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Revista Brasileira de Ginecologia E... Jan 2021To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil)...
OBJECTIVE
To determine the indications and outcomes of peripartum hysterectomies performed at Hospital de Clínicas de Porto Alegre (a university hospital in Southern Brazil) during the past 15 years, and to analyze the clinical characteristics of the women submitted to this procedure.
METHODS
A cross-sectional study of 47 peripartum hysterectomies from 2005 to 2019.
RESULTS
The peripartum hysterectomies performed in our hospital were indicated mainly due to placenta accreta or suspicion thereof (44.7% of the cases), puerperal hemorrhage without placenta accreta (27.7%), and infection (25.5%). Total hysterectomies accounted for 63.8% of the cases, and we found no difference between total versus subtotal hysterectomies in the studied outcomes. Most hysterectomies were performed within 24 hours after delivery, and they were associated with placenta accreta, placenta previa, and older maternal age.
CONCLUSION
Most (66.0%) patients were admitted to the intensive care unit (ICU). Those who did not need it were significantly older, and had more placenta accreta, placenta previa, or previous Cesarean delivery.
Topics: Adult; Brazil; Cross-Sectional Studies; Electronic Health Records; Female; Hospitals, University; Humans; Hysterectomy; Incidence; Peripartum Period; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Prenatal Care; Retrospective Studies; Risk Factors
PubMed: 33513629
DOI: 10.1055/s-0040-1721354 -
Surgery Journal (New York, N.Y.) Jul 2020According to the increase in the rate of cesarean section and the increase of high-aged pregnancy, we seem to more often encounter cases with placenta previa and...
According to the increase in the rate of cesarean section and the increase of high-aged pregnancy, we seem to more often encounter cases with placenta previa and placenta previa accrete spectrum. There are concerns about these cases, such as difficulty in controlling bleeding from the separation surface of placenta previa, the need for hysterectomy as a life-saving procedure, systemic management and hemostasis during massive hemorrhage, and treatment of disseminated intravascular coagulation (DIC). These cases are most frequently associated with cesarean hysterectomy.
PubMed: 32760794
DOI: 10.1055/s-0039-3402036 -
BMC Surgery Jan 2021A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the...
BACKGROUND
A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes.
METHODS
This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed.
RESULTS
The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04).
CONCLUSIONS
PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.
Topics: Adult; Blood Loss, Surgical; Cesarean Section; Female; Humans; Infant, Newborn; Middle Aged; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Premature Birth; Retrospective Studies
PubMed: 33407322
DOI: 10.1186/s12893-020-01027-9 -
American Journal of Obstetrics &... Oct 2023Placenta previa diagnosed on midtrimester ultrasound often resolves by the third trimester. Multiparity and previous cesarean delivery have been associated with...
BACKGROUND
Placenta previa diagnosed on midtrimester ultrasound often resolves by the third trimester. Multiparity and previous cesarean delivery have been associated with persistence of placenta previa at delivery. Risk factors for persistent placenta previa in nulliparas are not well characterized.
OBJECTIVE
This study aimed to identify risk factors for persistent placenta previa in the nulliparous population, and evaluate differences in outcomes between persistent and resolved placenta previa.
STUDY DESIGN
This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), a prospective cohort study that observed 10,037 nulliparous individuals throughout pregnancy. Nulliparas diagnosed with placenta previa on midtrimester ultrasound were included in this analysis. Baseline characteristics and delivery outcomes of nulliparas with persistent placenta previa were compared with those of nulliparas with resolved placenta previa. Multivariate logistic regression with stepwise model selection was used for adjusted analyses.
RESULTS
A total of 171 nulliparas (1.7%) in the nuMoM2b study were diagnosed with placenta previa on midtrimester ultrasound, of whom 17% (n=29) had persistent placenta previa at delivery. When compared with those with resolved placenta previa, nulliparas with persistent placenta previa were more likely to be older (median, 32 years [interquartile range, 30-37] vs 29 years [interquartile range, 25-31]; P<.01), have a previous pregnancy of <20 weeks (48.3% vs 22.5%; P=.01), have a previous dilation and curettage/evacuation procedure (27.6% vs 10.6%; P=.03), or have a pregnancy that resulted from assisted reproductive technology (31% vs 4.9%; P=.01). After adjusting for potential confounders, maternal age (adjusted odds ratio, 1.11; 95% confidence interval, 1.02-1.21), in vitro fertilization (adjusted odds ratio, 9.00; 95% confidence interval, 1.97-41.14), and previous pregnancy of <20 weeks (adjusted odds ratio, 2.77; 95% confidence interval, 1.10-6.95) remained statistically significant risk factors for persistent placenta previa. Persistent placenta previa was also associated with higher likelihood of antepartum admission (10.3% vs 0%; P<.01), preterm delivery (34.5% vs 12%; P<.01), lower neonatal birthweight (median, 2847 g [interquartile range, 2655-3310] vs 3263 g [interquartile range, 2855-3560]), and cesarean delivery (100% vs 20.4%; P<.001), but there were no differences in overall pregnancy or neonatal outcomes.
