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Timor-Tritsch IE, Kaelin Agten A, Monteagudo A, Calỉ G, D'Antonio F. The use of pressure balloons in the treatment of first trimester cesarean scar pregnancy. Best Pract Res Clin Obstet Gynaecol 2023; 91:102409. [PMID: 37716338 DOI: 10.1016/j.bpobgyn.2023.102409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
Cesarean scar pregnancy (CSP) is among the most severe complications of cesarean delivery. CSP refers to the abnormal implantation of the gestational sac in the area of the prior cesarean delivery (CD), potentially leading to severe hemorrhage, uterine rupture, or development of placenta accreta spectrum disorders (PAS). The management of women with CSP has not been standardized yet. In women who opted for termination, discussion about the treatments should consider maternal symptoms, gestational age at intervention, and the future reproductive risk. A multitude of treatments, either medical or surgical, for CSP has been reported in the published literature. The present review aims to provide up-to-date information on a recently introduced minimally invasive treatments for CSP, including the single and double balloon catheter. The methodology of using the single or double catheter is described in a step-by-step fashion illustrated by pictures as well as video recordings. Both catheters have their deserved place to be used as a primary method for terminating scar pregnancies as well as using them as adjuncts to other treatments. They were successfully used by multiple individual practitioners and institutions due to their simplicity and low complication rates. The rare, but possible post-procedure complications such as recurrent CSP and enhanced myometrial vascularity are also mentioned.
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Affiliation(s)
| | - Andrea Kaelin Agten
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, L8 7SS, United Kingdom
| | - Ana Monteagudo
- Icahn School of Medicine. Carnegie Maternal Fetal Associates New York, USA
| | - Giuseppe Calỉ
- Maternal Fetal Medicine Unit AO Villa Sofia-Cervello, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cali G, Labate F, Cucinella G, Fabio M, Buca D, Di Girolamo R, Khalil A, D'Antonio F. Placenta accreta spectrum disorders in twin pregnancies as an under reported clinical entity: a case series and systematic review. J Matern Fetal Neonatal Med 2022; 35:8848-8851. [PMID: 35282751 DOI: 10.1080/14767058.2021.2005568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/06/2021] [Accepted: 11/09/2021] [Indexed: 10/18/2022]
Abstract
Recent reports suggested a potential association between twin pregnancy and the occurrence of placenta accreta spectrum (PAS) disorders. Despite this, scarce data on PAS disorders in twins has been reported in the published literature. We present a series of twelve twin pregnancies complicated by PAS from two large institutions over 5 years. A systematic review of the literature was also conducted in order to find studies reporting on the risk factors, prenatal diagnosis using ultrasound and clinical outcomes of PAS in twin pregnancies.
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Affiliation(s)
- Giuseppe Cali
- Department of Obstetrics and Gynecology, Ospedali Riuniti, Palermo, Italy
| | - Francesco Labate
- Department of Obstetrics and Gynecology, Ospedali Riuniti, Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Ospedali Riuniti, Palermo, Italy
| | - Manuela Fabio
- Department of Obstetrics and Gynecology, Ospedali Riuniti, Palermo, Italy
| | - Danilo Buca
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Raffaella Di Girolamo
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's University of London, London, United Kingdom
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
- The Twins Trust Centre for Research and Clinical Excellence, Saint George's Hospital, London, United Kingdom
| | - 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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Jenabi E, Salimi Z, Salehi AM, Khazaei S. The environmental risk factors prior to conception associated with placenta accreta spectrum: An umbrella review. J Gynecol Obstet Hum Reprod 2022; 51:102406. [PMID: 35584759 DOI: 10.1016/j.jogoh.2022.102406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum(PAS) based on meta-analyses and systematic reviews. MATERIALS AND METHODS We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with the PAS were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). RESULT The risk factor of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestation (OR 1.90, 95% CI: 1.26, 2.88) was graded as the risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The methodological quality of four of the included meta-analyses, based on AMSTAR 2, was low and three meta-analyses were critically low. CONCLUSION The multifetal gestation and IVF were environmental risk factors for the PAS, while hypertension disorders, low SES, and male fetus were the protective factors. Abstract The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum based on meta-analysis and systematic reviews. We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with placenta accrete spectrum were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The risk factors of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestations (OR 1.90, 95% CI: 1.26, 2.88) was graded as risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The quality of five of the included meta-analyses, based on AMSTAR 2, was low and one meta-analysis was critically low (Table 3 and S3). The multifetal gestations and IVF were environmental risk factors for placenta accrete spectrum, while hypertension disorders, low socioeconomic status and male fetus were as the protective factors.
