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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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Abstract
This study was designed to explore the expression and the diagnostic value of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pernicious placenta previa (PPP) combined placental accreta/increta. A total of 140 PPP patients were enrolled and divided into two groups: 56 patients with placenta accreta/increta (PA group), and 84 patients without placenta accreta/increta (non-PA group). In the same period, 46 pregnant women without PPP who had undergone caesarean section were selected as controls. The levels of VEGF and sFlt-1 in serum were detected by enzyme-linked immunosorbent assay. Diagnostic efficiency of VEGF and sFlt-1 in serum were evaluated by receiver operating characteristics curve. It was found that both VEGF and sFlt-1 had diagnostic value for PPP and placenta accreta/increta combined PPP. In addition, the levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta. VEGF was negatively correlated with sFlt-1 in PPP patients. In summary, the levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.KEY POINTSThe levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta.VEGF is negatively correlated with sFlt-1 in PPP patients.The levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.
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Affiliation(s)
- Na Wang
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Dandan Shi
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Na Li
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
| | - Hongyuan Qi
- Obstetrics Department, Cangzhou Central Hospital, Cangzhou, China
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3
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Li J, Zhang N, Zhang Y, Hu X, Gao G, Ye Y, Peng W, Zhou J. Human placental lactogen mRNA in maternal plasma play a role in prenatal diagnosis of abnormally invasive placenta: yes or no? Gynecol Endocrinol 2019; 35:631-634. [PMID: 30784325 DOI: 10.1080/09513590.2019.1576607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To determine whether maternal plasma human placental lactogen (hPL) mRNA levels can predict abnormally invasive placenta. Study design: Sixty-eight singleton pregnant women with prior Cesarean deliveries were classified into three groups: 35 with normal placentation (control group); 21 with placenta previa alone (placenta previa group); 12 with placenta previa and placenta accreta (placenta accreta group). Maternal plasma hPL mRNA concentrations were measured by real-time reverse-transcription polymerase chain reaction Result: The multiple of the median (median, range) for hPL mRNA was significantly higher for the placenta accreta group (2.78, 1.09-4.56) than the control (1.00, 0.29-2.98) or placenta previa (1.12, 0.33-3.25) groups (Steel-Dwass test, p < .001 and p = .005, respectively), was not significantly different between the women with placenta accreta who underwent hysterectomies (2.96, 1.38-4.56) and the women whose deliveries did not result in hysterectomy (2.36, 1.09-3.25) in the placenta accreta group (Mann-Whitney U test, p = .372). Conclusion: hPL mRNA in maternal plasma may indicate abnormally invasive placenta but cannot predict whether abnormally invasive placenta will result in hysterectomy.
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Affiliation(s)
- Jing Li
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Ning Zhang
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yan Zhang
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Xiaoyu Hu
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Guoqiang Gao
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Yuanhua Ye
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Wei Peng
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
| | - Jun Zhou
- a Department of Obstetrics , Affiliated Hospital of Qingdao University , Qingdao , China
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4
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Pierzynski P, Laudanski P, Lemancewicz A, Sulkowski S, Laudanski T. Spontaneous rupture of unscarred uterus in the early second trimester: a case report of placenta percreta. Ginekol Pol 2012; 83:626-629. [PMID: 23342889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Prevalence of uterine rupture at delivery has been recently estimated at less than 1 in 2500 deliveries. Spontaneous uterine rupture in the early mid-trimester (16 weeks gestation or less), is far less frequent. We report a case of uterine rupture due to placenta percreta in otherwise uncomplicated pregnancy CASE A 35-year-old, gravida 5, para 5, at 15wk 2d gestation (menstrual age) with negative history of uterine scarring suddenly developed symptoms of incipient hypovolemic shock while being hospitalized for imminent miscarriage. On exploratory laparotomy we found a midline uterine rupture infiltrated by the placenta. Supracervical hysterectomy was performed. Postoperative lab analysis confirmed the elevated serum AFP levels. CONCLUSION Abnormal placentation and subsequent uterine rupture should be taken into consideration also in women in the second trimester who have no history of uterine instrumentation.
