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Obstetrics and Gynecology Oct 2020To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta).
OBJECTIVE
To investigate subsequent birth rates, maternal and neonatal outcomes for women with a history of placenta accreta spectrum (placenta accreta, increta, and percreta).
METHODS
A population-based record linkage study of women who had a first, second, or third birth in New South Wales from 2003 to 2016 was conducted. Data were obtained from birth and hospital records and death registrations. Women with a history of placenta accreta spectrum were matched to women without, on propensity score and parity, to compare outcomes with women who had similar risk profiles. Modified Poisson regression models were used to calculate adjusted relative risk (aRR) for a range of maternal and neonatal outcomes.
RESULTS
We identified recurrent placenta accreta spectrum in 27/570 (4.7%, 95% CI 3.0-6.5%) of second and 9/119 (7.6%, 95% CI 2.8-12.3%) of third pregnancies after placenta accreta spectrum in the preceding birth, with an overall recurrence rate of 38/689 (5.5%, 95% CI 3.9-7.5%, compared with the population prevalence of 25.5/10,000 births (95% CI 24.6-26.4). Subsequent births after placenta accreta spectrum had higher risk of postpartum hemorrhage (aRR 1.51, 95% CI 1.19-1.92), transfusion (aRR 2.13, 95% CI 1.17-3.90), cesarean delivery (aRR 1.19, 95% CI 1.02-1.37), manual removal of placenta (aRR 6.92, 95% CI 3.81-12.55), and preterm birth (aRR 1.43, 95% CI 1.03-1.98), with lower risk of small for gestational age (aRR 0.64, 95% CI 0.43-0.96), compared with similar-risk births.
CONCLUSION
Women with a history of placenta accreta spectrum have increased risk of maternal morbidity, preterm birth, and placenta accreta spectrum in the subsequent pregnancy compared with similar-risk women with no previous placenta accreta spectrum, although the absolute risks are generally low. These findings may be used to inform counseling of women on the risks of future pregnancies.
Topics: Adult; Australia; Blood Transfusion; Cesarean Section; Delivery, Obstetric; Female; Humans; Hysterectomy; Infant, Newborn; Male; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Premature Birth; Registries; Reproductive History; Risk Adjustment; Risk Factors
PubMed: 32925617
DOI: 10.1097/AOG.0000000000004051 -
International Journal of Hyperthermia :... 2021To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
OBJECTIVE
To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
MATERIALS AND METHODS
Thirty-four patients with placenta accreta, placenta increta, or placenta percreta were treated with USgHIFU from January 2016 to December 2019 and were retrospectively reviewed. The patients were classified into three categories according to the relationship between the trophoblastic villi and the myometrium, based on magnetic resonance imaging (MRI). Fifteen patients were classified as placenta accreta, 17 patients were classified as placenta increta, and 2 were classified as placenta percreta. All patients completed follow-up. Treatment efficacy and safety were evaluated.
RESULTS
No significant differences in baseline characteristics and results of HIFU ablation were observed between the patients with placenta accreta and those with placenta increta. The return of HCG levels to normal was longer in patients with placenta accreta compared with patients with placenta increta, while no significant difference was observed in the amount of intraoperative blood loss, the return of normal menstruation and the length of hospital stay.
CONCLUSIONS
HIFU treatment followed by hysteroscopic resection is safe and effective in the treatment of patients with placenta accreta and placenta increta.
Topics: Blood Loss, Surgical; Cesarean Section; Female; High-Intensity Focused Ultrasound Ablation; Humans; Placenta Accreta; Pregnancy; Retrospective Studies
PubMed: 33827369
DOI: 10.1080/02656736.2021.1909149 -
Ultrasound in Obstetrics & Gynecology :... May 2017
Review
Topics: Cesarean Section; Female; Humans; Hysterectomy; Magnetic Resonance Imaging; Placenta Accreta; Placenta, Retained; Pregnancy; Pregnancy Outcome; Prenatal Diagnosis; Terminology as Topic
PubMed: 28120421
DOI: 10.1002/uog.17417 -
Best Practice & Research. Clinical... Apr 2021Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe post-partum haemorrhage (PPH).... (Review)
Review
Placenta accreta spectrum (PAS) disorders are rare but potentially life-threatening obstetric conditions, which can result in severe post-partum haemorrhage (PPH). Traditional management necessitates peripartum hysterectomy, but this carries high rates of morbidity and mortality. More recently, interventional radiology techniques have been developed in order to reduce morbidity and preserve fertility. This article summarises and compares the various reported interventional radiology techniques. Arterial embolisation performed to treat PPH is the therapeutic option which is supported by the highest degree of evidence. The role of preventative procedures, such as temporary balloon occlusion of the internal iliac arteries or distal aorta, continues to be debated due to conflicting outcome data and concerns regarding associated morbidity. The choice of which, if any, interventional radiological technique is utilised is determined by local expertise, available resources and the planned obstetric approach. The most complex patients are likely to benefit from multidisciplinary management in high-volume centres.