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Affiliation(s)
- Ensiyeh Jenabi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Zohreh Salimi
- Autism Spectrum Disorder Research Center, Hamedan University of Medical Sciences, Hamedan, Iran.
| | - Amir Mohammad Salehi
- Medical Student, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Salman Khazaei
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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Wang Y, Zhou Y, Zeng L, Chen L, Zhao Y. Analysis of risk factors for massive intraoperative bleeding in patients with placenta accreta spectrum. BMC Pregnancy Childbirth 2022; 22:116. [PMID: 35148709 PMCID: PMC8832829 DOI: 10.1186/s12884-022-04391-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/11/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To analyze relevant factors for massive postpartum hemorrhage in women with placenta accreta spectrum in order to improve the ability to identify those at risk for intraoperative bleeding and improve outcome. METHODS This study is a retrospective study and based on data from Hospital electronic medical record. Placenta accreta patients who delivered by cesarean section at Peking University Third Hospital from September 2017 to December 2019 were selected and included. According to the amount of intraoperative bleeding, they were categoried into the massive bleeding group (bleeding volume ≥ 2000 mL, 68 cases) and non-massive bleeding group (bleeding volume < 2000 mL, 99 cases). Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors or ultrasound imaging characteristics and the severity of bleeding during operation. RESULTS (1) There were statistically significant differences in gravidity, parity, number of prior cesarean deliveries and placenta accreta ultrasound scores (P < 0.05) between the two groups of patients. (2) Among the ultrasonographic indicators, the disappearance of the post-placental clear space, the emergence of cross-border blood vessels in the region of subplacental vascularity, interruption or disappearance of the bladder line, and the presence of the cervical blood sinus had the most significant correlation with hemorrhage during PAS (P < 0.05). CONCLUSION The presence of cervical blood sinus, interruption or disappearance of bladder line, the disappearance of the post-placental clear space and abnormal subplacental vascularity are independent risk factors for massive hemorrhage during PAS. We should pay more attention to these indicators in prenatal ultrasound examination in order to reduce the intraoperative bleeding and improve maternal outcomes.
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Affiliation(s)
- Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yadan Zhou
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital, Zhengzhou, 450007, Henan, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
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Maison N, Rattanaburi A, Pruksanusak N, Buhachat R, Tocharoenvanich S, Harnprasertpong J, Sae-Aib N, Suphasynth Y, Atjimakul T, Pichatechaiyoot A, Jiamset I, Nanthamongkolkul K. Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital. J OBSTET GYNAECOL 2021; 42:424-429. [PMID: 34155959 DOI: 10.1080/01443615.2021.1910638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A retrospective study was conducted to evaluate the intraoperative blood volume loss in pregnant women with PAS according to gestational age at delivery. A total of 116 women were enrolled, 39 (33.6%) had an intraoperative massive blood loss (>5000 ml). The massive haemorrhage group had statistically significantly higher percentages of increta and percreta type than the non-massive haemorrhage group (94.9 vs. 67.5%, p < .001). Multiple linear regression analysis showed a decreasing trend of intraoperative blood loss after 34 weeks' gestation with the nadir period between 35 and 36+6 weeks' gestation, especially from 36-36+6 weeks' gestation which was statistically significant, p <.05. The perinatal morbidities from 36-36+6 weeks were not statistically significantly different from 37 weeks' gestation. Therefore, we recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36-36+6 weeks' gestation.Impact statementWhat is already known on this subject? Massive obstetric haemorrhage from PAS disorders is the main concern for caesarean hysterectomy among these patients as it leads to secondary complications including coagulopathy, multisystem organ failure, and death.What do the results of this study add? The amount of intraoperative blood loss in pregnant women who underwent caesarean hysterectomy due to PAS, was lowest from 36-36+6 weeks' gestation.What are the implications of these findings for clinical practice and/or further research? We recommend that pregnant women with PAS and stable clinical symptoms should be scheduled for caesarean hysterectomy from 36-36+6 weeks' gestation.
