-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a rare, life-threatening complication of pregnancy. Predicting PAS severity is critical to individualise care planning for the birth. We aim to explore whether radiomic analysis of T2-weighted magnetic resonance imaging (MRI) can predict severe cases by distinguishing between histopathological subtypes antenatally. METHODS This was a bi-centre retrospective analysis of a prospective cohort study conducted between 2018 and 2022. Women who underwent MRI during pregnancy and had histological confirmation of PAS were included. Radiomic features were extracted from T2-weighted images. Univariate regression and multivariate analyses were performed to build predictive models to differentiate between non-invasive (International Federation of Gynecology and Obstetrics [FIGO] grade 1 or 2) and invasive (FIGO grade 3) PAS using R software. Prediction performance was assessed based on several metrics including sensitivity, specificity, accuracy and area under the curve (AUC) at receiver operating characteristic analysis. RESULTS Forty-one women met the inclusion criteria. At univariate analysis, 0.64 sensitivity (95% confidence interval [CI] 0.0-1.00), specificity 0.93 (0.38-1.0), 0.58 accuracy (0.37-0.78) and 0.77 AUC (0.56-.097) was achieved for predicting severe FIGO grade 3 PAS. Using a multivariate approach, a support vector machine model yielded 0.30 sensitivity (95% CI 0.18-1.0]), 0.74 specificity (0.38-1.00), 0.58 accuracy (0.40-0.82), and 0.53 AUC (0.40-0.85). CONCLUSION Our results demonstrate a predictive potential of this machine learning pipeline for classifying severe PAS cases. RELEVANCE STATEMENT This study demonstrates the potential use of radiomics from MR images to identify severe cases of placenta accreta spectrum antenatally. KEY POINTS • Identifying severe cases of placenta accreta spectrum from imaging is challenging. • We present a methodological approach for radiomics-based prediction of placenta accreta. • We report certain radiomic features are able to predict severe PAS subtypes. • Identifying severe PAS subtypes ensures safe and individualised care planning for birth.
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Affiliation(s)
- Helena C Bartels
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland.
| | - Jim O'Doherty
- Siemens Medical Solutions, Malvern, PA, USA
- Department of Radiology & Radiological Science, Medical University of South Carolina, Charleston, SC, USA
- Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Eric Wolsztynski
- Statistics Department, University College Cork, Cork, Ireland
- Insight Centre for Data Analytics, Dublin, Ireland
| | - David P Brophy
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Roisin MacDermott
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - David Atallah
- Department of Gynecology and Obstetrics, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Souha Saliba
- Department of Radiology: Fetal and Placental Imaging, Hôtel-Dieu de France University Hospital, Saint Joseph University, Beirut, Lebanon
| | - Constance Young
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Paul Downey
- Department of Histopathology, National Maternity Hospital, Dublin, Ireland
| | - Jennifer Donnelly
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Donal J Brennan
- Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland
- University College Dublin Gynaecological Oncology Group (UCD-GOG), Mater Misericordiae University Hospital and St Vincent's University Hospital, Dublin, Ireland
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
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23
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Birendra R, Jigyasa S. A Retrospective Study of Maternal and Neonatal Outcome in Placenta Accreta Spectrum After Planned or Emergency Delivery From a Tertiary Care Centre in North India. Cureus 2023; 15:e44725. [PMID: 37809253 PMCID: PMC10552932 DOI: 10.7759/cureus.44725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Aim This retrospective study aimed to evaluate the incidence, sociodemographic profile, feto-maternal outcomes, and associated risk factors of placenta accreta spectrum (PAS) among all the deliveries. Methods This retrospective cohort study included all women diagnosed with PAS either preoperatively or intraoperatively. Data on maternal high-risk factors such as previous surgical history, association with placenta praevia, parity and primary outcomes such as the operative procedure carried out, transfusion requirements and ICU admission, as well as neonatal variables such as Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. The study was carried out over a period of 10 months at our centre. Results A cohort of 32 women were identified with placenta accreta, increta, or percreta. The mean maternal age was 31 years. The mean gestational age at the time of diagnosis was 32.75 weeks. Around 50% of patients had risk factors for the abnormally invasive placenta, such as placenta praevia, and 75% had a history of previous caesarean sections. Hysterectomy was done in 28 cases (87.5%). Blood transfusion was done in all the cases. There were two maternal deaths in the study group. The perinatal outcome was better in the antenatally detected cases. Conclusion An increased incidence of PAS has been seen. Early risk factor identification and strategic management improve maternal and foetal outcomes. Our findings demonstrated that PAS pregnancies managed in our centre had maternal and neonatal outcomes comparable to those in developed countries. It is hypothesized that this is because pregnancies with PAS are managed using a multidisciplinary approach.
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Affiliation(s)
- Ruchi Birendra
- Obstetrics and Gynaecology, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Singh Jigyasa
- Obstetrics and Gynaecology, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, IND
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24
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Rebeiz MC, El-Kak F, van den Akker T, Hamadeh R, McCall SJ. Maternal mortality is preventable in Lebanon: A case series of maternal deaths to identify lessons learned using the "Three Delays" model. Int J Gynaecol Obstet 2023; 162:922-930. [PMID: 37102363 DOI: 10.1002/ijgo.14770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE To identify the lessons learned from women who died during pregnancy or childbirth in Lebanon between 2018 and 2020. METHOD This is a case series and synthesis of maternal deaths between 2018 and 2020 that were reported by healthcare facilities to the Ministry of Public Health in Lebanon. The notes recorded from the maternal mortality review reports were analyzed using the "Three Delays" model to identify preventable causes and lessons learned. RESULTS A total of 49 women died before, during, or after childbirth, with hemorrhage being the most frequent cause (n = 16). The possible factors that would have prevented maternal deaths included a prompt recognition of clinical severity, availability of blood for transfusion and magnesium sulfate for eclampsia, adequate transfer to tertiary care hospitals comprising specialist care, and involvement of skilled medical staff in obstetric emergencies. CONCLUSION Many maternal deaths in Lebanon are preventable. Better risk assessment, use of an obstetric warning system, access to adequately skilled human resources and medications, and improved communication and transfer mechanisms between private and tertiary care hospitals may avoid future maternal deaths.
