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Best Practice & Research. Clinical... Aug 2023Screening for clinically significant placenta accreta spectrum (PAS) is possible with a high degree of accuracy (both sensitivity and specificity >90-95%). The group of... (Review)
Review
Screening for clinically significant placenta accreta spectrum (PAS) is possible with a high degree of accuracy (both sensitivity and specificity >90-95%). The group of women to focus on are those with placenta previa and one or more prior Cesarean deliveries. Screening for PAS not associated with placenta previa is not as productive, and several false negatives have been described. The results of the screening program indicate that women have a low or high probability of PAS. Screen-positive women or those with uncertain ultrasound features should be referred to a center of excellence. Those confirmed to have a high probability of PAS should electively be delivered at such centers.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Placenta Previa; Retrospective Studies; Cesarean Section; Ultrasonography; Placenta
PubMed: 37541113
DOI: 10.1016/j.bpobgyn.2023.102392 -
The Journal of Maternal-fetal &... Dec 2017Previous studies found a positive association between placenta previa and smoking during pregnancy. However, the results of these studies are inconsistent. The aim was... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Previous studies found a positive association between placenta previa and smoking during pregnancy. However, the results of these studies are inconsistent. The aim was to perform meta-analysis of the association between smoking during pregnancy and placenta previa.
METHODS
Major electronic databases, including PubMed, Web of Science, and Scopus were searched until June 2015. The heterogeneity across studies was explored by Q-test and I statistic. The possibility of publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) estimate with its 95% confidence intervals using a random-effects model.
RESULTS
The literature search yielded 991 publications until October 2015 with 9,094,443 participants. Based on the random effect model, compared to nonsmoker women, the estimated OR and RR of placenta previa was 1.42 (95% CI: 1.30, 1.54) and 1.27 (95% CI: 1.18, 1.35), respectively.
CONCLUSIONS
There is sufficient documents based on the observational studies that smoking during pregnancy is significantly associated with an increased risk of placenta previa. Therefore, smoking during pregnancy can be considered as a predictor of placenta previa.
Topics: Female; Humans; Placenta Previa; Pregnancy; Pregnancy Complications; Risk Factors; Smoking
PubMed: 27936997
DOI: 10.1080/14767058.2016.1271405 -
Obstetrics and Gynecology Clinics of... Mar 2020Primary disorders of placental implantation have immediate consequences for the outcome of a pregnancy. These disorders have been known to clinical science for more than... (Review)
Review
Primary disorders of placental implantation have immediate consequences for the outcome of a pregnancy. These disorders have been known to clinical science for more than a century, but have been relatively rare. Recent epidemiologic obstetric data have indicated that the rise in their incidence over the last 2 decades has been iatrogenic in origin. In particular, the rising numbers of pregnancies resulting from in vitro fertilization (IVF) and the increased use of caesarean section for delivery have been associated with higher frequencies of previa implantation, accreta placentation, abnormal placental shapes, and velamentous cord insertion. These disorders often occur together.
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Risk Factors; Ultrasonography, Prenatal; Vasa Previa
PubMed: 32008663
DOI: 10.1016/j.ogc.2019.10.002 -
Radiologic Clinics of North America Mar 2020Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta... (Review)
Review
Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta is a key component to evaluate during any imaging performed during pregnancy. The most common disease processes involving the placenta include placenta accreta spectrum disorders and placental masses. Several systemic processes such as infection and fetal hydrops can too affect the placenta; however, their imaging features are nonspecific such as placental thickening, heterogeneity, and calcifications. Ultrasound is the first line of imaging during pregnancy, and MR imaging is reserved for problem solving, when there is need for higher anatomic resolution.
Topics: Abruptio Placentae; Female; Humans; Magnetic Resonance Imaging; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Ultrasonography, Prenatal
PubMed: 32044013
DOI: 10.1016/j.rcl.2019.11.004 -
American Journal of Obstetrics &... Aug 2023This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa.
DATA SOURCES
A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022.
STUDY ELIGIBILITY CRITERIA
The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. In addition, maternal age, assisted reproductive technology, previous cesarean delivery, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa.