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Affiliation(s)
- Piotr Pierzynski
- Department of Reproductive Medicine and Gynaecological Endocrinology, Medical University of Bialystok, Poland.
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5
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Dreux S, Salomon LJ, Muller F, Goffinet F, Oury JF, Sentilhes L. Second-trimester maternal serum markers and placenta accreta. Prenat Diagn 2012; 32:1010-2. [PMID: 22729439 DOI: 10.1002/pd.3932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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6
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Yarandi F, Eftekhar Z, Shojaei H, Rahimi-Sharbaf F, Baradaran F. Conservative management of placenta increta: case report and literature review. Acta Med Iran 2011; 49:396-398. [PMID: 21874645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Placenta increta, a rare complication of pregnancy, is associated with significant postpartum hemorrhage often requiring emergency hysterectomy. We report a case of conservative management, with a combination of parenteral methotrexate, serial ultrasound and β-hCG assessment. Serum β-hCG levels were undetectable after 8 weeks of therapy. A scan at 6 months showed complete involution of the uterus. Review of the literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with placenta increta.
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Affiliation(s)
- Fariba Yarandi
- Department of Gynecological Oncology, School of Medicine, Tehran University of Medical Sciences, Mirza Koochak-Khan Hospital, Tehran, Iran.
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7
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García-Cavazos R, Colín-Valenzuela A, Espino y Sosa S. [Alpha-fetoprotein as an early predictor of adverse perinatal outcome]. Ginecol Obstet Mex 2010; 78:268-274. [PMID: 20939237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The alpha-fetoprotein (AFP) is a glycoprotein, which is produced by the human fetus. Previous studies have shown associations between elevated AFP levels and an increased risk of adverse perinatal outcomes. OBJECTIVE To determine if abnormal AFP levels are associated with adverse perinatal outcomes. The AFP concentrations were calculated as Multiples of the medians (MoM). PATIENTS AND METHOD A prospective cohort study, including 283 pregnant women, the maternal serum concentration of AFP was determined between 15 and 20 weeks of pregnancy, and the pregnancy was followed until term, when we search for the perinatal outcomes. The study was made in the Instituto Nacional de Perinatología, in Mexico City, from August 2007 to January 2008. For the analyses, the AFP concentrations were calculated as Multiples of the medians (MoM). RESULTS The threshold of 1.5 MoM increases the risk for preterm delivery (RR: 1.77, IC 95%: 1.04-3.03), abruption placentae (RR: 3.67, IC 95%: 1.59-8.49), placenta accreta (RR: 3.67, IC 95%: 1.59-8.49) and for intrauterine growth restriction (RR: 2.86, IC 95%: 1.74-4.68) There was a weak relation between AFP concentration and birth weight (r = -0.12, p = 0.047) and no correlation with pregnancy weeks at birth. CONCLUSIONS There is a relation between adverse perinatal outcome and abnormal AFP levels. The evidence of an increase in the AFP concentration in fetuses without congenital defects should alert de clinician about the possibility of other adverse perinatal outcomes and those results must be included in the prenatal risk assessment.
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8
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Abstract
Placenta accreta is a rare condition. Its management is always a dilemma. Traditionally, hysterectomy has been the treatment of choice. However, with appropriate case selection, conservative management is possible with or without using methotrexate. This case report describes conservative management of placenta accreta with serial monitoring of ssHCG.
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9
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Papadakis JC, Christodoulou N, Papageorgiou A, Rasidaki M. Placenta percreta presenting in the first trimester and resulting in severe consumption coagulopathy and hysterectomy: a case report. CLIN EXP OBSTET GYN 2008; 35:225-226. [PMID: 18754300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Placenta percreta complicating pregnancy in the first trimester is extremely rare, and only a few cases have been reported in the literature. A patient with risk factors for placenta percreta that presented as first trimester fetal demise, unresponsive to medical management with prostaglandin, is presented. The patient required an emergency hysterectomy to control the bleeding after uterine curettage which was complicated by severe consumption coagulopathy. This rare entity can lead to significant mortality and morbidity, particularly in the background of an increased prevalence of the disease and its associated risk factors, and the large number of spontaneous and induced abortions performed worldwide.