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Affiliation(s)
- Nuttaporn Maison
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Athithan Rattanaburi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ninlapa Pruksanusak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rakchai Buhachat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sathana Tocharoenvanich
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jitti Harnprasertpong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nungrutai Sae-Aib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Yuthasak Suphasynth
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Thiti Atjimakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Aroontorn Pichatechaiyoot
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ingporn Jiamset
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kulisara Nanthamongkolkul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Bassetty KC, Vijayaselvi R, Yadav B, David LS, Beck MM. Placenta accreta spectrum: Management and outcomes in a tertiary centre in India: An observational cross-sectional study. Trop Doct 2021; 51:398-403. [PMID: 34013811 DOI: 10.1177/00494755211013642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our observational cross-sectional study looked at the risk factors, diagnosis, management and outcomes of placenta accrete spectrum at the Christian Medical College and Hospital, Vellore, India, between January 2013 and December 2018. A total of 21 cases of placenta accrete spectrum are described among whom a preop diagnosis was available in 14 cases. A previous history of Caesarean section and placenta previa was present in 90%. Caesarean hysterectomy was carried out in 80%, but none of those managed conservatively required interval hysterectomy. Urinary tract injury was the most common surgical complication, seen in over 50%. The mean blood loss was 3.5 l and 14 patients required intensive care unit admission, but no maternal mortality ensued. Thus, we conclude that the conservative management in carefully selected cases is feasible.
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Affiliation(s)
- Karthik C Bassetty
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, India
| | - Reeta Vijayaselvi
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, India
| | - Bijesh Yadav
- Department of Clinical Epidemiology and Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - Liji S David
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, India
| | - Manisha M Beck
- Department of Obstetrics and Gynecology, Christian Medical College and Hospital, Vellore, India
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Calì G, D'Antonio F. Radical surgery including the role of an interval hysterectomy. Best Pract Res Clin Obstet Gynaecol 2021; 72:75-83. [PMID: 33824063 DOI: 10.1016/j.bpobgyn.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/18/2022]
Abstract
The incidence of placenta accrete spectrum (PAS) disorders is increasing worldwide. Pregnancies complicated by PAS are at a high risk of intrapartum surgical complications, mainly due to severe maternal hemorrhage, potentially leading to death, thus highlighting the need for a tailored an appropriate surgical management for these women. Despite its clinical relevance, there are still unanswered questions regarding the surgical management of women with PAS. Hysterectomy has been considered as the gold standard for the surgical treatment of these women. However, the surgical approach has not yet been standardized, and several conservative surgical procedures such as the Triple P Procedure are also being performed for PAS. Interventional radiology techniques have been demonstrated to reduce the risk of severe blood loss in women with postpartum hemorrhage, but their role in the management of women with PAS has not yet been fully defined. The aim of this chapter is to provide an up-to-date insight on the radical surgical approach to adopt during cesarean delivery in pregnancies complicated by PAS disorders.
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Affiliation(s)
- Giuseppe Calì
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy.