Topics: Balloon Occlusion; Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Radiology, Interventional
PubMed: 33640296
DOI: 10.1016/j.bpobgyn.2021.01.007 -
International Journal of Gynaecology... Jun 2022To examine the detection rate of placenta previa and placenta accreta spectrum (PAS) by routine mid-pregnancy obstetric ultrasound and to estimate risk factors and... (Observational Study)
Observational Study
OBJECTIVE
To examine the detection rate of placenta previa and placenta accreta spectrum (PAS) by routine mid-pregnancy obstetric ultrasound and to estimate risk factors and prevalence within this cohort.
METHODS
This was an observational cohort study with prospectively collected data. Women attending routine mid-pregnancy obstetric ultrasound at the Sahlgrenska University Hospital with a suspected cup-shaped placenta (cohort 1, n = 339) and women diagnosed with placenta previa or PAS (cohort 2, n = 227) were analyzed according to detection rate, risk factors, and prevalence.
RESULTS
The detection rates of placenta previa and PAS were 49% (98) and 25% (14), respectively. However, 216 (99%) women with placenta previa were diagnosed prenatally, as were 14 (50%) women with PAS. In vitro fertilization was identified as the strongest independent risk factor for placenta previa (odds ratio 6.96; 95% confidence interval 4.77-10.16, P < 0.001). Risk factors were present for all women with PAS. The prevalence of placenta previa was 44/10 000 deliveries, and for PAS, 5.6/10 000 deliveries.
CONCLUSION
The existing routine mid-pregnancy obstetric ultrasound screening showed low detection rate for placenta previa and PAS. Adding risk factors could improve the detection rate.
Topics: Female; Humans; Pregnancy; Cesarean Section; Placenta; Placenta Accreta; Placenta Previa; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34383328
DOI: 10.1002/ijgo.13876 -
Journal of Ultrasound in Medicine :... Aug 2021The placenta accreta spectrum (PAS) incidence has risen substantially over the past century, paralleling a rise in cesarean delivery (CD) rates. Prenatal diagnosis of...
OBJECTIVES
The placenta accreta spectrum (PAS) incidence has risen substantially over the past century, paralleling a rise in cesarean delivery (CD) rates. Prenatal diagnosis of PAS improves maternal outcomes. The Placenta Accreta Index (PAI) is a standardized approach to prenatal diagnosis of PAS incorporating clinical risk and ultrasound (US) findings suggestive of placental invasion. We sought to validate the PAI for prediction of PAS in pregnancies with prior CD.
METHODS
This work was a retrospective cohort study of pregnancies with 1 or more prior CDs that received a US diagnosis of placenta previa or low-lying placenta in the third trimester. Images of third-trimester US with a complete placental evaluation were read by 2 blinded physicians, and the PAI was applied. Surgical outcomes and pathologic findings were reviewed. Placenta accreta spectrum was diagnosed if clinical evidence of invasion was seen at time of delivery or if any placental invasion was identified histologically. International Federation of Gynecology and Obstetrics criteria were used.
RESULTS
A total of 194 women met inclusion criteria. Cesarean hysterectomy was performed in 92 (47%), CD in 97 (50%), and vaginal delivery in 5 (3%). Of those who underwent hysterectomy, PAS was histologically confirmed in 79 (85%) pregnancies. Of the remaining 13 who underwent hysterectomy, all met International Federation of Gynecology and Obstetrics grade 1 clinical criteria for PAS. With a threshold of greater than 4, the PAI has a sensitivity of 87%, specificity of 77%, positive predictive value of 72%, and negative predictive value of 90% for PAS diagnosis.
CONCLUSIONS
Contemporaneous application of the PAI, a standardized approach to US diagnosis, is useful in the prenatal prediction of PAS.
Topics: Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 33058255
DOI: 10.1002/jum.15530 -
Best Practice & Research. Clinical... Apr 2021Accreta placentation and in particular its invasive forms are impacting maternal health outcomes globally and the prevalence of placenta accreta spectrum (PAS) continues... (Review)
Review
Accreta placentation and in particular its invasive forms are impacting maternal health outcomes globally and the prevalence of placenta accreta spectrum (PAS) continues to increase. The Royal College of Obstetricians and Gynaecologists (RCOG) and the American College of Obstetricians and Gynecologists (ACOG) with the Society for Maternal-Fetal Medicine (SMFM) have updated their national guidelines, whereas the Federation International of Gynecology and Obstetrics (FIGO) and the Society of Obstetricians and Gynecologists of Canada (SOGC) have developed new guidelines on the diagnosis and management of PAS. A comparison of these guidelines highlights common strong recommendations on the need to carefully evaluate women at high risk for PAS (e.g. prior uterine surgery presenting with anterior low-lying placenta or placenta previa), using multi-modal ultrasound imaging. For women diagnosed with PAS, multidisciplinary team-based care, with full logistic support structures (immediate access to comprehensive blood products, adult and neonatal intensive care) and established expertise in complex pelvic surgery, is critical to maximise safe outcomes for mothers and newborns.