METHODS
Study screening was conducted 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
Among 2598 studies that were initially retrieved, 5 were included in the review. With the exception of 1 study, 4 studies were included in the meta-analysis. This meta-analysis showed that placenta accreta spectrum without placenta previa was associated with less risk of invasive placenta (odds ratio, 0.24; 95% confidence interval, 0.16-0.37), blood loss (mean difference, -1.19; 95% confidence interval, -2.09 to -0.28) and hysterectomy (odds ratio, 0.11; 95% confidence interval, 0.02-0.53), and more difficult to diagnose prenatally (odds ratio, 0.13; 95% confidence interval, 0.04-0.45) than placenta accreta spectrum with placenta previa. In addition, assisted reproductive technology and a previous uterine procedure were strong risk factors for placenta accreta spectrum without placenta previa, whhereas previous cesarean delivery was a strong risk factor for placenta accreta spectrum with placenta previa.
CONCLUSION
The differences in clinical aspects of placenta accreta spectrum with and without placenta previa need to be understood.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Retrospective Studies; Placenta Previa; Hysterectomy; Risk Factors
PubMed: 37211089
DOI: 10.1016/j.ajogmf.2023.101027 -
International Journal of Gynecological... Oct 2023Placenta accreta spectrum encompasses cases where the placenta is morbidly adherent to the myometrium. Placenta percreta, the most severe form of placenta accreta... (Review)
Review
Placenta accreta spectrum encompasses cases where the placenta is morbidly adherent to the myometrium. Placenta percreta, the most severe form of placenta accreta spectrum (grade 3E), occurs when the placenta invades through the myometrium and possibly into surrounding structures next to the uterine corpus. Maternal morbidity of placenta percreta is high, including severe maternal morbidity in 82.1% and mortality in 1.4% in the recent nationwide U.S. statistics. Although cesarean hysterectomy is commonly performed for patients with placenta accreta spectrum, conservative management is becoming more popular because of reduced morbidity in select cases. Treatment of grade 3E disease involving the urinary bladder, uterine cervix, or parametria is surgically complicated due to the location of the invasive placenta deep in the maternal pelvis. Cesarean hysterectomy in this setting has the potential for catastrophic hemorrhage and significant damage to surrounding organs. We propose a step-by-step schema to evaluate cases of grade 3E disease and determine whether immediate hysterectomy or conservative management, including planned delayed hysterectomy, is the most appropriate treatment option. The approach includes evaluation in the antenatal period with ultrasound and magnetic resonance imaging to determine suspicion for placenta previa percreta with surrounding organ involvement, planned cesarean delivery with a multidisciplinary team including experienced pelvic surgeons such as a gynecologic oncologist, intra-operative assessment including gross surgical field exposure and examination, cystoscopy, and consideration of careful intra-operative transvaginal ultrasound to determine the extent of placental invasion into surrounding organs. This evaluation helps decide the safety of primary cesarean hysterectomy. If safely resectable, additional considerations include intra-operative use of uterine artery embolization combined with tranexamic acid injection in cases at high risk for pelvic hemorrhage and ureteral stent placement. Availability of resuscitative endovascular balloon occlusion of the aorta is ideal. If safe resection is concerned, conservative management including planned delayed hysterectomy at around 4 weeks from cesarean delivery in stable patients is recommended.
Topics: Female; Pregnancy; Humans; Placenta Accreta; Placenta; Placenta Previa; Myometrium; Cesarean Section; Hysterectomy; Retrospective Studies
PubMed: 37524496
DOI: 10.1136/ijgc-2023-004615 -
Taiwanese Journal of Obstetrics &... Sep 2022
Topics: Female; Gestational Age; Humans; Placenta Previa; Pregnancy; Uterine Diseases
PubMed: 36088070
DOI: 10.1016/j.tjog.2022.06.008 -
The Journal of Maternal-fetal &... Jul 2018Several epidemiological studies have determined that assisted reproductive techniques (ART) can increase the risk of placenta previa. To date, only a meta-analysis has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several epidemiological studies have determined that assisted reproductive techniques (ART) can increase the risk of placenta previa. To date, only a meta-analysis has been performed for assessing the relationship between placenta previa and ART. This meta-analysis was conducted to estimate the association between placenta previa and ART in singleton and twin pregnancies.
METHODS
A literature search was performed in major databases PubMed, Web of Science, and Scopus from the earliest possible year to April 2017. The heterogeneity across studies was explored by Q-test and I statistic. The publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) and relative risk (RR) estimates with its 95% confidence intervals (CI) using a random-effects model.