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, Italy
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9
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Garofalo A, Pilloni E, Alemanno MG, Garofalo G, Sciarrone A, Todros T, Viora E. Ultrasound accuracy in prenatal diagnosis of abnormal placentation of posterior placenta previa. Eur J Obstet Gynecol Reprod Biol 2019; 242:86-91. [PMID: 31574389 DOI: 10.1016/j.ejogrb.2019.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the accuracy of ultrasound in prenatal diagnosis of Placenta accrete spectrum disorders in patients with posterior placenta previa, and to assess the impact of prenatal diagnosis in our population. STUDY DESIGN We prospectively enrolled 198 women with posterior placenta previa from 2011 to 2017. We performed transabdominal and transvaginal ultrasound examinations (Grey-scale and colour/power Doppler). The diagnosis of placenta accreta spectrum disorders was based on detection of at least two of the following criteria: loss of retroplacental clear zone, interruption of uterine serosa-bladder wall interface, turbulent placental lacunae with high velocity flow, myometrial thickness <1 mm, increased vascularity of uterine serosa-bladder wall interface, loss of vascular arch parallel to basal plate and/or irregular intraplacental vascularization. Definitive diagnosis was made at delivery with Caesarean section. Furthermore, we compared maternal outcomes in cases diagnosed antenatal versus that one's diagnosed at delivery. RESULTS There were 20/198 cases of placenta accreta spectrum disorders. The two-criteria system identified 12 cases of placenta accreta, providing a 60.0% of sensitivity, 98.8% of specificity, 85.7% of positive and 95.7% of negative predictive value. Maternal outcomes were better in women with prenatal diagnosis of placenta accreta spectrum disorders, although not statistical significant. CONCLUSIONS Our data showed that grey-scale and Color-Doppler ultrasound evaluation for detecting placenta accreta spectrum disorders on posterior placenta previa have high specificity, positive and negative predictive value, but a low sensitivity. Nevertheless, an antenatal diagnosis of placenta accreta spectrum disorders for posterior placenta previa should be encouraged.
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Affiliation(s)
- Anna Garofalo
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy.
| | - Eleonora Pilloni
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
| | - Maria Grazia Alemanno
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
| | - Giulia Garofalo
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
| | - Andrea Sciarrone
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
| | - Tullia Todros
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
| | - Elsa Viora
- Department of Obstetrics and Gynaecology, Ultrasound Centre, University of Turin, Sant'Anna Hospital, Italy
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10
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Luo L, Sun Q, Ying D, Wu X, Yan P, Yang Y, Chen Z. Scoring system for the prediction of the severity of placenta accrete spectrum in women with placenta previa: a prospective observational study. Arch Gynecol Obstet 2019; 300:783-91. [PMID: 31250197 DOI: 10.1007/s00404-019-05217-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/07/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE The clinical outcomes are significantly different in accreta, increta, and percreta. There is currently no scoring system that can preoperatively distinguish its severity in an at-risk population. The aim of this study is to establish a scoring system for the prediction of the severity of placenta accrete spectrum (PAS) in women with placenta previa. METHODS A prospective observational study was conducted in patients with placenta previa who delivered at a Chinese tertiary care center between June 12, 2016 and June 30, 2018. Optimal scaling regression was performed to determine the parameters which really contribute to the prediction of PAS, and calculate percentage of contribution. RESULTS Among 392 cases with placenta previa, 79, 53, and 28 had been surgically and/or histologically confirmed as accreta, increta, or percreta, respectively. Seven parameters were scheduled for the estimated scores for PAS, and five of them were finally entered into the predictive model. Their percentage of contribution was as follows: placental lacunas (19%), vascularity at the uterus-bladder interface (17.5%), myometrial thickness and hypoechoic retroplacental zone (25.6%), bladder line (22.6%), and previous caesarean sections (15.3%). The thresholds of scores for the prediction of accreta, increta, and percreta yielded 2.25-6.2, 6.2-8.95, and ≧ 8.95, respectively, with the positive and negative predictive value, and false positive rates of the scoring system were 96.68%, 95.44%, and 3.32%, respectively. CONCLUSIONS The scoring system can predict the severity of PAS in women with placenta previa. This will help identify the actual high-risk patients and improve their treatment.
