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Open Life Sciences 2023CXCR4 and CXCR7 have been revealed to be receptors of CXCL12. This research was designed to probe the expression of chemokine CXCL12 and its receptors CXCR4 and CXCR7 in...
CXCR4 and CXCR7 have been revealed to be receptors of CXCL12. This research was designed to probe the expression of chemokine CXCL12 and its receptors CXCR4 and CXCR7 in placental tissues of patients with placenta previa and the effect of CXCL12/CXCR4/CXCR7 axis on the biological functions of human trophoblast cells. CXCL12, CXCR4, and CXCR7 expression in placental tissue from patients with placenta previa and healthy puerperae was detected. CXCL12, CXCR4, and CXCR7 expression in human trophoblast cell lines (HTR8/SVneo cells) was assessed after suppression or overexpression of CXCL12, CXCR4, and CXCR7. The cell proliferative, invasive, and migratory capacities were also evaluated in HTR8/SVneo cells after suppression or overexpression of CXCL12, CXCR4, and CXCR7. CXCL12, CXCR4, and CXCR7 expression was elevated in placental tissues from patients with placenta previa. Downregulation of CXCL12, CXCR4, and CXCR7 could lead to decreased mRNA levels of CXCL12, CXCR4, and CXCR7 in HTR-8/SVneo cells, which was accompanied by diminished cell proliferative, migratory, and invasive capabilities. Overexpression of CXCL12, CXCR4, and CXCR7 genes presented an opposite tendency. CXCL12, CXCR4, and CXCR7 are highly expressed in placental tissues of patients with placenta previa and induce the biological activities of HTR8/SVneo cells.
PubMed: 37589008
DOI: 10.1515/biol-2022-0642 -
Taiwanese Journal of Obstetrics &... Mar 2022
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 35361376
DOI: 10.1016/j.tjog.2022.02.004 -
Acta Obstetricia Et Gynecologica... Jul 2023This study examined obstetric outcomes in patients diagnosed with uterine adenomyosis.
INTRODUCTION
This study examined obstetric outcomes in patients diagnosed with uterine adenomyosis.
MATERIAL AND METHODS
This historical cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was all hospital deliveries in women aged 15-54 years between January 2016 and December 2019. The exposure was a diagnosis of uterine adenomyosis. The main outcome measures were obstetric characteristics, including placenta previa, placenta accreta spectrum, and placental abruption. Secondary outcomes were delivery complications including severe maternal morbidity. Analytic steps to assess these outcomes included (i) a 1-to-N propensity score matching to mitigate and balance prepregnancy confounders to assess obstetric characteristics, followed by (ii) an adjusting model with preselected pregnancy and delivery factors to assess maternal morbidity. Sensitivity analyses were also performed with restricted cohorts to account for prior uterine scar, uterine myoma, and extra-uterine endometriosis.
RESULTS
After propensity score matching, 5430 patients with adenomyosis were compared to 21 720 patients without adenomyosis. Adenomyosis was associated with an increased odds of placenta accreta spectrum (adjusted-odds ratio [aOR] 3.07, 95% confidence interval [CI] 2.01-4.70), placenta abruption (aOR 3.21, 95% CI: 2.60-3.98), and placenta previa (aOR 5.08, 95% CI: 4.25-6.06). Delivery at <32 weeks of gestation (aOR 1.48, 95% CI: 1.24-1.77) and cesarean delivery (aOR 7.72, 95% CI: 7.04-8.47) were both increased in women with adenomyosis. Patients in the adenomyosis group were more likely to experience severe maternal morbidity at delivery compared to those in the nonadenomyosis group (aOR 1.86, 95% CI: 1.59-2.16). Results remained robust in the aforementioned several sensitivity analyses.
CONCLUSIONS
This national-level analysis suggests that a diagnosis of uterine adenomyosis is associated with an increased risk of placental pathology (placenta accreta spectrum, placenta abruption, and placental previa) and adverse maternal outcomes at delivery.
Topics: Pregnancy; Humans; Female; Placenta Previa; Placenta; Placenta Accreta; Cohort Studies; Risk Factors; Adenomyosis; Propensity Score; Abruptio Placentae; Retrospective Studies
PubMed: 37087741
DOI: 10.1111/aogs.14581 -
Journal of Clinical Medicine Jan 2023This study aimed to investigate the diagnostic accuracy of the placenta accreta index (PAI) for predicting placenta accreta spectrum (PAS) in women with placenta previa....