RESULTS
The literature search yielded 1529 publications until September 2016 with 1,388,592 participants. The overall estimate of OR was 2.67 (95%CI: 2.01, 3.34) and RR was 3.62 (95%CI: 0.21, 7.03) based on singleton pregnancies. The overall estimate of OR was 1.50 (95%CI: 1.26, 1.74) based on twin pregnancies.
CONCLUSIONS
We showed based on odds ratio reports in observational studies that ART procedures are a risk factor for placenta previa.
Topics: Female; Humans; Observational Studies as Topic; Placenta Previa; Pregnancy; Pregnancy, Twin; Reproductive Techniques, Assisted
PubMed: 28514884
DOI: 10.1080/14767058.2017.1332035 -
The Journal of Maternal-fetal &... Aug 2020To clarify perinatal outcomes of patients with placenta previa (PP) with the placenta mainly positioned in the lateral uterine wall (lateral PP), thereby clinically...
To clarify perinatal outcomes of patients with placenta previa (PP) with the placenta mainly positioned in the lateral uterine wall (lateral PP), thereby clinically characterizing this condition. The retrospective cohort study was performed involving patients with lateral PP between January 2006 and December 2016. The placental position was determined and classified by magnetic resonance imaging. This study included 98 patients with PP, which was classified into three types according to the main placental position sites: lateral ( = 30), anterior ( = 32), and posterior ( = 36) PP. Overall, the median blood loss at cesarean section (CS) was 1808 mL and transfusion was performed for 78 patients (80%). Univariate analysis showed that patients with lateral PP bled less at CS than those with non-lateral PP (anterior + posterior PP) [median 1510 (interquartile range 1080-2168) versus 1975 (1570-2860) mL: =.02]. The other parameters including rates of conception by assisted reproductive technology, prior CS, antepartum bleeding, and placenta accreta spectrum did not show the significances. Among the three groups of PP (lateral versus anterior versus posterior), patients with lateral PP bled less than those with anterior (=.05) or posterior (=.13) PP, but this was nonsignificant [lateral 1510 (1080-2168) versus anterior 2145 (1580-3348) versus posterior 1808 (1533-2555) mL]. When dividing into lateral PP to two types: placenta showing anterior dominancy versus posterior dominancy, patients with lateral PP and anterior dominancy bled more those with posterior dominancy [2430 (1410-3400) versus 1170 (1050-1588) mL: =.002]. Patients with lateral PP bled significantly less than those with non-lateral (anterior or posterior) PP. Patients with lateral PP and anterior dominancy bled more than those with posterior dominancy.
Topics: Cesarean Section; Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies
PubMed: 30518276
DOI: 10.1080/14767058.2018.1556634 -
Oxidative Medicine and Cellular... 2023Placenta previa increases the risks of obstetrical complications. Many studies have reported a link between various ABO blood types and pregnancy complications. This...
BACKGROUND
Placenta previa increases the risks of obstetrical complications. Many studies have reported a link between various ABO blood types and pregnancy complications. This study is aimed at describing and comparing the characteristics and outcomes of women with placenta previa by ABO blood type.
METHODS
Data for this study was obtained from a retrospective cohort study between January 1, 2014, and June 30, 2019, of all clinically confirmed placenta previa in a university-based tertiary medical center. Both types of A, B, O, AB, and combining O and non-O blood types were compared to the characteristics and outcomes.
RESULTS
1678 participants with placenta previa were included in this study. The highest participants were blood type O with 666 (39.7%), followed by type A with 508 (30.3%) and type B with 395 (23.5%), and the lowest participants were AB with 109 (6.5%). Blood type AB had a higher incidence of antepartum hemorrhage ( = 0.017), predelivery anemia ( = 0.036), and preterm birth ( = 0.015) in placenta previa women. Meanwhile, the incidence of rhesus D positive (97.9% vs. 95.8%, = 0.012) and twins (5.0% vs. 2.7%, = 0.011) was higher in the non-O group, and the incidence of neonatal asphyxia (5.9% vs. 9.2%, = 0.016) was lower in the non-O group.
CONCLUSION
Type AB blood may be a potential risk factor for women with placenta previa. This finding may help provide any obstetrician to predict the risk of complication for placenta previa women by the ABO blood types.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Placenta Previa; Pregnant Women; Retrospective Studies; Premature Birth; Pregnancy Complications; Risk Factors; Placenta
PubMed: 36743690
DOI: 10.1155/2023/4725064