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Journal of Ultrasound in Medicine :... Sep 2023To determine the rate of resolution of placenta previa and low-lying placenta (LLP) and the effect of pelvic rest recommendations on the timing of follow-up imaging.
OBJECTIVE
To determine the rate of resolution of placenta previa and low-lying placenta (LLP) and the effect of pelvic rest recommendations on the timing of follow-up imaging.
METHODS
Retrospective review of pregnancies with previa/LLP detected on mid-trimester exam at our ultrasound unit from 2019 to 2021. LLP was defined as the lower edge of placenta located within 2 cm of the internal cervical os. Previa was defined as any portion of the placenta touching with the internal os. Demographics, placental location, activity restrictions, and delivery outcomes were analyzed. Timing of follow-up imaging was stratified by individuals advised and not advised pelvic rest.
RESULTS
Exactly 144 patients had previa and 266 had LLP on the mid-trimester exam with complete records. Previa resolution happened in 51.4% (74/144) of cases. Exactly 62% (46/74) of previa resolutions occurred by the 28-week ultrasound. Exactly 45% (65/144) of previa patients were advised pelvic rest. Most pelvic rest and non-pelvic rest patients had a 28-week scan. Even when clearance occurred, most patients in both groups had a repeat ultrasound at 32 weeks. Exactly 75% of LLP resolved by the 28-week scan, and the remainder by delivery. Exactly 12% (32/259) of LLP patients were advised pelvic rest.
CONCLUSION
Most societies recommend follow-up imaging at 32 weeks; however, our results suggest this may be done sooner and closer to 28 weeks. Pelvic rest did not affect timing of repeat imaging or delivery.
Topics: Pregnancy; Humans; Female; Placenta Previa; Placenta; Follow-Up Studies; Ultrasonography, Prenatal; Pregnancy Trimester, Second; Retrospective Studies
PubMed: 36928922
DOI: 10.1002/jum.16220 -
Journal of Global Health Dec 2023Although maternal age might affect pregnancy outcomes, it remains unclear whether this relationship is linear or curvilinear and if it differs between nulliparous and...
BACKGROUND
Although maternal age might affect pregnancy outcomes, it remains unclear whether this relationship is linear or curvilinear and if it differs between nulliparous and multiparous women. We aimed to characterize the relationship between maternal age and risks of pregnancy outcomes in a diverse sample of Chinese singleton pregnant women and to evaluate whether the relationship varied by parity.
METHODS
We based this prospective multicenter cohort study on data from 18 495 singleton pregnant women who participated in the University Hospital Advanced Age Pregnant Cohort Study, conducted in eight Chinese public hospitals from 2016 to 2021. We used restricted cubic splines to model nonlinear relationships between maternal age continuum and adverse outcomes, and performed multivariable log-binomial regression to estimate the adjusted relative risk (RR) and 95% confidence interval (CI).
RESULTS
Among 18 495 singleton pregnant women (mean age 35.7, standard deviation (SD) = 4.2 years), maternal age was not related to postpartum hemorrhage or small for gestational age, but showed a positive, nonlinear relationship to gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum, placenta previa, cesarean delivery, preterm birth, large for gestational age, macrosomia, and fetal congenital anomaly, with inflection points around 35.6-40.4 years. Compared to women younger than 35 years, older women had higher risks of adverse pregnancy outcomes, except for postpartum hemorrhage and small for gestational age. The risks of placenta accreta spectrum, placenta previa, large for gestational age, and macrosomia were highest for women aged 40-44 years, and risks of gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, cesarean delivery, preterm birth and congenital anomaly were highest for those aged ≥45 years. Most risks were more pronounced in nulliparous than multiparous women (P for interaction <0.02).
CONCLUSIONS
Delayed childbirth was related to increased risks of adverse pregnancy outcomes, especially for nulliparous women. Appropriate childbearing age, generally before 35 years, is recommended for optimising pregnancy outcomes.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Aged; Adult; Maternal Age; Diabetes, Gestational; Premature Birth; Placenta Previa; Pre-Eclampsia; Fetal Macrosomia; Hypertension, Pregnancy-Induced; Postpartum Hemorrhage; Cohort Studies; Placenta Accreta; Prospective Studies; Pregnancy Outcome; Infant, Newborn, Diseases; Retrospective Studies
PubMed: 38038697
DOI: 10.7189/jogh.13.04161 -
International Journal of Women's Health 2023Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal...