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Affiliation(s)
- Marie-Claire Rebeiz
- Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Faysal El-Kak
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Randa Hamadeh
- Primary Healthcare Department, Ministry of Public Health, Global Health Team of Experts, Beirut, Lebanon
| | - Stephen J McCall
- Centre for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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25
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Futcher F, Moufawad G, Centini G, Hayek J, Tarchichi J, Bakar J, Habib N. Intrauterine Tamponade Balloon for Management of Severe Postpartum Haemorrhage: Does Early Insertion Change the Outcome? A Retrospective Study on Blood Loss. J Clin Med 2023; 12:5439. [PMID: 37685506 PMCID: PMC10487974 DOI: 10.3390/jcm12175439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
The French College of Gynecologists and Obstetricians (CNGOF) recommends the use of intrauterine tamponade balloon (IUTB) in postpartum haemorrhage for bleeding that is refractory after sulprostone before either surgery or interventional radiology. However, the elapsed time between uterotonic drug injection and the insertion of intrauterine tamponade balloon was not reliably assessed. OBJECTIVE To evaluate the role of the timing of IUTB insertion and to assess the correlation between the time of insertion and outcome. METHODS A retrospective study in two tertiary care centres, including patients transferred for severe PPH management. RESULTS A total of 81 patients were included: 52 patients with IUTB inserted before 15 min (group 1) and 29 patients with IUTB inserted after 15 min (group 2). The mean volume of blood loss in the group of patients with IUTB inserted before 15 min was significantly lower than in group of patients with IUTB set after 15 min. CONCLUSION An IUTB could be inserted simultaneously with a uterotonic agent, within 15 min and not after 15 min as suggested by local guidelines, but further prospective studies are required to confirm this.
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Affiliation(s)
- Françoise Futcher
- Department of Obstetrics and Gynecology, Moulins-Yzeure Hospital, 10 Av. du Général de Gaulle, 03006 Moulins, France;
| | - Graziella Moufawad
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Gabriele Centini
- Department of Molecular and Reproductive Medicine, University of Siena, 53100 Siena, Italy;
| | - Jad Hayek
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Jana Tarchichi
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Joseph Bakar
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
| | - Nassir Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78201 Mantes-la-Jolie, France; (G.M.); (J.H.); (J.T.); (J.B.)
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26
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Huang YC, Yang CC. Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34498. [PMID: 37565895 PMCID: PMC10419427 DOI: 10.1097/md.0000000000034498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Although planned cesarean delivery (PCD) is the mainstay of management for abnormal placentation, some patients still require emergency cesarean delivery (ECD). We aimed to systematically analyze the impact of various modes of delivery on neonatal outcomes. METHODS This study was complied with the PRISMA guidelines and was registered in the PROSPERO (code: CRD42022379487). A systematic search was conducted on Ovid MEDLINE and Embase, Web of Science, PubMed, and the Cochrane databases. Data extracted included gestational age at delivery, birth weight, the Apgar scores at 1 and 5 minutes, numbers of newborns with low Apgar score (<7) at 5 minutes, the rates of neonatal intensive care unit admission, and the rates of neonatal mortality. RESULTS Fifteen cohort studies met the inclusion criteria, comprising a total of 2565 women (2567 neonates) who underwent PCD (n = 1483) or ECD (n = 1082) for prenatally diagnosed placenta accreta spectrum (PAS) and/or placenta previa (PP). Compared with the ECD group, neonates in the PCD group had significantly higher gestational ages (standardized mean difference [SMD]: 2.20; 95% confidence interval [CI]: 1.25-3.15; P < .001), birth weights (SMD: 1.64; 95% CI: 1.00-2.27; P < .001), and Apgar scores at 1 minute (SMD: 0.51; 95% CI: 0.29-0.73; P < .001) and 5 minutes (SMD: 0.47; 95% CI: 0.25-0.70; P < .001). Additionally, the PCD group had significantly lower rates of neonatal intensive care unit admission (odds ratio [OR]: 0.21; 95% CI: 0.14-0.29; P < .001), low Apgar score at 5 minutes (OR: 0.27; 95% CI: 0.11-0.69; P = .01), and neonatal mortality (OR: 0.13; 95% CI: 0.05-0.33; P < .001). CONCLUSION When pregnancies are complicated by abnormal placentation, PCD is linked to noticeably better neonatal outcomes than emergent delivery.
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Affiliation(s)
- Yi-Chien Huang
- Division of Neonatology, Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Chun Yang
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
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27
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Bhide A. Routine screening for placenta accreta spectrum. Best Pract Res Clin Obstet Gynaecol 2023; 90:102392. [PMID: 37541113 DOI: 10.1016/j.bpobgyn.2023.102392] [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: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/06/2023]
Abstract
Screening for clinically significant placenta accreta spectrum (PAS) is possible with a high degree of accuracy (both sensitivity and specificity >90-95%). The group of women to focus on are those with placenta previa and one or more prior Cesarean deliveries. Screening for PAS not associated with placenta previa is not as productive, and several false negatives have been described. The results of the screening program indicate that women have a low or high probability of PAS. Screen-positive women or those with uncertain ultrasound features should be referred to a center of excellence. Those confirmed to have a high probability of PAS should electively be delivered at such centers.
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Carusi DA, Duzyj CM, Hecht JL, Butwick AJ, Barrett J, Holt R, O'Rinn SE, Afshar Y, Gilner JB, Newton JM, Shainker SA. Knowledge Gaps in Placenta Accreta Spectrum. Am J Perinatol 2023; 40:962-969. [PMID: 37336213 DOI: 10.1055/s-0043-1761635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Since its first description early in the 20th Century, placenta accreta and its variants have changed substantially in incidence, risk factor profile, clinical presentation, diagnosis and management. While systematic use of diagnostic tools and a multidisciplinary team care approach has begun to improve patient outcomes, the condition's pathophysiology, epidemiology, and best practices for diagnosis and management remain poorly understood. The use of large databases with broadly accepted terminology and diagnostic criteria should accelerate research in this area. Future work should focus on non-traditional phenotypes, such as those without placenta previa-preventive strategies, and long term medical and emotional support for patients facing this diagnosis. KEY POINTS: · Placenta accreta spectrum research may be improved with standardized terminology and use of large databases.. · Placenta accreta prediction should move beyond ultrasound with the addition of biomarkers, and needs to extend to those without traditional risk factors.. · Future research should identify practices that can prevent future accreta development..
