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Indian Journal of Pathology &... Feb 2020Abnormal placentations such as placenta accreta, placenta increta and placenta percreta are important causes of hemorrhage after delivery causing maternal morbidity and...
BACKGROUND
Abnormal placentations such as placenta accreta, placenta increta and placenta percreta are important causes of hemorrhage after delivery causing maternal morbidity and mortality. Risk factors for abnormal placentation are prior caesarean section, placenta previa and pre-eclampsia. There is a need for reliable antenatal diagnosis for these serious conditions. If these pregnancies can be identified, antepartum, site and time of delivery as well as the surgical approach can be planned ahead; this decreases the incidence of maternal mortality due to massive hemorrhage.
AIM
(1) To study the incidence of abnormal placentation in emergency peripartum hysterectomy specimen. (2) To evaluate various risk factors associated with abnormal placentation.
MATERIALS AND METHOD
Retrospective cross-section study done in patients with abnormal placentation leading to emergency peripartum hysterectomy during a course of eight-year period.
RESULT
We received total of 18 emergency hysterectomy specimens during eight-year period of which placenta accreta accounts 55.5 percent (10/18), placenta increta upto 38.8 percent (7/18) and placenta percreta 5.5 percent (1/18). Analysis of result with parity shows uniparous women up to 22.2 percent (4/18), and multiparous women 77.7 percent (14/18). Risk factor analysis shows previous caesarean section in 55.5 percent (10/18), placenta previa in 33.3 percent (6/18) and pre-eclampsia in 11.1 percent (2/18).
CONCLUSION
In our study, among abnormal placentation, incidence of placenta accreta accounts for 55.5 percent and it is more common in multiparous women than uniparous women. Among risk factors in our study, previous caesarean section is commonly associated with abnormal placentation followed by a placenta previa and pre-eclampsia.
Topics: Adult; Cesarean Section; Cross-Sectional Studies; Female; Humans; Hysterectomy; Incidence; Peripartum Period; Placenta; Placenta Accreta; Placenta Previa; Pre-Eclampsia; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 32108636
DOI: 10.4103/IJPM.IJPM_229_19 -
Archives of Gynecology and Obstetrics Dec 2019The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study...
PURPOSE
The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa.
METHODS
This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher's exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI).
RESULTS
We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8-3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1-9.6).
CONCLUSIONS
Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.
Topics: Adult; Female; Humans; Hysterectomy; Morbidity; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies
PubMed: 31691015
DOI: 10.1007/s00404-019-05338-y -
American Journal of Obstetrics &... Dec 2023This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum.
DATA SOURCES
A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022.
STUDY ELIGIBILITY CRITERIA
Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa.
METHODS
Study screening was performed after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis.
RESULTS
Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21-0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% confidence interval, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% confidence interval, -3.25 to -0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10-0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12-11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06-0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24-7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12-11.25) showed statistical significance. No significant difference was found for the other outcomes.
CONCLUSION
Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Placenta Accreta; Placenta Previa; Cesarean Section; Intensive Care Units; Maternal Mortality
PubMed: 37865220
DOI: 10.1016/j.ajogmf.2023.101197 -
Best Practice & Research. Clinical... May 2022Placenta accreta spectrum (PAS) is a potentially life-threatening disorder with unique anesthetic challenges, and its incidence has increased over the past decades. We... (Review)
Review
Placenta accreta spectrum (PAS) is a potentially life-threatening disorder with unique anesthetic challenges, and its incidence has increased over the past decades. We review current guidelines and best practice evidence for antenatal diagnosis and preoperative evaluation, management pathways, multidisciplinary staff coordination, and surgery location. We address specific considerations for choice of anesthesia modality, the role of interventional radiology, and various techniques for minimizing hemorrhage for both planned and unplanned cases, as well as postoperative care for the PAS patient.
Topics: Anesthesia; Anesthetics; Cesarean Section; Female; Humans; Hysterectomy; Placenta; Placenta Accreta; Pregnancy
PubMed: 35659951
DOI: 10.1016/j.bpa.2022.01.003 -
The Journal of Maternal-fetal &... Aug 2019The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.
OBJECTIVE
The objective of this study is to identify the maternal and neonatal outcomes in women with placenta increta or placenta percreta in China.
MATERIALS AND METHODS
We retrospectively analyzed 2219 cases from 20 tertiary care centers in China between January 2011 and December 2015. All cases were diagnosed of placenta increta or placenta percreta, based on either intraoperative findings or histopathological findings.
RESULTS
The incidence of placenta increta and placenta percreta progressively increased from 0.18% in 2011 to 0.78% in 2015. Compared with the placenta increta, placenta percreta was strongly related to serious adverse outcomes: postpartum hemorrhage (65.9% versus 38.6%, p = .003), blood transfusion (86.2% versus 46.5%, p < .001), hysterectomy (43.3% versus 11.2%, p < .001), preterm birth (65.7% versus 49.9%, p < .001), and the need for neonatal intensive care unit (NICU) admission (54.5% versus 36.7%, p < .001).
CONCLUSION
The incidence of placenta increta and placenta percreta is likely to increase in China. The depth of placenta implantation is associated with the severity of outcomes. Placenta percreta tends to have worse maternal and neonatal outcomes.