This study aimed to investigate the diagnostic accuracy of the placenta accreta index (PAI) for predicting placenta accreta spectrum (PAS) in women with placenta previa. We analyzed 33 pregnancies with placenta previa at Keio University Hospital. The PAI was assessed in the early third trimester, and PAS was diagnosed histologically or clinically defined as retained placenta after manual removal attempts. The PAI and incidence of PAS were analyzed. Ten women (30%) were diagnosed with PAS and had higher volumes of perioperative bleeding ( = 0.016), higher rate of requiring uterine artery embolization ( = 0.005), and peripartum hysterectomy ( = 0.0002) than women without PAS. A PAI > 2 was the most useful cut-off point for predicting PAS and was more sensitive than prediction values using traditional evaluation (history of cesarean section and placental location). Post-hoc analysis revealed a higher rate of previous history of cesarean delivery (30% vs. 4.4%, = 0.038), severe placental lacunae (≥grade2) (70% vs. 8.7%, = 0.0003), thin myometrial thickness (90% vs. 22%, = 0.0003), anterior placenta (100% vs. 30%, = 0.0002), and presence of bridging vessels (30% vs. 0%, = 0.0059) in PAS women. PAI could help predict the outcomes of women with placenta previa with and without a history of cesarean delivery to reduce PAS-induced perinatal complications.
PubMed: 36769741
DOI: 10.3390/jcm12031090 -
European Journal of Obstetrics,... May 2024Increasing placental thickness is associated with adverse outcomes including earlier gestational age at delivery, lower birthweight, and lower umbilical artery pH. We...
OBJECTIVE
Increasing placental thickness is associated with adverse outcomes including earlier gestational age at delivery, lower birthweight, and lower umbilical artery pH. We aim to determine whether mid-trimester placenta previa thickness is associated with persistence of previa at time of delivery.
STUDY DESIGN
Single-center retrospective cohort study of singleton gestations with previa diagnosed at 18-24 weeks delivering between 2015 and 2019. The thickest portion of the placenta was measured in a longitudinal plane on transabdominal imaging to determine placental thickness. We defined three cohorts: 1) thick placenta (>1 standard deviation above the mean), 2) thin placenta (>1 standard deviation below the mean), and 3) average placenta (within 1 standard deviation above or below the mean). Primary outcome was previa persistence at time of delivery. Secondary outcomes included postpartum hemorrhage, cesarean delivery, placenta accreta spectrum, and maternal morbidity composite (use of Bakri balloon, B-lynch, or O'Leary, peripartum hysterectomy, blood transfusion, ICU admission, or death). In all analyses, average thickness was used as the base comparator.
RESULTS
Of 239 pregnancies with mid-trimester previa there were 34 thin, 166 average, and 39 thick placentas. Patients with thick placenta were older, more likely to have prior cesarean delivery, fibroid uterus, and delivery at an earlier gestational age. After adjusting for confounders, thick placenta was associated with persistent previa (aOR 6.85 [3.13-15.00]) and cesarean delivery (aOR 2.76 [1.26-6.08]).
CONCLUSION
At diagnosis of mid-trimester previa, thick placenta is associated with persistence at time of delivery and delivery by cesarean section. This suggests placental thickness may assist with risk stratification and coordination of care.
Topics: Pregnancy; Humans; Female; Cesarean Section; Placenta Previa; Retrospective Studies; Placenta; Ultrasonography; Placenta Accreta
PubMed: 38401448
DOI: 10.1016/j.ejogrb.2024.02.033 -
Cureus Jul 2023Objectives Placenta previa is characterised as the placenta implant in the lower uterine segment, wholly or partially covering the internal os. Uterine scars from...
Objectives Placenta previa is characterised as the placenta implant in the lower uterine segment, wholly or partially covering the internal os. Uterine scars from surgical operations are a potential factor of placenta previa. The present study aims to estimate the role of ultrasound in determining the incidence of placenta previa in the scarred and unscarred uterus. Also, it aims to evaluate the types of placenta previa in the scarred and unscarred uterus. Methods This hospital-based, prospective, observational study was performed from September 2021 to August 2022 among patients referred to the Department of Radiology, Fakhruddin Ali Ahmed Medical College and Hospital (FAAMCH), Barpeta, Assam. Written informed consent was obtained from the subjects. Transabdominal and transvaginal ultrasonography methods were used to assess placenta previa. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY) considering a p-value < 0.05 as significant. Results Out of the 517 subjects with bleeding per vagina, 41 (7.9%) were diagnosed with placenta previa by ultrasonography. The mean maternal age was 27.80 ± 5.36 years, and the most prevalent age group was 20-24 years (31.71%). The majority (70.73%) of cases had scarred uterus. The most prevalent placental position was fundo-body anterior. Complete placenta previa was present in 26% of the total cases in the present study. Conclusion The incidence of placenta previa in the scarred uterus was higher than that of the unscarred uterus. The high prevalence of placenta previa in women with scarred uterus necessitates improved monitoring and management to avoid disastrous outcomes.