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Affiliation(s)
- Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina M Duzyj
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Roxane Holt
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennifer B Gilner
- Division of Maternal-Fetal Medicine, Duke University Medical Center, Durham, North Carolina
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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29
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Shaamash AH, AlQasem MH, Al Ghamdi DS, Mahfouz AA, Eskandar MA. Placenta accreta spectrum in major placenta previa diagnosed only by MRI: incidence, risk factors, and maternal morbidity. Ann Saudi Med 2023; 43:219-217. [PMID: 37554027 DOI: 10.5144/0256-4947.2023.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis. OBJECTIVES Evaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP. DESIGN A 10-year retrospective cohort study. SETTING Tertiary care hospital. PATIENTS AND METHODS We report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US). MAIN OUTCOME MEASURES Risk factors for PAS in major PP and maternal complications. SAMPLE SIZE 299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding. CONCLUSION MRI may be a valuable adjunct in the evaluation of PAS in major PP; as a complement, but not substitute US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or deep/extra-uterine extension on US. LIMITATION Single center, small sample size, lack of complete histopathological diagnosis. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ayman Hussien Shaamash
- From the Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mehad H AlQasem
- From the Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Deama S Al Ghamdi
- From the Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ahmed A Mahfouz
- From the Department of Community and Family Medicine, King Khalid University, Abha, Saudi Arabia
| | - Mamdoh A Eskandar
- From the Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
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30
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Kishimoto N, Miyamoto M, Imauji A, Takada M, Nishitani S, Tanabe R, Ito T, Hada T, Otsuka Y, Takano M. Clinical significance of retained products of conception in placenta previa: a retrospective analysis. BMC Pregnancy Childbirth 2023; 23:481. [PMID: 37391723 DOI: 10.1186/s12884-023-05805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Retained products of conception (RPOC) often cause severe postpartum hemorrhage (PPH) but the clinical significance of RPOC in placenta previa is unclear. This study aimed to investigate the clinical significance of RPOC in women with placenta previa. The primary outcome was to evaluate risk factors of RPOC and the secondary outcome was to consider risk factors of severe PPH. METHODS Singleton pregnant women with placenta previa who underwent cesarean section (CS) and placenta removal during the operation at the National Defense Medical College Hospital between January 2004 and December 2021 were identified. A retrospective analysis was performed to examine the frequency and risk factors of RPOC and the association of RPOC with severe PPH in pregnant women with placenta previa. RESULTS This study included 335 pregnant women. Among these, 24 (7.2%) pregnant women developed RPOC. Pregnant women with prior CS (Odds Ratio (OR) 5.98; 95% Confidence Interval (CI) 2.35-15.20, p < 0.01), major previa (OR 3.15; 95% CI 1.19-8.32, p < 0.01), and placenta accreta spectrum (PAS) (OR 92.7; 95% CI 18.39-467.22, p < 0.01) were more frequent in the RPOC group. Multivariate analysis revealed that prior CS (OR 10.70; 95% CI 3.47-33.00, p < 0.01,) and PAS (OR 140.32; 95% CI 23.84-825.79, p < 0.01) were risk factors for RPOC. In pregnant women who have placenta previa with RPOC or without RPOC, the ratio of severe PPH were 58.3% and 4.5%, respectively (p < 0.01). Furthermore, the occurrence of prior CS (OR 9.23; 95% CI 4.02-21.20, p < 0.01), major previa (OR 11.35; 95% CI 3.35-38.38, p < 0.01), placenta at the anterior wall (OR 3.44; 95% CI 1.40-8.44, p = 0.01), PAS (OR 16.47; 95% CI 4.66-58.26, p < 0.01), and RPOC (OR 29.70; 95% CI 11.23-78.55, p < 0.01) was more in pregnant women with severe PPH. In the multivariate analysis for severe PPH, prior CS (OR 4.71; 95% CI 1.29-17.13, p = 0.02), major previa (OR 7.50; 95% CI 1.98-28.43, p < 0.01), and RPOC (OR 13.26; 95% CI 3.61-48.63, p < 0.01) were identified as risk factors. CONCLUSIONS Prior CS and PAS were identified as risk factors for RPOC in placenta previa and RPOC is closely associated with severe PPH. Therefore, a new strategy for RPOC in placenta previa is needed.
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Affiliation(s)
- Naohisa Kishimoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Akari Imauji
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Minori Takada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Soko Nishitani
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Risa Tanabe
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Tsubasa Ito
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Taira Hada
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yuka Otsuka
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, 3-2, Namiki, Tokorozawa, Saitama, 359-8513, Japan
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He Y, Liu M, Yang YJ, Li L, Huang Q, Liu L. Prophylactic uterine artery embolization during cesarean delivery for management of hemorrhage in complete placenta previa: An observational study. Medicine (Baltimore) 2023; 102:e34052. [PMID: 37327290 PMCID: PMC10270538 DOI: 10.1097/md.0000000000034052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Complete placenta previa is a major cause of morbidity and mortality in pregnant women and fetuses. This study aimed to evaluate whether prophylactic uterine artery embolization (PUAE) could reduce bleeding in patients with complete placenta previa. We retrospectively analyzed patients with complete placenta previa admitted to Taixing People's Hospital for elective cesarean delivery between January 2019 and December 2020. The women were treated with PUAE (PUAE group, n = 20) or without (control group, control, n = 20). Risk factors for bleeding (age, gestational age, pregnancy times, delivery times, cesarean delivery times), intraoperative blood loss, hemoglobin difference before and after surgery, transfusions volume, hysterectomy cases, major maternal complication cases, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time were compared between 2 groups. There were no significant differences on risk factors for bleeding, neonatal birth weight, neonatal Apgar score in 1 minute, postoperative hospitalization time between 2 groups. However, the intraoperative blood loss, hemoglobin before and after operation, transfusion volume in the PUAE group was significantly lower than the control. There was no case of hysterectomy or major maternal complications in both groups. PUAE during cesarean may be an effective and safe strategy to reduce intraoperative blood loss and transfusion volume for patients with complete placenta previa.
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Affiliation(s)
- Yun He
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Min Liu
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Ya Jing Yang
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Li Li
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Qing Huang
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
| | - Lanhua Liu
- Department of Obstetrics and Gynecology, Taixing People’s Hospital, TaiXing, China
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Ma Y, Hu Y, Ma J. Animal models of the placenta accreta spectrum: current status and further perspectives. Front Endocrinol (Lausanne) 2023; 14:1118168. [PMID: 37223034 PMCID: PMC10200980 DOI: 10.3389/fendo.2023.1118168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/20/2023] [Indexed: 05/25/2023] Open
Abstract
Placenta accreta spectrum disorder (PAS) is a kind of disease of placentation defined as abnormal trophoblast invasion of part or all of the placenta into the myometrium, even penetrating the uterus. Decidual deficiency, abnormal vascular remodeling in the maternal-fetal interface, and excessive invasion by extravillous trophoblast (EVT) cells contribute to its onset. However, the mechanisms and signaling pathways underlying such phenotypes are not fully understood, partly due to the lack of suitable experimental animal models. Appropriate animal models will facilitate the comprehensive and systematic elucidation of the pathogenesis of PAS. Due to the remarkably similar functional placental villous units and hemochorial placentation to humans, the current animal models of PAS are based on mice. There are various mouse models induced by uterine surgery to simulate different phenotypes of PAS, such as excessive invasion of EVT or immune disturbance at the maternal-fetal interface, which could define the pathological mechanism of PAS from the perspective of the "soil." Additionally, genetically modified mouse models could be used to study PAS, which is helpful to exploring the pathogenesis of PAS from the perspectives of both "soil" and "seed," respectively. This review details early placental development in mice, with a focus on the approaches of PAS modeling. Additionally, the strengths, limitations and the applicability of each strategy and further perspectives are summarized to provide the theoretical foundation for researchers to select appropriate animal models for various research purposes. This will help better determine the pathogenesis of PAS and even promote possible therapy.