Topics: Adult; China; Female; Humans; Hysterectomy; Incidence; Intensive Care Units, Neonatal; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Severity of Illness Index
PubMed: 29514533
DOI: 10.1080/14767058.2018.1442429 -
AJR. American Journal of Roentgenology Jan 2017The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and...
OBJECTIVE
The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and diagnostic pitfalls. Appropriate examination indications and recommendations for optimizing image acquisition and interpretation are summarized.
CONCLUSION
MRI increases the accuracy of the workup of high-risk patients and aids in multidisciplinary delivery planning to improve maternal outcome. Reader accuracy and confidence require adherence to examination performance, image interpretation criteria, and awareness of common pitfalls.
Topics: Algorithms; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Patient Positioning; Placenta Accreta; Pregnancy; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27762597
DOI: 10.2214/AJR.16.16281 -
Obstetrical & Gynecological Survey Jun 2024Placenta accreta spectrum (PAS) represents a range of disorders characterized by abnormal placental invasion and is associated with severe maternal morbidity and... (Review)
Review
IMPORTANCE
Placenta accreta spectrum (PAS) represents a range of disorders characterized by abnormal placental invasion and is associated with severe maternal morbidity and mortality.
OBJECTIVE
The aim of this study was to review and compare the most recently published major guidelines on the diagnosis and management of this potentially life-threatening obstetric complication.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the International Society for Abnormally Invasive Placenta, the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada on PAS disorders was carried out.
RESULTS
There is a consensus among the reviewed guidelines regarding the definition and the diagnosis of PAS using specific sonographic signs. In addition, they all agree that the use of magnetic resonance imaging should be limited to the evaluation of the extension to pelvic organs in case of placenta percreta. Moreover, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada agree that screening for PAS disorders should be based on clinical risk factors along with sonographic findings. Regarding management, they all highlight the importance of a multidisciplinary team approach and recommend delivery by elective cesarean section at a tertiary center with experienced staff and appropriate resources. Routine preoperative ureteric stenting and occlusion of pelvic arteries are universally not recommended. Moreover, hysterectomy following the delivery of the fetus, expectant management with placenta left in situ, and conservative management in case of focal disease and desired fertility are all considered as acceptable treatment options. The reviewed guidelines also suggest some measures for intraoperative and postoperative hemorrhage control and recommend prophylactic administration of antibiotics. Methotrexate after expectant management is unanimously discouraged. On the other hand, there is no common pathway with regard to the optimal timing of delivery, the recommended mode of anesthesia, the preferred skin incision, and the effectiveness of the delayed hysterectomy approach.
CONCLUSIONS
PAS disorders are mainly iatrogenic conditions with a constantly rising incidence and potentially devastating consequences for both the mother and the neonate. Thus, the development of uniform international practice protocols for effective screening, diagnosis, and management seems of paramount importance and will hopefully drive favorable pregnancy outcomes.
Topics: Humans; Placenta Accreta; Female; Pregnancy; Practice Guidelines as Topic; Cesarean Section; Hysterectomy; Ultrasonography, Prenatal
PubMed: 38896432
DOI: 10.1097/OGX.0000000000001274 -
Disease Markers 2018. Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe... (Review)
Review
. Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.
Topics: Biomarkers; Female; Fetal Proteins; Gonadotropins; Humans; Placenta Accreta; Pregnancy; Pregnancy-Associated Plasma Protein-A
PubMed: 30057649
DOI: 10.1155/2018/1507674 -
Placenta Jun 2020Placenta accreta spectrum (PAS) is a major obstetrical problem whose incidence is rising. Current guidelines recommend screening of all women with placenta previa and... (Review)
Review
Placenta accreta spectrum (PAS) is a major obstetrical problem whose incidence is rising. Current guidelines recommend screening of all women with placenta previa and risk factors for PAS between 20 and 24 weeks. Risk factors, diagnosis, and management of previa PAS are well established, but an apparently normal location of the placenta does not exclude PAS. Literature data are scarce on uterine body PAS, which carries a high risk of maternal and neonatal adverse outcome, but is still easily missed on prenatal ultrasound. We conducted a comprehensive review to identify possible risk factors, clinical presentations, and diagnostic modalities of uterine PAS. A total of 133 cases were found during a 70-year period (1949-2019). The vast majority of them presented with signs of uterine rupture, even prior to the viability threshold of 24 weeks (up to 45%). Major risk factors included previous cesarean delivery, uterine curettage, uterine surgery, Asherman's syndrome, manual removal of the placenta, endometritis, high parity, young maternal age, in vitro fertilization, radiotherapy, uterine artery embolization, and uterine leiomyoma. Diagnosis was pre-symptomatic in only 3% of cases. Future studies should differentiate between previa PAS and uterine body PAS.
Topics: Female; Gestational Age; Humans; Maternal Age; Placenta; Placenta Accreta; Pregnancy; Risk Factors; Ultrasonography, Prenatal; Uterus
PubMed: 32452401
DOI: 10.1016/j.placenta.2020.04.005 -
Acta Obstetricia Et Gynecologica... Jun 2021
Topics: Female; Humans; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Prenatal Diagnosis
PubMed: 34002367
DOI: 10.1111/aogs.14148