PubMed: 37641748
DOI: 10.7759/cureus.42586 -
Biology of Reproduction Jul 2021The obstetrical conditions placenta accreta spectrum (PAS) and placenta previa are a significant source of pregnancy-associated morbidity and mortality, yet the specific...
The obstetrical conditions placenta accreta spectrum (PAS) and placenta previa are a significant source of pregnancy-associated morbidity and mortality, yet the specific molecular and cellular underpinnings of these conditions are not known. In this study, we identified misregulated gene expression patterns in tissues from placenta previa and percreta (the most extreme form of PAS) compared with control cases. By comparing this gene set with existing placental single-cell and bulk RNA-Seq datasets, we show that the upregulated genes predominantly mark extravillous trophoblasts. We performed immunofluorescence on several candidate molecules and found that PRG2 and AQPEP protein levels are upregulated in both the fetal membranes and the placental disk in both conditions. While this increased AQPEP expression remains restricted to trophoblasts, PRG2 is mislocalized and is found throughout the fetal membranes. Using a larger patient cohort with a diverse set of gestationally aged-matched controls, we validated PRG2 as a marker for both previa and PAS and AQPEP as a marker for only previa in the fetal membranes. Our findings suggest that the extraembryonic tissues surrounding the conceptus, including both the fetal membranes and the placental disk, harbor a signature of previa and PAS that is characteristic of EVTs and that may reflect increased trophoblast invasiveness.
Topics: Eosinophil Major Basic Protein; Extraembryonic Membranes; Female; Gene Expression Regulation; Humans; Metalloproteases; Placenta Accreta; Placenta Previa; Pregnancy; Proteoglycans
PubMed: 33982062
DOI: 10.1093/biolre/ioab068 -
Pakistan Journal of Medical Sciences 2020To assess maternal and fetal morbidity associated with placenta previa and morbidly adherent placenta (MAP).
OBJECTIVES
To assess maternal and fetal morbidity associated with placenta previa and morbidly adherent placenta (MAP).
METHODS
All patients with placenta previa who delivered in services hospital from April 1, 2017 to March 31, 2019 were included. Maternal and fetal outcomes were compared amongst patients with placenta previa and MAP.
RESULTS
Total of 8002 patients delivered with 152 (1.9%) diagnosed as placenta previa and 56 (36.8%) amongst them had MAP. One hundred thirty-one out of One hundred fifty-two (86.1%) of our patients were booked. Increased number of caesarean section, multi parity and anterior placenta had significant association with MAP (p<0.0001). Maternal morbidity in terms of postpartum hemorrhage >2000ml, caesarean hysterectomy, number of blood transfusions, bladder injury, need for ICU admission was significantly more in patients with MAP (p<0.0001). Case fatality was 3% with two maternal deaths in MAP and none in placenta previa. Fetal outcome was good in both groups as gestational age at delivery was 36 weeks or more, birth weight was ≥ 2.5 kg and >6 APGAR score (p<0.05). Two neonatal deaths occurred in MAP and one in placenta previa owing to prematurity.
CONCLUSION
MAP is a dreadful complication of placenta previa with increased maternal morbidity. Regular antenatal care with adequate arrangement of blood transfusion and multidisciplinary approach can reduce maternal mortality.
PubMed: 32704270
DOI: 10.12669/pjms.36.5.1647 -
Women's Health (London, England) Aug 2017Obstetric haemorrhage is associated with increased risk of serious maternal morbidity and mortality. Postpartum haemorrhage is the commonest form of obstetric... (Review)
Review
Obstetric haemorrhage is associated with increased risk of serious maternal morbidity and mortality. Postpartum haemorrhage is the commonest form of obstetric haemorrhage, and worldwide, a woman dies due to massive postpartum haemorrhage approximately every 4 min. In addition, many experience serious morbidity such as multi-organ failure, complications of multiple blood transfusions, peripartum hysterectomy and unintended damage to pelvic organs, loss of fertility and psychological sequelae, including posttraumatic stress disorders. Anticipation of massive postpartum haemorrhage, prompt recognition of the cause and institution of timely and appropriate measures to control bleeding and replacement of the lost blood volume and restoration of oxygen carrying capacity (i.e. haemoglobin) and correction of the 'washout phenomenon' leading to coagulopathy will help save lives. Obstetric shock index may help in avoidance of underestimation of blood loss and the use of tranexamic acid, oxytocics and timely peripartum hysterectomy, if appropriate, will help save lives. Triple P procedure has been recently developed as the conservative surgical alternative for women with abnormal invasion of the placenta and has been shown to significantly reduce the blood loss and to reduce inpatient stay.