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Affiliation(s)
- Yongdan Ma
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yongyan Hu
- Laboratory Animal Center, Peking University First Hospital, Beijing, China
| | - Jingmei Ma
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing, China
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Mousa A, Elkhateb IT, Gaafar HM, Elsherbini MM, Mousa H, Abdalla M, Abdelbar A, Rida D, Majd HS, Collins SL. Kasr Alainy simplified uterine preserving surgery for conservative management of placenta accreta spectrum (PAS): A modified surgical approach. Eur J Obstet Gynecol Reprod Biol 2023; 284:150-161. [PMID: 37001252 DOI: 10.1016/j.ejogrb.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The incidence of placenta accreta spectrum (PAS) is rising rapidly due to the global surge in Caesarean delivery. It is associated with significant maternal morbidity and mortality. It is usually managed with Caesarean hysterectomy. However, uterine preserving surgeries can have advantages over Caesarean hysterectomy and intentional placental retention techniques. STUDY DESIGN We present a modified technique of uterine preserving surgery that uses a safe approach for placental bed surgical devascularization. This is followed by resection of the invaded uterine segment and uterine wall reconstruction. RESULTS The technique was used in the management of 20 patients with antenatally suspected PAS that were confirmed at laparotomy. It was successful in preserving the uterus in 18/20 (90 %) women. The mean intraoperative blood loss in was 1305 CC (SD: +361.6) with a mean operative time of 123 min (SD: ±38.7). There was only one urinary bladder injury and no other maternal morbidity. CONCLUSION Our surgical technique is safe and may be useful for conservative surgical management of PAS, particularly in low- and middle-income countries, where access to complex resources, such as interventional radiology, is limited.
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Zhang Y, Chen L, Zhou W, Lin J, Wen H. Nomogram to predict postpartum hemorrhage in cesarean delivery for twin pregnancies: a retrospective cohort study in China. Front Med (Lausanne) 2023; 10:1139430. [PMID: 37144027 PMCID: PMC10151667 DOI: 10.3389/fmed.2023.1139430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 03/28/2023] [Indexed: 05/06/2023] Open
Abstract
Background Postpartum hemorrhage (PPH) is the most common cause of maternal morbidity and mortality worldwide. A reliable risk assessment tool for PPH could optimize available interventions to reduce adverse maternal outcomes. Objective The objective of this study was to explore a nomogram predicting the risk of postpartum hemorrhage after cesarean delivery for twin pregnancies. Methods This single-center retrospective cohort study conducted twin pregnancies who underwent cesarean delivery between January 2014 and July 2021. Propensity score matching at baseline was used to match PPH (blood loss ≥1000 mL) and non-PPH group (blood loss <1000 mL). A nomogram was developed to predict the risk of PPH in cesarean delivery for twin pregnancies. The receiver operating characteristic curve (ROC), calibration plot, and decision curve analysis (DCA) were, respectively, used to evaluate the discrimination, calibration, and clinical utility of the prediction models. Results After propensity score matching, 186 twin pregnancies in the PPH group were matched with 186 controls in the non-PPH group. Seven independent prognostic variables, including antepartum albumin, assisted reproductive technology, hypertensive disorders of pregnancy, placenta previa, placenta accrete spectrum, intrapartum cesarean delivered, and estimated weights of twins, were used to build the nomogram. Based on the performance of the model, it appears that a good calibration (Hosmer-Lemeshow χ2 = 4.84, P > 0.05), an excellent predictive ability (area under the curve: 0.778, 95% CI: 0.732-0.825), and a good positive net benefit in the predictive model have been achieved. Conclusion The nomogram was first generated to predict PPH in cesarean delivery for twin pregnancies, which could help clinicians to provide a reference for the preoperative surgical plan, choose optimal treatments, optimize healthcare resources, and thereby reduce the associated adverse maternal outcomes.
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Affiliation(s)
| | | | | | | | - Hong Wen
- Department of Gynecological Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Argote-Ríos DF, Zapata-Salazar LF, Martínez-Ruíz D, Sinisterra-Díaz SE, Sarria-Ortiz D, Nieto-Calvache AJ. Desenlaces maternos según el tipo de placenta previa en un hospital de alta complejidad en Cali, Colombia. Estudio de cohorte retrospectivo. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2023; 74:28-36. [PMID: 37093943 PMCID: PMC10174715 DOI: 10.18597/rcog.3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/12/2022] [Indexed: 04/03/2023]
Abstract
Objetivos: describir la frecuencia de complicaciones maternas en mujeres gestantes con placenta previa (PP) mayor o menor y evaluar una posible de asociación entre tipo de PP y la presencia de hemorragia materna severa y otros resultados maternos asociados.
Materiales y métodos: cohorte retrospectiva, descriptiva. Se incluyeron gestantes con 20 semanas o más de embarazo, con diagnóstico confirmado de placenta previa, quienes fueron atendidas en un hospital de alto nivel de complejidad localizado en Cali (Colombia), entre enero de 2011 y diciembre de 2020. Se excluyeron las gestantes con diagnóstico de placenta previa y acretismo placentario concomitante. Las variables recolectadas fueron: edad materna, índice de masa corporal, tabaquismo, obesidad, paridad, presencia de sangrado, hemorragia posparto, manejo de la hemorragia posparto, transfusión y admisión a UCI de la gestante. Se realizó análisis descriptivo. El protocolo fue aprobado por el comité de ética de la Fundación Valle de Lili.
Resultados: 146 pacientes cumplieron con los criterios de inclusión. La población estuvo constituida por mujeres con una mediana de edad de 32 años, sin antecedente quirúrgico, con diagnóstico prenatal de placenta previa a la semana 22. En el 70,5 % de los casos se trató de pacientes con placenta previa mayor. Las complicaciones más frecuentes fueron hemorragia posparto (37,9 % vs. 16,3 % para pacientes con placenta previa mayor y menor, respectivamente), requerimiento de transfusión (23,3 y 9,3 %, respectivamente) y el ingreso materno a la UCI (40,8 % vs. 18,6 %, respectivamente). No se registraron muertes maternas.