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Affiliation(s)
- J C Papadakis
- Department of Obstetrics and Gynecology, Leoforos Knossou, Heraklion, Crete, Greece.
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10
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Pinho S, Sarzedas S, Pedroso S, Santos A, Rebordão M, Avillez T, Casal E, Hermida M. Partial placenta increta and methotrexate therapy: three case reports. CLIN EXP OBSTET GYN 2008; 35:221-224. [PMID: 18754299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The term placenta accreta is used to describe any placental implantation in which there is abnormally firm adherence to the uterine wall. This condition complicates 1/2,500 deliveries and is rising in incidence. Abnormal placentation is associated with increased maternal morbidity and mortality from severe hemorrhage, uterine perforation, infection and loss of fertility. The reported experience of methotrexate treatment in the conservative management of placenta accreta is scant. Three cases of partial placenta increta managed with methotrexate are described. The patients were assessed with clinical surveillance, serum beta human chorionic gonadotrophin (beta-hCG) and imaging (ultrasonography and magnetic resonance in one case). In all cases conservative management with methotrexate resulted in undetectable serum beta-hCG, a decrease in the size of partial placenta retained, and undetectable vascularization.
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Affiliation(s)
- S Pinho
- Department of Obstetrics, Gamrcia de Orta Hospital, Almada, Portugal.
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11
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Okada M, Mitsui T, Morita T, Nomura M, Ohta T, Itakura A. A case of placenta accreta complicated by severe IUGR and maternal coagulopathy. Acta Obstet Gynecol Scand 2007; 86:760-2. [PMID: 17520413 DOI: 10.1080/00016340600617312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mayumi Okada
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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12
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Balkanli-Kaplan P, Gucer F, Oz-Puyan F, Yuce MA, Kutlu K. Placenta percreta diagnosed after first-trimester pregnancy termination: a case report. J Reprod Med 2006; 51:662-4. [PMID: 16967639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Placenta percreta in early pregnancy has been documented in only a few cases. This is the first report of placenta percreta diagnosed after an extended period from pregnancy termination. CASE A woman with a history of a previous cesarean section presented with heavy and irregular vaginal bleeding beginning immediately after pregnancy termination at 7 weeks' gestation. Failed response to hormonal treatment and curettage necessitated hysterectomy. Histologic examination revealed a placenta percreta. CONCLUSION Although placenta percreta is an uncommon occurrence, clinicians should consider it in patients who have a uterotomy scar and complain of long-term metrorrhagia following pregnancy termination.
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Affiliation(s)
- Petek Balkanli-Kaplan
- Department of Obstetrics and Gynecology, Medical Faculty, Trakya University, 22030 Edirne, Turkey.
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13
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Kapoor DS, Tincello DG, Kingston RE. Life-threatening obstetric haemorrhage in second trimester from a placenta percreta with raised alpha-fetoprotein levels. J OBSTET GYNAECOL 2003; 23:570-1. [PMID: 12963529 DOI: 10.1080/0144361031000156609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D S Kapoor
- Department of Obstetrics and Gynaecology, Liverpool Women's Hospital, Liverpool, UK.
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14
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Jimbo M, Sekizawa A, Sugito Y, Matsuoka R, Ichizuka K, Saito H, Okai T. Placenta increta: Postpartum monitoring of plasma cell-free fetal DNA. Clin Chem 2003; 49:1540-1. [PMID: 12928242 DOI: 10.1373/49.9.1540] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masatoshi Jimbo
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo 142-8666, Japan
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15
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Sekizawa A, Jimbo M, Saito H, Iwasaki M, Sugito Y, Yukimoto Y, Otsuka J, Okai T. Increased cell-free fetal DNA in plasma of two women with invasive placenta. Clin Chem 2002; 48:353-4. [PMID: 11805017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan.