CONCLUSION
In nulliparous individuals diagnosed with placenta previa on midtrimester ultrasound, older maternal age, previous pregnancy of <20 weeks, and in vitro fertilization are associated with persistent placenta previa at delivery.
PubMed: 37598887
DOI: 10.1016/j.ajogmf.2023.101136 -
Journal of Family Medicine and Primary... Mar 2021Placenta previa is a major cause of hemorrhage affecting 0.4-0.5% of all pregnancy's early detection of cases and senior input will significantly reduce maternal and...
BACKGROUND
Placenta previa is a major cause of hemorrhage affecting 0.4-0.5% of all pregnancy's early detection of cases and senior input will significantly reduce maternal and fetal morbidity and mortality.
OBJECTIVES
The aim of the study is to determine risk factors, fetal and maternal outcome in pregnancy complicated by placenta previa.
METHOD
This is descriptive cross-sectional study in women diagnosed with placenta previa at Dongola maternity hospital, Sudan from December 2018 to June 2019.
RESULTS
There were 3,674 deliveries and 52 cases of placenta previa during the study period with prevalence of 1.4%. The average age of the patients was 34.8 years and most of them were above 35 years (53.8%), and (63.5%) were para 3 and more. Other identified risk factors included previous cesarean section (69.1%), previous uterine evacuation (13.5%), and assisted reproductive technique (5.8%). Maternal complications were hemorrhage needing blood transfusion (40.4%), cesarean hysterectomy (21.2%), and bladder injury (3.8%), but (34.6%) were with good outcome and no maternal death. NICU admission with RDS (25%), prematurity (25%), and death (5.8%) were the fetal complications, while in (44.2%) fetal outcome was good.
CONCLUSION
The most identifiable risk factors for placenta previa were previous uterine scars, advanced maternal age, and multiparity. And it is associated with adverse maternal and fetal outcomes.
PubMed: 34041154
DOI: 10.4103/jfmpc.jfmpc_2111_20 -
Cureus May 2024Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence... (Review)
Review
Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence on maternal and perinatal outcomes in placenta previa, addressing its epidemiology, pathophysiology, diagnosis, and management strategies. Placenta previa complicates pregnancies, with increasing incidence linked to factors such as advanced maternal age and rising cesarean rates. Maternal complications, including hemorrhage and placenta accreta spectrum disorders, pose substantial risks. At the same time, perinatal outcomes are marked by increased rates of preterm birth, intrauterine growth restriction, and neonatal morbidity and mortality. Timely diagnosis and appropriate management, including antenatal corticosteroids and multidisciplinary care, are critical for optimizing outcomes. Future research should focus on improving diagnostic methods, evaluating novel interventions, and assessing long-term neurodevelopmental outcomes. This review underscores the importance of informed clinical practice and ongoing research efforts to enhance outcomes for women and infants affected by placenta previa.
PubMed: 38841031
DOI: 10.7759/cureus.59737 -
Medicine Oct 2016Placenta previa is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Placenta previa is characterized by the abnormal placenta overlying the endocervical os, and it is known as one of the most feared adverse maternal and fetal-neonatal complications in obstetrics.
OBJECTIVES
We aimed to obtain overall and regional estimates of placenta previa prevalence among deliveries in Mainland China.
METHODS
The research was performed a systematic review, following the Meta-analysis of observational studies in epidemiology (MOOSE) guidelines for systematic reviews of observational studies, and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement for reporting systematic reviews and meta-analysis. Electronic databases were searched and included hospital-based studies that reported placenta previa prevalence in Mainland China. Random-effects meta-analyses were used to pool prevalence estimates of placenta previa. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. For exploring the geographical distributions of placenta previa, the ArcGIS software (Esri) was used to construct the map of prevalence.
RESULTS
A total of 80 articles and 86 datasets (including 1,298,548 subjects and 14,199 placenta previa cases) from 1965 through 2015 were included. The pooled overall prevalence of placenta previa among deliveries was 1.24% (95% confidence interval [CI], 1.12-1.36) in Mainland China during 1965 to 2015. And, the trend in the prevalence of placenta previa was steady. The occurrence rate of placenta previa in the region groups Northeast, North, Northwest, Central China, East, South, and Southwest was 1.20%, 1.01%, 1.10%, 1.15%, 0.93%, 1.42%, and 2.01%, respectively. The prevalence map based on a geographic information system showed an unequal geographic distribution.
CONCLUSIONS
The results showed that placenta previa is currently a high-burden disease in Mainland China. This review would be useful for the design of placenta previa planning and implementation adequate health care systems and treatment programs in Mainland China.
Topics: China; Delivery, Obstetric; Female; Humans; Placenta Previa; Pregnancy; Prevalence
PubMed: 27749592
DOI: 10.1097/MD.0000000000005107 -
Surgery Journal (New York, N.Y.) Dec 2021Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens...