Conclusiones: las mujeres con placenta previa experimentan una frecuencia elevada de complicaciones; probablemente, dicha frecuencia es más alta cuando se documenta placenta previa mayor. Se requieren más estudios que comparen la frecuencia de complicaciones maternas según el tipo de placenta previa.
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Staniczek J, Manasar-Dyrbuś M, Skowronek K, Winkowska E, Stojko R. Foley Catheter as a Tourniquet for Peripartum Hemorrhage Prevention in Patients with Placenta Accreta Spectrum-A Two Case Report and a Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040641. [PMID: 37109599 PMCID: PMC10146152 DOI: 10.3390/medicina59040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
One of the most perilous complications in obstetrics, often leading to severe bleeding and sometimes a need for urgent hysterectomy, is placenta accreta spectrum, which significantly increases the risk of peri-partum complications, even including the risk of death for the mother and the child. Dealing with excessive bleeding in this situation is paramount. We have found a Foley catheter tourniquet to be useful as a temporary tourniquet to control placental and uterine hemorrhage. We have used this method and find it very useful. In this publication, we describe the last two cases of the use of the Foley catheter as a tourniquet for peri-partum hemorrhage prevention, and we will present a review of the literature in this field.
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Affiliation(s)
- Jakub Staniczek
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maisa Manasar-Dyrbuś
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Kaja Skowronek
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Ewa Winkowska
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Rafał Stojko
- Department of Gynecology, Obstetrics and Gynecological Oncology, Medical University of Silesia, 40-055 Katowice, Poland
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Seguin N, Visintini S, Muldoon KA, Walker M. Use of tranexamic acid (TXA) to reduce preterm birth and other adverse obstetrical outcomes among pregnant individuals with placenta previa: a systematic review protocol. BMJ Open 2023; 13:e068892. [PMID: 36882250 PMCID: PMC10008160 DOI: 10.1136/bmjopen-2022-068892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Placenta previa is a placental implantation pathology where the placenta overlies the internal endocervical os. Placenta previa affects approximately 4 per 1000 pregnancies and increases the risk of antepartum bleeding, emergent preterm labour and emergency caesarean sections. Currently, placenta previa is managed through expectant management. Guidelines primarily revolve around the mode and timing of delivery, in-hospital admissions and surveillance. However, the methods to prolong pregnancy have not proven to be clinically effective. Tranexamic acid (TXA), an antifibrinolytic agent, is effectively used to prevent and treat postpartum haemorrhage as well as menorrhagia, with limited adverse effect, and may prove to be an effective treatment for placenta previa. The objective of this systematic review protocol is to review and synthesise the evidence of TXA use for antepartum haemorrhage in placenta previa. METHODS AND ANALYSIS Preliminary searches were conducted on 12 July 2022. We will search MEDLINE, EMBASE, CINAHL, Scopus and the Cochrane Central Register of Controlled Trials. Grey literature resources such as clinical trials registries (ClinicalTrials.gov and the WHO's International Clinical Trials Registry) and preprint servers (Europe PMC and Open Science Framework) will also be searched. The search terms will comprise of index headings and keyword searches related to TXA and the placenta or antepartum bleeding. Cohort and randomised and non-randomised trials will be considered. The target population is pregnant people, of any age, with placenta previa. The intervention is TXA given in the antepartum period. The main outcome of interest is preterm birth before 37 weeks, however, all perinatal outcomes will be collected. Title and abstract will be screened by two reviewers and any conflict will be discussed and evaluated by a third reviewer. The literature will be summarised in narrative form. ETHICS AND DISSEMINATION No ethics approval is required for this protocol. Findings will be disseminated through peer-review publication, lay summaries and conference presentations. PROSPERO REGISTRATION NUMBER CRD42022363009).
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Affiliation(s)
- Niève Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarah Visintini
- Berkman Library, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Katherine A Muldoon
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Walker
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- International and Global Health Office, University of Ottawa, Ottawa, Ontario, Canada
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Legesse AY, Teka H, Kiros S. Placenta Percreta Managed by Ultrasound-Guided Vertical Transfundal Uterine Incision with Hysterectomy: Case Report. Int Med Case Rep J 2023; 16:221-225. [PMID: 37012984 PMCID: PMC10066697 DOI: 10.2147/imcrj.s403052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Placenta accreta spectrum is an obstetrics complication in which the placenta has abnormally adhered to the decidua and uterine wall. Placenta percreta is the rarest and sternest variant of accreta syndrome. In this study, we present a case of placenta percreta where we have done ultrasound-guided trans fundal vertical uterine incision to deliver a healthy fetus and subsequent cesarean hysterectomy. Antepartum diagnosis, involvement of a multidisciplinary team, appropriate counseling of women and their families, ultrasound guidance for placental margin demarcation, and vertical transfundal uterine incision can be considered for patients with placenta percreta.
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Affiliation(s)
- Awol Yemane Legesse
- Department of Obstetrics and Gynecology, Mekelle University, Mekelle, Tigray, Ethiopia
- Correspondence: Awol Yemane Legesse, Obstetrician and Gynecologist, Department of Obstetrics and Gynecology, Mekelle University, P.O. Box: 1871, Mekelle, Tigray, Ethiopia, Email
| | - Hale Teka
- Department of Obstetrics and Gynecology, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Sara Kiros
- Department of Pathology, Mekelle University, Mekelle, Tigray, Ethiopia
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Pineles BL, Sibai BM, Sentilhes L. Is conservative management of placenta accreta spectrum disorders practical in the United States? Am J Obstet Gynecol MFM 2023; 5:100749. [PMID: 36113717 DOI: 10.1016/j.ajogmf.2022.100749] [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: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
This commentary discusses the issues related to conservative management (also called leaving the placenta in situ or intentional retention of the placenta) of placenta accreta spectrum disorders. Considerations related to placenta accreta spectrum disorder management in the United States are compared with France, where conservative management is a well-accepted management option. The history of placenta accreta spectrum disorder treatment is reviewed, finding that since 1937, the most common treatment in the United States been cesarean-hysterectomy without placental removal. Although definitive studies have yet to be conducted, a growing body of evidence suggests that conservative management is able to reduce maternal morbidity, compared with cesarean-hysterectomy. International and national guidelines from several countries are examined. Comparisons between the United States and France that are addressed in the commentary include population and geography, structure of the healthcare system, physician training and acceptability, and patient acceptability. Considering the differences between the countries, conservative management is feasible in the United States. Different options for placenta accreta spectrum disorder management should be rigorously researched in multicenter international collaborations. Conservative management should be considered as an option for women with placenta accreta spectrum disorders in the United States, especially for those desiring fertility preservation.