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Matsumura N, Inoue T, Fukuoka M, Sagawa N, Fujii S. Changes in the serum levels of human chorionic gonadotropin and the pulsatility index of uterine arteries during conservative management of retained adherent placenta. J Obstet Gynaecol Res 2000; 26:81-7. [PMID: 10870298 DOI: 10.1111/j.1447-0756.2000.tb01288.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our purpose was to assess the natural course of retained adherent placenta at term. METHODS Five cases of retained adherent placenta, clinically diagnosed as placenta accreta, were managed conservatively without methotrexate. To assess the biochemical and circulatory changes in the placentas, the serum levels of human chorionic gonadotropin (hCG) and the pulsatility index (PI) of the uterine arteries were examined. RESULTS Serum hCG levels decreased spontaneously; the half-life of serum hCG was calculated to be 5.2 +/- 0.26 days (mean +/- SEM). The PI of the uterine arteries remained at the level of pregnant women at term, but became elevated within a few days after the removal of the placentas. All the placentas were successfully removed transvaginally within 6 weeks postpartum. CONCLUSIONS The changes in serum hCG observed in this study indicated the spontaneous degeneration of the placenta. Such changes might be similar to those reported to occur during treatment with methotrexate. In contrast, the PI of the uterine arteries did not reflect degeneration of the placenta.
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Affiliation(s)
- N Matsumura
- Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Abstract
OBJECTIVE To identify risk factors associated with placenta accreta in a large cohort study. METHODS Data for this study came from the Taiwan Down Syndrome Screening Group, an ongoing project on feasibility of serum screening in an Asian population. Women who had serum screening for Down syndrome at 14-22 weeks' gestation using alpha-fetoprotein (AFP) and free beta-hCG between January 1994 and June 1997, and delivered in the same institution, were included (n = 10,672). Those who had multiple gestations (n = 200), overt diabetes (n = 11), or fetal malformations (n = 101) were excluded. If a woman was involved more than once, one randomly selected pregnancy was included in the analysis (n = 9349). Twenty-eight pregnancies were complicated by placenta accreta, diagnosed by clinical presentation (n = 26) or histologic confirmation (n = 2). Multiple logistic regression with adjustment for potentially confounding variables was used to identify independent risk factors for placenta accreta. RESULTS Women who had placenta previa (odds ratio [OR] 54.2; 95% confidence interval [CI] 17.8, 165.5) and second-trimester serum levels of AFP and free beta-hCG greater than 2.5 multiples of the median (OR 8.3; 95% CI 1.8, 39.3 and OR 3.9; 95% CI 1.5, 9.9, respectively), and were 35 years and older (OR 3.2; 95% CI 1.1, 9.4) were at increased risk of having placenta accreta. CONCLUSION Risk factors for placenta accreta include placenta previa, abnormally elevated second-trimester AFP and free beta-hCG levels, and advanced maternal age.
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Affiliation(s)
- T H Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan
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18
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McDuffie RS, Harkness L, McVay RM, Haverkamp AD. Midtrimester hemoperitoneum caused by placenta percreta in association with elevated maternal serum alpha-fetoprotein level. Am J Obstet Gynecol 1994; 171:565-6. [PMID: 7520215 DOI: 10.1016/0002-9378(94)90304-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report a case of hemoperitoneum in the second trimester due to placenta percreta which was associated with an elevated maternal serum alpha-fetoprotein. A 29-year-old woman, gravida 4, para 1-0-2-1, was seen at 17 weeks' gestation with an acute abdomen. Maternal serum alpha-fetoprotein in a sample drawn 1 week previously revealed a value of 5.0 multiples of the median. At laparotomy, placenta percreta was discovered. This case of placenta percreta diagnosed in the second trimester was associated with an elevated maternal serum alpha-fetoprotein level. Physicians counseling patients with unexplained elevated maternal serum alpha-fetoprotein levels should include placenta accreta or percreta in the differential diagnosis and should maintain an awareness of its existence in patients with acute abdomen in pregnancy.