Topics: Adult; Canada; Female; Humans; Infant, Newborn; Placenta Accreta; Placenta Previa; Placentation; Pregnancy; Ultrasonography, Prenatal
PubMed: 32698993
DOI: 10.1016/j.bpobgyn.2020.06.007 -
Current Opinion in Anaesthesiology Jun 2021The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the... (Review)
Review
PURPOSE OF REVIEW
The incidence of placenta accreta spectrum is increasing and it is a leading cause of peripartum hysterectomy and massive postpartum hemorrhage. The purpose of the present article is to provide a contemporary overview of placenta accreta spectrum pertinent to the obstetric anesthesiologist.
RECENT FINDINGS
Recent changes in the terminology used to report invasive placentation were proposed to clarify diagnostic criteria and guidelines for use in clinical practice. Reduced morbidity is associated with scheduled preterm delivery in a center of excellence using a multidisciplinary team approach. Neuraxial anesthesia as a primary technique is increasingly being used despite the known risk of major bleeding. The use of viscoelastic testing and endovascular interventions may aid hemostatic resuscitation and improve outcomes.
SUMMARY
Accurate diagnosis and early antenatal planning among team members are essential. Obstetric anesthesiologists should be prepared to manage a massive hemorrhage, transfusion, and associated coagulopathy. Increasingly, viscoelastic tests are being used to assess coagulation status and the ability to interpret these results is required to guide the transfusion regimen. Balloon occlusion of the abdominal aorta has been proposed as an intervention that could improve outcomes in women with placenta accreta spectrum, but high-quality safety and efficacy data are lacking.
Topics: Anesthetics; Cesarean Section; Female; Humans; Hysterectomy; Infant, Newborn; Placenta Accreta; Postpartum Hemorrhage; Pregnancy
PubMed: 33935172
DOI: 10.1097/ACO.0000000000000985 -
Magma (New York, N.Y.) Dec 2022To evaluate the placental function by monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in patients with placenta previa.
OBJECTIVES
To evaluate the placental function by monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in patients with placenta previa.
METHODS
A total of 62 patients with placenta accreta spectrum (PAS) disorders and 11 patients with normal placentas were retrospectively enrolled, who underwent conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI). The apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, mean kurtosis (MK), and diffusion coefficient (MD) from DKI, and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis.
RESULTS
Comparisons between patients with PAS disorders and patients with normal placentas demonstrated that MD mean, D mean, and D* mean values in patients with PAS disorders were significantly higher than those in patients with normal placentas (p < 0.05). Comparisons between patients with accreta, increta, and percreta, and patients with normal placentas showed that the D mean was significantly higher in patients with placenta increta and percreta than in patients with normal placentas (p < 0.05).
CONCLUSION
The accreta lesions in PAS disorders had deceased cellularity and increased blood movement. The alteration of placental cellularity was more prominent in placenta increta and percreta.
Topics: Humans; Female; Pregnancy; Placenta Accreta; Placenta Previa; Retrospective Studies; Placenta; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Perfusion
PubMed: 35802217
DOI: 10.1007/s10334-022-01023-5 -
Placenta Jun 2022Our study aimed to distinguish patients with placenta accreta (crete, increta, and percreta) from those with placenta previa using maternal plasma levels of soluble...
INTRODUCTION
Our study aimed to distinguish patients with placenta accreta (crete, increta, and percreta) from those with placenta previa using maternal plasma levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF) and the sFlt-1/PLGF ratio.
METHODS
We obtained maternal plasma from 185 women in late pregnancy and sorted them into three groups: 72 women with normal placental imaging results (control group), 50 women with placenta previa alone (PP group), and 63 women with placenta previa and placenta accreta (PAS group). The concentrations of sFlt-1 and PLGF in the maternal plasma were measured using ELISA kits and the sFlt-1/PLGF ratio was calculated.
RESULT
The median (min-max) sFlt-1 levels and the sFlt-1/PLGF ratio in the PAS group (12.8 ng/ml, 3.8-34.2 ng/ml) (133, 14-361) were lower than in the PP group (28.7 ng/ml, 13.1-60.3 ng/ml) (621, 156-2013) (p < 0.0001 and P < 0.0001, respectively). The median (min-max) PLGF levels in the PAS group (108 pg/ml, 38-679 pg/ml) was higher than that in the PP group (43 pg/ml, 12-111 pg/ml) (p < 0.0001 and p < 0.0001, respectively). The area under the ROC of the sFlt-1 levels, PLGF levels, and sFlt-1/PLGF ratio were 0.91, 0.90, and 0.99, respectively; the cut-off values were 18.9 ng/ml, 75.9 pg/ml, and 229.5, respectively. The concentration of sFlt-1 and sFlt-1/PLGF ratio were associated with the volume of blood loss (-.288*, -.301*).
DISCUSSION
The concentrations of sFlt-1 and PLGF and ratio of plasma sFlt-1/PLGF may distinguish patients with placenta accreta from those with placenta previa.
Topics: Biomarkers; Diagnosis, Differential; Female; Humans; Placenta; Placenta Accreta; Placenta Growth Factor; Placenta Previa; Pre-Eclampsia; Pregnancy; Receptor Protein-Tyrosine Kinases; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1
PubMed: 35635854
DOI: 10.1016/j.placenta.2022.05.009