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Affiliation(s)
- Beth L Pineles
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Sibai).
| | - Baha M Sibai
- Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX (Drs Pineles and Sibai)
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France (Dr Sentilhes)
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Elmaraghy AM, Taha Fayed S, Abd ElHamid Ali M, Ali Hassanien M, Mohamed Mamdouh A. Diagnostic Accuracy of Placental Thickness in Lower Uterine Segment Measured by Ultrasound in Prediction of Placenta Accreta Spectrum in Patients with Placenta Previa. A Diagnostic Test Accuracy Study. Int J Womens Health 2023; 15:311-320. [PMID: 36814526 PMCID: PMC9940499 DOI: 10.2147/ijwh.s399520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
Objective The aim of the study was to evaluate the association between placental thickness and placenta accreta spectrum (PAS) in patients with placenta previa. Materials and Methods In this prospective study, 40 patients diagnosed with placenta previa were included. The maximum placental thickness in the lower uterine segment was obtained using a transabdominal scan. For the image to be deemed suitable, a midline sagittal section of the lower uterine segment (with the implanted placenta) and the cervical canal, with the intervening urinary bladder had been required. Intraoperative attendance was ensured for the detection of cases with spontaneous separation and cases with morbid adherence. All specimens removed were sent for histopathology to confirm PAS. The primary outcome of the study was to detect a threshold of placental thickness which can be used as a cut-off value in such screening test. The number of units of packed RBCs transfused during the operation and bladder injury were secondary measures of outcome. Results Forty patients were included in the study; 20 patients were ultimately diagnosed with PAS while 20 patients did not have PAS. Mean placental thickness was significantly higher in the PAS patients compared with those with no invasive placentation (61.00 mm Vs 43.00 mm, P value 0.000). Using receiver operating characteristic (ROC) curve, a threshold placental thickness of 58mm was associated with 55% sensitivity, 90% specificity, 84.6% positive predictive value, and 66.7% negative predictive value. Multivariate logistic regression showed that placental thickness more than 58mm and having past history of more than three cesarean sections were independent risk factors for PAS among patients with placenta previa. Conclusion Placental thickness in the lower uterine segment is increased in patients with placenta previa with PAS compared to those with no PAS. Such finding can be implemented into clinical practice by using placental thickness as a screening test for PAS in patients with placenta previa. ClinicalTrialsgov ID NCT05500404.
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Affiliation(s)
- Ahmed Mohammed Elmaraghy
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,Correspondence: Ahmed Mohammed Elmaraghy, Email
| | - Salah Taha Fayed
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Abd ElHamid Ali
- Department of Obstetrics & Gynecology, Bani Sweif Hospital, Ministry of Health, Bani Sweif, Egypt
| | - Monira Ali Hassanien
- Obstetrics and Gynecology, Ultrasound and Fetal Care Unit, Ain Shams University Maternity Hospital, Cairo, Egypt
| | - Ahmed Mohamed Mamdouh
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Capannolo G, D'Amico A, Alameddine S, Di Girolamo R, Khalil A, Calì G, Trish IT, Coutinho CM, Herrera M, Liberati M, Lucidi A, Palacios-Jaraquemada J, Buca D, D'Antonio F. Placenta accreta spectrum disorders clinical practice guidelines: A systematic review. J Obstet Gynaecol Res 2023; 49:1313-1321. [PMID: 36796351 DOI: 10.1111/jog.15544] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/28/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To objectively assess the quality of the published clinical practice guidelines (CPGs) on the management of pregnancies complicated by placenta accreta spectrum (PAS)disorders. METHODS MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to the management of pregnancies with suspected PAS disorders were evaluated: risk factors for PAS, prenatal diagnosis, role of interventional radiology and ureteral stenting, and optimal surgical management. The assessment of risk of bias and quality assessment of the CPGs were performed using the (AGREE II) tool (Brouwers et al., 2010). To define a CPG as of good quality we adopted a cut-off score >60%. RESULTS Nine CPGs were included. Specific risk factors for referral were assessed by 44.4% (4/9) of CPGs, mainly consisting in the presence of placenta previa and a prior cesarean delivery or uterine surgery. About 55.6% of CPGs (5/9) suggested ultrasound assessment of women with risk factors for PAS in the second and third trimester of pregnancy and 33.3% (3/9) recommended magnetic resonance imaging (MRI); 88.9% (8/9) of CPGs recommended cesarean delivery at 34-37 weeks of gestation. There was not generally consensus on the use of interventional radiology and ureteral stenting before surgery for PAS. Finally, hysterectomy was the recommend surgical approach by 77.8% (7/9) of the included CPGs. CONCLUSION Most of the published CPGs on PAS are generally of good quality. There was general agreement among the different CPGs on PAS as a regard as risk stratification, timing at diagnosis and delivery but not on the indication for MRI, use of interventional radiology and ureteral stenting.
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Affiliation(s)
- Giulia Capannolo
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alice D'Amico
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Sara Alameddine
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, Federico II, University of Naples, Naples, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - Ilan T Trish
- Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Health, New York, New York, USA
| | - Conrado M Coutinho
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo: Ribeirão Preto, São Paulo, Brazil
| | - Mauricio Herrera
- Maternal fetal medicine, Obstetric Department, Clinica Colsanitas Bogotà, Bogota, Colombia
| | - Marco Liberati
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alessandro Lucidi
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Danilo Buca
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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West S, Martin A, Copping R, Gard G, Maher R, Seeho S. Staged treatment of placenta accreta spectrum: A combined surgical and radiological approach. Aust N Z J Obstet Gynaecol 2023. [PMID: 36695433 DOI: 10.1111/ajo.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. AIMS The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. METHODS AND MATERIALS Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. RESULTS Forty-six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. CONCLUSION This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity.
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Affiliation(s)
- Simon West
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Amy Martin
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia
| | - Ross Copping
- Liverpool Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Greg Gard
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia
| | - Richard Maher
- Royal North Shore Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Sean Seeho
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
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43
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Blood Type and Outcomes in Pregnant Women with Placenta Previa. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:4725064. [PMID: 36743690 PMCID: PMC9891818 DOI: 10.1155/2023/4725064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Background Placenta previa increases the risks of obstetrical complications. Many studies have reported a link between various ABO blood types and pregnancy complications. This study is aimed at describing and comparing the characteristics and outcomes of women with placenta previa by ABO blood type. Methods Data for this study was obtained from a retrospective cohort study between January 1, 2014, and June 30, 2019, of all clinically confirmed placenta previa in a university-based tertiary medical center. Both types of A, B, O, AB, and combining O and non-O blood types were compared to the characteristics and outcomes. Results 1678 participants with placenta previa were included in this study. The highest participants were blood type O with 666 (39.7%), followed by type A with 508 (30.3%) and type B with 395 (23.5%), and the lowest participants were AB with 109 (6.5%). Blood type AB had a higher incidence of antepartum hemorrhage (p = 0.017), predelivery anemia (p = 0.036), and preterm birth (p = 0.015) in placenta previa women. Meanwhile, the incidence of rhesus D positive (97.9% vs. 95.8%, p = 0.012) and twins (5.0% vs. 2.7%, p = 0.011) was higher in the non-O group, and the incidence of neonatal asphyxia (5.9% vs. 9.2%, p = 0.016) was lower in the non-O group. Conclusion Type AB blood may be a potential risk factor for women with placenta previa. This finding may help provide any obstetrician to predict the risk of complication for placenta previa women by the ABO blood types.