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Affiliation(s)
- R S McDuffie
- Department of Obstetrics and Gynecology, Kaiser Permanente/Saint Joseph Hospital, Denver, Colorado
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Kupferminc MJ, Tamura RK, Wigton TR, Glassenberg R, Socol ML. Placenta accreta is associated with elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1993; 82:266-9. [PMID: 7687756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine whether placenta accreta/percreta/increta is associated with elevation of second-trimester maternal serum alpha-fetoprotein (MSAFP) levels. METHODS We reviewed the medical records of 44 women who had emergency cesarean hysterectomy. Twenty women had placenta accreta/percreta/increta (study group) and 24 underwent cesarean hysterectomy for other indications (control group). Pertinent maternal and neonatal variables were abstracted from the prenatal records and hospital charts. Chi-square and Fisher exact tests were used to analyze categorical variables. Student t test was used to analyze continuous variables. RESULTS Nine of 20 patients (45%) with placenta accreta/percreta/increta and none of 24 subjects in the control group had an elevated MSAFP value (P < .001). Maternal estimated blood loss was also significantly greater in the study group (4469 +/- 1851 versus 1885 +/- 1113 mL; P < .0001), as was the number of blood units transfused (7.7 +/- 4.7 versus 3.0 +/- 2.2; P < .001). None of the other examined variables were different between the groups. CONCLUSIONS A significant association exists between placenta accreta/percreta/increta and elevated MSAFP values. Patients with an unexplained elevation of MSAFP may have an increased risk for placenta accreta and associated blood loss at cesarean hysterectomy.
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Affiliation(s)
- M J Kupferminc
- Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois
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20
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Zelop C, Nadel A, Frigoletto FD, Pauker S, MacMillan M, Benacerraf BR. Placenta accreta/percreta/increta: a cause of elevated maternal serum alpha-fetoprotein. Obstet Gynecol 1992; 80:693-4. [PMID: 1383899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the relationship between elevated maternal serum alpha-fetoprotein (MSAFP) and abnormal placental adherence (placenta accreta/percreta/increta). METHODS We reviewed the MSAFP levels of 11 women who had cesarean hysterectomies because of placenta accreta/percreta/increta. The control group consisted of 14 women who delivered by cesarean because of placenta previa but who had no abnormal placental adherence. RESULTS Five of the 11 women with placenta accreta/percreta/increta had elevated MSAFP, whereas all 14 controls had normal levels. CONCLUSION These results indicate a significant association between elevated MSAFP and placenta accreta/percreta/increta (P = .017). Patients with an unexplained elevation of MSAFP as well as placenta previa may be at increased risk for abnormal placental adherence.
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Affiliation(s)
- C Zelop
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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21
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Ginsberg NA, Fausone ME, Gerbie M, Applebaum M, Verlinsky Y. Elevated maternal serum alpha-fetoprotein associated with placenta accreta. J Assist Reprod Genet 1992; 9:497-500. [PMID: 1282836 DOI: 10.1007/bf01204059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- N A Ginsberg
- Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois
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McCool RA, Bombard AT, Bartholomew DA, Calhoun BC. Unexplained positive/elevated maternal serum alpha-fetoprotein associated with placenta increta. A case report. J Reprod Med 1992; 37:826-8. [PMID: 1280687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Maternal serum alpha-fetoprotein (MSAFP) is a regularly utilized antenatal screening test for the identification of pregnancies at increased risk for a variety of genetic and nongenetic abnormalities. Complete mid-trimester evaluation of the patient with a positive screening test may fail to reveal an etiology for a positive MSAFP value. This case report concerns an unexplained positive/elevated MSAFP screening test for a patient found at delivery to have abnormal placentation.
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Affiliation(s)
- R A McCool
- Department of Obstetrics and Gynecology, United States Air Force Medical Center, Keesler Air Force Base, Mississippi
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