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Romeo V, Ricciardi C, Cuocolo R, Stanzione A, Verde F, Sarno L, Improta G, Mainenti PP, D'Armiento M, Brunetti A, Maurea S. Machine learning analysis of MRI-derived texture features to predict placenta accreta spectrum in patients with placenta previa. Magn Reson Imaging 2019; 64:71-76. [PMID: 31102613 DOI: 10.1016/j.mri.2019.05.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate whether a machine learning (ML) analysis employing MRI-derived texture analysis (TA) features could be useful in assessing the presence of placenta accreta spectrum (PAS) in patients with placenta previa (PP). The hypothesis is that TA features may reflect histological abnormalities underlying PAS in patients with PP thus helping in differentiating positive from negative cases. MATERIALS AND METHODS Pre-operative MRI examinations of 64 patients with PP of which 20 positive (12 accreta, 7 increta and 1 percreta) and 44 negative for PAS were retrospectively selected. Multiple (n = 3) rounded regions of interest (ROIs) were manually positioned on sagittal or coronal T2-weighted images over homogeneous placental tissue close to the placental-myometrial interface for each patient to extract TA features. After balancing the dataset with the Synthetic Minority Over-sampling Technique, training and testing sets were obtained using Hold-out with a 75/25% split. Different algorithms were applied on the training set using the wrapper method, which looks for the best combination of features based on the optimization of a heuristic function in order to get the highest accuracy, and a 10-fold Cross-validation. The accuracy of the best models was also assessed on the test set. Histology was used as the standard of reference. RESULTS A total of 192 ROIs were positioned and a ROI-based analysis was then conducted. Among the different algorithms, k-nearest neighbors obtained the highest accuracy (98.1%), precision (98.7%), sensitivity (97.5%) and specificity (98.7%) while exploiting the lowest number of features (n = 26); conversely, the Naïve Bayes algorithm got the lowest scores showing an accuracy of 80.5%. CONCLUSION ML analysis using MRI-derived TA features could be a feasible tool in the identification of placental tissue abnormalities underlying PAS in patients with PP. This approach might represent an additional tool in the clinical practice, thus expanding the application field of artificial intelligence to medical images.
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Affiliation(s)
- Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Carlo Ricciardi
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Renato Cuocolo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy.
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Francesco Verde
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Laura Sarno
- University of Naples "Federico II", Department of Neuroscience, Reproductive and Dentistry Sciences, Naples, Italy
| | - Giovanni Improta
- University of Naples "Federico II", Department of Public Health, Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy
| | - Maria D'Armiento
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
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Sun W, Yu L, Liu S, Chen Y, Chen J, Wen SW, Chen D. Comparison of maternal and neonatal outcomes for patients with placenta accreta spectrum between online-to-offline management model with standard care model. Eur J Obstet Gynecol Reprod Biol 2018; 222:161-165. [PMID: 29408749 DOI: 10.1016/j.ejogrb.2018.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Online-to-offline is a new model for emergent medical service with the ability to connect care providers with patients on instant basis. This study aims to evaluate maternal and neonatal outcomes in patients with placenta accreta spectrum managed by an online-to-offline care model. METHODS Starting from January 1, 2015, management of patients with placenta accreta spectrum was changed from standard care model into an online-to-offline care model through "Wechat" in Guangzhou Medical Centre for Critical Obstetrical Care. This study compared maternal and neonatal outcomes in patients affected by placenta accreta spectrum between 2015 (online-to-offline model) and 2014 (standard care model). RESULTS A total of 209 cases of placenta accrete spectrum were treated in our center in 2015 and 218 such cases were treated in 2014. Patients treated in 2015 had lower rate of hysterectomy (14.83% versus 20.64%) and shorter hospital stay (7 days versus 8 days). The average interval from admission to emergency cesarean section for critically ill patients was 38.5 min in 2015 versus 50.7 min in 2014. CONCLUSION Patients affected by placenta accreta spectrum managed by online-to-offline care model have reduced risk of hysterectomy, shorter hospital stay, and shorter response time from admission to emergency cesarean section.
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Affiliation(s)
- Wen Sun
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China; OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Lin Yu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Shiliang Liu
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China; Public Health Agency of Canada, Ottawa, Canada
| | - Yanhong Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Juanjuan Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China
| | - Shi Wu Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Ottawa, Canada; Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada; School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa Faculty of Medicine, Ottawa, Canada.
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, China.
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