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Alteri A, Cermisoni GC, Pozzoni M, Gaeta G, Cavoretto PI, Viganò P. Obstetric, neonatal, and child health outcomes following embryo biopsy for preimplantation genetic testing. Hum Reprod Update 2023; 29:291-306. [PMID: 36655536 PMCID: PMC10152168 DOI: 10.1093/humupd/dmad001] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/06/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Preimplantation genetic testing (PGT) of embryos developed in vitro requires a biopsy for obtaining cellular samples for the analysis. Signs of cell injury have been described in association with this procedure. Thus, the consequences of the biopsy on obstetric and neonatal outcomes have been the subject of some quantitative analyses, although the reliability of data pooling may be limited by important issues in the various reports. OBJECTIVE AND RATIONALE The present review identifies evidence for whether pregnancies conceived after embryo biopsy are associated with a higher risk of adverse obstetric, neonatal, and long-term outcomes. Available evidence has been summarized considering manipulation at various stages of embryo development. SEARCH METHODS We used the scoping review methodology. Searches of article databases were performed with keywords pertaining to the embryo biopsy technique and obstetric, neonatal, and postnatal outcomes. Studies in which embryos were biopsied at different stages (i.e. both at the cleavage and blastocyst stages) were excluded. We included data on fresh and frozen embryo transfers. The final sample of 31 documents was subjected to qualitative thematic analysis. OUTCOMES Sound evidence is lacking to fully address the issues on the potential obstetric, neonatal or long-term consequences of embryo biopsy. For polar body biopsy, the literature is too scant to draw any conclusion. Some data, although limited and controversial, suggest a possible association of embryo biopsy at the cleavage stage with an increased risk of low birthweight and small for gestational age neonates compared to babies derived from non-biopsied embryos. An increase in preterm deliveries and birth defects in cases of trophectoderm biopsy was suggested. For both biopsy methods (at the cleavage and blastocyst stages), an increased risk for hypertensive disorders of pregnancy was found. However, these findings may be explained by confounders such as other embryo manipulation procedures or by intrinsic patient or population characteristics. WIDER IMPLICATIONS Since there is inadequate evidence to assess obstetric, neonatal, and long-term health outcomes following embryo biopsy, an invasive PGT strategy should be developed with a cautious approach. A non-invasive approach, based on the analysis of embryo cell-free DNA, needs to be pursued to overcome the potential limitations of embryo biopsy.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | | | - Mirko Pozzoni
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Gerarda Gaeta
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Ivo Cavoretto
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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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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Larcher L, Jauniaux E, Lenzi J, Ragnedda R, Morano D, Valeriani M, Michelli G, Farina A, Contro E. Ultrasound diagnosis of placental and umbilical cord anomalies in singleton pregnancies resulting from in-vitro fertilization. Placenta 2023; 131:58-64. [PMID: 36493624 DOI: 10.1016/j.placenta.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION placental anomalies can affect fetal and maternal outcome due to severe maternal hemorrhage potentially resulting in hysterectomy and cord accident including abruption that can determine fetal damage or death. The aims of our study are to determine if the rate of placental and umbilical cord anomalies are more common in IVF singleton pregnancies compared to spontaneous pregnancies; to evaluate the role of ultrasound in screening for these anomalies and to investigate if oocyte donor fertilization is an additional risk factor for the development of these anomalies. METHODS this was a prospective cohort study involving two tertiary centers. Patients with a singleton pregnancy conceived with IVF and patients presenting with a spontaneous conception were recruited between 1st May 2019 to 31st March 2021. A total of 634 pregnancies were enrolled in the study. All patients underwent similar antenatal care, which included ultrasound examinations at 11-14, 19-22 and 33-35 weeks. Ultrasound findings of placental and/or umbilical cord abnormalities were recorded using the same protocol for both groups and confirmed after birth. RESULTS IVF pregnancies had a significantly higher risk of low-lying placenta, placenta previa, bilobed placenta and velamentous cord insertion (VCI) compared with spontaneous pregnancies. In the heterologous subgroup there was a significant increased incidence of placenta accreta spectrum (PAS) disorders than in spontaneous pregnancies. All these anomalies were identified prenatally on ultrasound imaging and confirmed at birth. DISCUSSION IVF pregnancies in general and those resulting from donor oocyte in particular are at higher risk of placental and umbilical cord abnormalities compared to spontaneous pregnancies. These anomalies can be diagnosed accurately at the mid-trimester detailed fetal anomaly scan and our findings support the need for a targeted ultrasound screening of these anomalies in IVF pregnancies.
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Affiliation(s)
- L Larcher
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy.
| | - E Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - R Ragnedda
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - D Morano
- Department of Obstetrics and Gynecology S. Anna University Hospital, Cona, Ferrara, Italy
| | - M Valeriani
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - G Michelli
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - A Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - E Contro
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
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Dang X, Fan C, Cui F, He Y, Sun G, Ruan J, Fan Y, Lin X, Wu J, Liu Y, Wang S, Bao Y, Xu J, Du H, Chen S, Deng D, Qiao F, Zeng W, Feng L, Liu H. Interactions between ultrasonographic cervical length and placenta accreta spectrum on severe postpartum hemorrhage in women with placenta previa. Int J Gynaecol Obstet 2022; 161:1069-1074. [PMID: 36572390 DOI: 10.1002/ijgo.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore the interactions between cervical length (CL) and placenta accreta spectrum (PAS) on severe postpartum hemorrhage (SPPH) in patients with placenta previa. METHODS A retrospective case-control study was conducted at four medical centers in China, and 588 patients with placenta previa were included. The logistic regression analysis and restricted cubic splines (RCS) were used to evaluate the association between CL and SPPH. Furthermore, the joint effect of CL and PAS on SPPH was assessed, and the additive and multiplicative interactions were calculated. RESULTS After adjusting for potential confounders, the negative linear dose-response relationship was confirmed by RCS, and the change of odds ratio (OR) was more significant when CL was 2.5 cm or less. The risk of SPPH was significantly higher when CL of 2.5 cm or less co-existed with placenta increta/percreta than when CL of 2.5 cm less, or placenta increta/percreta existed alone (adjusted OR [aOR]CL ≤2.5cm&placenta accreta/non-PAS 3.40, 95% confidence interval [CI] 1.37-8.45; aORplacenta increta/percreta&CL >2.5cm 4.75, 95% CI 3.03-7.47; aORCL ≤2.5cm&placenta increta/percreta 14.51, 95% CI 6.08-34.64), and there might be additive interaction between CL and placenta increta/percreta on SPPH (attributable proportion due to interaction 50.7%, 95% CI 6.1%-95.3%). CONCLUSION If CL was routinely performed during PAS evaluation, the increased OR of short CL and PAS could allow better patient preparation through counseling.