Placenta accreta spectrum (PAS) disorder often causes a large amount of intraoperative bleeding in a short period which makes maternal circulation unstable and threatens life. As a countermeasure, two-stage surgery combined with selective uterine arterial embolization (UAE), named "stepwise treatment" was introduced in 2003. At a cesarean section (CS), only the baby is delivered and the placenta is left in situ. The transcatheter angiographic UAE is performed on the operation day, followed by the total hysterectomy on 5 to 7 days after CS. The difficulty in the operative procedures for hysterectomy and the amount of bleeding can be reduced by the added effect of the blood flow interruption by UAE and the uterine involution. Although there are not many indication cases, this is the prudent operation that should be considered for the most severe PAS case such as total placenta increta/percreta with placenta previa. In this article, the practical procedures and tips of stepwise treatment are described.
PubMed: 35036544
DOI: 10.1055/s-0041-1728748 -
Advances in Clinical and Experimental... Mar 2023Placenta previa is a pregnancy condition associated with the development of complications related to placental insufficiency, including hypertension, preeclampsia and...
BACKGROUND
Placenta previa is a pregnancy condition associated with the development of complications related to placental insufficiency, including hypertension, preeclampsia and perinatal mortality. Dysfunction in uteroplacental arteries causes the release of cytokines, leukotrienes and immunomodulatory hormones, which leads to an inflammatory reaction.
OBJECTIVES
The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway and vascular endothelial growth factor (VEGF) are known to play crucial roles in inflammation and angiogenetic regulation. This study aimed to demonstrate the morphometric and immunohistochemical effects on inflammation and angiogenesis underlying placenta previa.
MATERIAL AND METHODS
Twenty pregnant patients with placenta previa and 20 healthy pregnant patients, all between 30 and 38 weeks gestational age, were included in the study. The gestational age of the pregnancies was determined according to the last date of menstruation and/or ultrasonographic measurements. Blood samples and clinical data were obtained from the prenatal patient groups. Samples were taken from the connecting stem region from both groups.
RESULTS
The mean difference between the control and placenta previa patients was statistically significant for the parameters of blood vessels in villi, diameter of floating small villus, decidual cells, syncytial knots, congestion in blood vessels, fibrinoid accumulation, and inflammation. Significant degeneration and apoptotic changes in the syncytial cells of the root villi and an increase in syncytial nodes and bridges were observed in the placenta previa specimens. In the connecting stem region of the placenta previa samples, blood vessel dilatation, endothelial cell hyperplasia and a higher number of syncytial nodes were observed. In the immunohistochemical examination of the placenta previa samples, an increase in NF-κB and VEGF expression was observed in the endothelial cells, syncytial cells and Hofbauer cells.
CONCLUSIONS
Vascular endothelial growth factor was found to stimulate endothelial cell proliferation and migration, and to significantly affect angiogenesis during the developmental process of the placenta and remodeling of the uterine vessels, inducing NF-κB signaling and apoptotic development during cytotrophoblastic invasion in the vascularization of the placenta.
Topics: Humans; Pregnancy; Female; Placenta Previa; Placenta; Vascular Endothelial Growth Factor A; NF-kappa B; Endothelial Cells; Vascular Endothelial Growth Factors; Inflammation
PubMed: 36374543
DOI: 10.17219/acem/154858 -
BMC Pediatrics Nov 2023Congenital abnormalities, as one of the fetal complications of placenta previa, may cause health problems or disability of the child throughout life. This study aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Congenital abnormalities, as one of the fetal complications of placenta previa, may cause health problems or disability of the child throughout life. This study aimed to determine the relationship between placenta previa and congenital abnormalities.
METHODS
Potential articles were retrieved from three electronic databases (PubMed/Medline, Scopus, and Web of Sciences) up to 21 May 2023 without limit of time and language. A random effect model was applied for meta-analysis. The heterogeneity was calculated based on I statistic and Cochrane Q-test. All analyses were conducted at the significance level of 0.05 using STATA software, version 14. The quality assessment of the included studies was performed using the improved Newcastle-Ottawa Scale.
RESULTS
In the initial search, 829 articles were retrieved. Finally, according to the inclusion criteria, eight studies were analyzed in the meta-analysis. A significant association was reported between placenta previa and risk of congenital abnormalities based on crude form (OR = 1.81, 95% CI = 1.34 to 2.28) and adjusted studies (OR = 6.38, 95% CI = 1.47 to 11.30). The high heterogeneity was observed among the studies reported based on adjusted and crude form, respectively (I = 97.9%, P = 0.000) (I = 80.6%, P = 0.000). Therefore, publication bias was not observed among studies. Seven studies of the included studies were of high quality.
CONCLUSION
Our study provides evidence that there is a positive and significant association between placenta previa and congenital malformations, including all structural anomalies, chromosomal defects, and congenital hypothyroidisms. Therefore, monitoring congenital abnormalities in the fetus of a mother with placenta previa is necessary.
Topics: Pregnancy; Female; Child; Humans; Placenta Previa; Network Meta-Analysis; Mothers
PubMed: 38031046
DOI: 10.1186/s12887-023-04433-z