Topics: Abruptio Placentae; Antifibrinolytic Agents; Blood Transfusion; Disseminated Intravascular Coagulation; Female; Humans; Placenta Previa; Postnatal Care; Postpartum Hemorrhage; Pregnancy; Risk Assessment
PubMed: 28681676
DOI: 10.1177/1745505717716860 -
JAMA Network Open Aug 2022Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited...
IMPORTANCE
Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited regarding whether placenta previa is associated with a higher risk of worse maternal outcomes among patients with PAS disorders.
OBJECTIVE
To examine the association between placenta previa and the risk of severe maternal morbidities (SMMs) and higher resource use among patients with PAS disorders.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study extracted records of 3793 patients with PAS diagnosis and delivery indicators between October 1, 2015, and December 31, 2019, from the US National Inpatient Sample database.
EXPOSURES
Placenta previa.
MAIN OUTCOMES AND MEASURES
Data on 21 Centers for Disease Control and Prevention-defined SMMs and 25 study-defined surgical morbidities associated with PAS were extracted. Six surgical procedures (cystoscopy, intra-arterial balloon occlusion, cesarean delivery, hysterectomy, cystectomy, and oophorectomy), hospital length of stay, and inpatient costs were compared. Multivariable Poisson regression models built in the generalized estimating equation framework were used.
RESULTS
Among 3793 patients with PAS (median [IQR] age at admission, 33 [29-37] years), 621 women (16.4%) were Black, 765 (20.2%) were Hispanic, 1779 (46.9%) were White, 441 (11.6%) were of other races and/or ethnicities (47 [1.2%] were American Indian, 220 [5.8%] were Asian or Pacific Islander, and 174 [4.6%] were of multiple or other races and/or ethnicities), and 187 (4.9%) were of unknown race and ethnicity. A total of 1323 patients (34.9%) had placenta previa and 2470 patients (65.1%) did not; of those with placenta previa, 405 patients (30.6%) had invasive PAS. Patients with vs without placenta previa had a significantly higher rate and risk of any SMM (935 women [70.7%] vs 1087 women [44.0%]; P < .001; adjusted risk ratio [aRR], 1.19; 95% CI, 1.12-1.27) and any surgical morbidity (1170 women [88.4%] vs 1667 women [67.5%]; P < .001; aRR, 1.18; 95% CI, 1.13-1.23). With regard to specific outcomes, those with vs without placenta previa had a significantly higher rate of peripartum hemorrhage (878 patients [66.4%] vs 1217 patients [49.3%]; P < .001), blood product transfusion (413 patients [31.2%] vs 610 patients [24.7%]; P < .001), shock (83 patients [6.3%] vs 108 patients [4.4%]; P = .01), disseminated intravascular coagulation or other coagulopathy (77 patients [5.8%] vs 105 patients [4.3%]; P = .04), and urinary tract injury (44 patients [3.3%] vs 41 patients [1.7%]; P = .002). Patients with vs without placenta previa were more likely to undergo cesarean delivery (1292 patients [97.7%] vs 1787 patients [72.3%]; P < .001), hysterectomy (786 patients [59.4%] vs 689 patients [27.9%]; P < .001), cystoscopy (301 patients [22.8%] vs 203 patients [8.2%]; P < .001), cystectomy (157 patients [11.9%] vs 98 patients [4.0%]; P < .001), and intra-arterial balloon occlusion (121 patients [9.1%] vs 77 patients [3.1%]; P < .001) and to have significantly longer hospital length of stay (median [IQR], 5 [4-11] days vs 3 [3-5] days; P < .001) and total inpatient costs (median [IQR], $17 496 [$10 863-$30 619] vs $9728 [$6130-$16 790]; P < .001). Hypertensive disorder of pregnancy was associated with a decreased risk of placenta previa (aRR, 0.67; 95% CI, 0.46-0.96) among patients with PAS.
CONCLUSIONS AND RELEVANCE
In this study, placenta previa was associated with an increased risk of maternal and surgical morbidities and higher resource use among women with PAS. These findings suggest that interventions to alleviate maternal and surgical morbidities are especially needed for patients with placenta previa-complicated PAS disorders.
Topics: Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; United States
PubMed: 35994286
DOI: 10.1001/jamanetworkopen.2022.28002