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Affiliation(s)
- Xiaohe Dang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuifang Fan
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Feipeng Cui
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi He
- Department of Obstetrics, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology, Xianning, China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinghan Ruan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yilin Fan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingguang Lin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - JianLi Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanyan Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaoshuai Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yindi Bao
- Department of Obstetrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jie Xu
- Department of Obstetrics, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science And Technology, Xianning, China
| | - Hui Du
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suhua Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongrui Deng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fuyuan Qiao
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjiang Zeng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Feng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyi Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Risk-factor model for postpartum hemorrhage after cesarean delivery: a retrospective study based on 3498 patients. Sci Rep 2022; 12:22100. [PMID: 36543795 PMCID: PMC9772352 DOI: 10.1038/s41598-022-23636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the risk factors of patients with postpartum hemorrhage (PPH) after cesarean delivery (CD) and to develop a risk-factor model for PPH after CD. Patients were selected from seven affiliated medical institutions of Chongqing Medical University from January 1st, 2015, to January 1st, 2020. Continuous and categorical variables were obtained from the hospital's electronic medical record systems. Independent risk factors were identified by univariate analysis, least absolute shrinkage and selection operator and logistic regression. Furthermore, logistic, extreme gradient boosting, random forest, classification and regression trees, as well as an artificial neural network, were used to build the risk-factor model. A total of 701 PPH cases after CD and 2797 cases of CD without PPH met the inclusion criteria. Univariate analysis screened 28 differential indices. Multi-variable analysis screened 10 risk factors, including placenta previa, gestational age, prothrombin time, thrombin time, fibrinogen, anemia before delivery, placenta accreta, uterine atony, placental abruption and pregnancy with uterine fibroids. Areas under the curve by random forest for the training and test sets were 0.957 and 0.893, respectively. The F1 scores in the random forest training and test sets were 0.708. In conclusion, the risk factors for PPH after CD were identified, and a relatively stable risk-factor model was built.
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49
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Subba K, Vyapury V, Wetherall N, Toozs-Hobson P. Haemodynamic stability following adrenaline intracervical block for major haemorrhage during surgical management of late miscarriage: A case report. Case Rep Womens Health 2022; 37:e00476. [PMID: 36593895 PMCID: PMC9803693 DOI: 10.1016/j.crwh.2022.e00476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The risk of heavy bleeding after a miscarriage is higher in women undergoing medical management compared with surgical. According to the literature, oxytocin receptor mRNA expression in the myometrium is not well formed during early gestation. Adrenaline may be considered in miscarriage which remains refractory to uterotonics and where bleeding from the placental bed may contribute to haemorrhage, before proceeding to surgical intervention. It is used in various settings to control bleeding in gynaecological procedures. A 34-year-old woman in her third pregnancy presented at 15 + 1 weeks of gestation with an open cervical os and bulging membrane. Within three hours of admission, she passed the fetus but failed to deliver the placenta and continued to bleed. She was taken to theatre for surgical management of miscarriage. The bleeding persisted following suction evacuation and despite the standard dose of oxytocin, and misoprostol uterotonics were given. Because the source of bleeding could be the placental bed, potentially low lying at this stage, a 4.4 ml prefix combination of 12.5 μg/ml adrenaline (1:80,000) and lidocaine (20 mg/ml) was administered as an intracervical block equally at four quadrants at the level of the cervical isthmus. This arrested the bleeding immediately and controlled the bleeding until discharge. This technique has not been described previously, which we believe causes vasoconstriction of the placental bed.
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Affiliation(s)
- Kamana Subba
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, United Kingdom,Corresponding author.
| | - Vinodhan Vyapury
- Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Natasha Wetherall
- Department of Haematology, Dorset County Hospital, NHS Foundation Trust, Dorchester, United Kingdom
| | - Philip Toozs-Hobson
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, NHS Foundation Trust, United Kingdom
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50
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Halici-Ozturk F, Beyazit F, Yakut K, Yücel Yetiskin FD, Öztürk M, Sinaci S, Caglar AT. Effect of placenta previa on umbilical cord hematocrit value. J Matern Fetal Neonatal Med 2022; 35:10362-10367. [PMID: 36176062 DOI: 10.1080/14767058.2022.2128651] [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 Placenta previa is one of the causes of neonatal anemia. This condition is mainly explained by antenatal hemorrhage and incision of the anteriorly located placenta during cesarean section. However, the mechanism of neonatal anemia in placenta previa has not been extensively studied or well elucidated. This study investigates whether placenta previa is associated with lower hematocrit levels in newborns with no antenatal hemorrhage and placental incision. KEY FINDINGS This prospective study investigated 47 patients with previa and 43 control patients who gave birth with a cesarean section at 34-38 weeks of gestation. Blood samples were obtained from the fetal end of the umbilical vein. The mean umbilical cord hematocrit value was 49.3% in the control patients and 46.7% in the patients with previa, and the difference was statistically significant (p = .029). No significant association was observed between hematocrit value and birth weight, gestational age, newborn gender, placenta position, or preoperative maternal hemoglobin level. CONCLUSION The study findings reveal that even if not complicated by antepartum or intrapartum hemorrhage, placenta previa may be associated with lower hematocrit values in newborns. Although in none of the cases, the umbilical cord hematocrit value was not as low as to be defined as anemia, this effect of previa on newborns should be considered because of the importance of iron status.
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Affiliation(s)
- Filiz Halici-Ozturk
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Fatma Beyazit
- Department of Obstetrics and Gynecology, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Kadriye Yakut
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women Health Care Training and Research Hospital, Ankara, Turkey
| | - Fatma Didem Yücel Yetiskin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Merve Öztürk
- Department of Obstetrics and Gynecology, Isparta City Hospital, Isparta, Turkey
| | - Selcan Sinaci
- Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - A Turhan Caglar
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women Health Care Training and Research Hospital, Ankara, Turkey
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