OBJECTIVE
Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars.
METHODS
This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021.
RESULTS
The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group ( <0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency ( <0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of <2 years or ≥5 years (4.7%) than in cases with 2 years ≤ interval time <5 years (2.5%) ( <0.05).
CONCLUSION
Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications.
PubMed: 37746587
DOI: 10.2147/IJWH.S422187 -
Scientific Reports Mar 2024This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or...
This study aimed to identify the risk factors for placenta accreta spectrum (PAS) in women who had at least one previous cesarean delivery and a placenta previa or low-lying. The PACCRETA prospective population-based study took place in 12 regional perinatal networks from 2013 through 2015. All women with one or more prior cesareans and a placenta previa or low lying were included. Placenta accreta spectrum (PAS) was diagnosed at delivery according to standardized clinical and histological criteria. Of the 520,114 deliveries, 396 fulfilled inclusion criteria; 108 were classified with PAS at delivery. Combining the number of prior cesareans and the placental location yielded a rate ranging from 5% for one prior cesarean combined with a posterior low-lying placenta to 63% for three or more prior cesareans combined with placenta previa. The factors independently associated with PAS disorders were BMI ≥ 30, previous uterine surgery, previous postpartum hemorrhage, a higher number of prior cesareans, and a placenta previa. Finally, in this high-risk population, the rate of PAS disorders varies greatly, not only with the number of prior cesareans but also with the exact placental location and some of the women's individual characteristics. Risk stratification is thus possible in this population.
Topics: Pregnancy; Female; Humans; Placenta Previa; Placenta; Placenta Accreta; Prospective Studies; Cesarean Section; Risk Factors; Retrospective Studies
PubMed: 38503816
DOI: 10.1038/s41598-024-56964-9 -
European Review For Medical and... Nov 2023Endometriosis is a common gynecological disease, affecting 5 to 10% of women of childbearing age. We analyzed pregnancy complications and neonatal outcomes of patients...
OBJECTIVE
Endometriosis is a common gynecological disease, affecting 5 to 10% of women of childbearing age. We analyzed pregnancy complications and neonatal outcomes of patients with pregnancies complicated with endometriosis. The aim of the study was to explore the effects of endometriosis on pregnancy and to evaluate the potential pregnancy risks associated with this disease.
PATIENTS AND METHODS
The retrospective study included 3,809 parturients who were routinely examined, hospitalized and underwent cesarean section delivery in Fujian Maternal and Child Health Hospital from January 2014 to December 2020. Among them, 1,026 parturients were diagnosed with endometriosis after the cesarean section (endometriosis group), and 2,783 parturients without endometriosis comprised the control group. The endometriosis group was further divided into subgroups according to the severity of the disease: 882 parturients with stage Ⅰ or Ⅱ of endometriosis, and 144 parturients with stage Ⅲ or Ⅳ of endometriosis. General data of all patients and medical records of pregnancy complications and neonatal outcomes for each group were collected and retrospectively analyzed.
RESULTS
There were no statistically significant differences in the age, gestational age, gestation, and parity times between all groups (p>0.05). The incidence of preeclampsia and placenta previa in the endometriosis group was higher than that in the control group (p<0.05). There was no significant difference in rates of other pregnancy complications, such as chronic hypertension with pregnancy, preeclampsia with chronic hypertension, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), intrahepatic cholestasis of pregnancy (ICP), premature rupture of membranes or placental abruption between the two groups. The incidence of placenta previa in the group of patients with stage III/IV endometriosis was higher than in patients with stage I/II endometriosis (p<0.05). However, there was no significant difference in the incidence of other pregnancy complications. The amount of postpartum hemorrhage (1,000-1,500 ml) in the endometriosis group was greater than that in the control group, and the difference was statistically significant (p<0.05). However, there was no significant difference in the incidence of postpartum hemorrhage in patients with pregnancies complicated with endometriosis at different stages.
CONCLUSIONS
In pregnant women, endometriosis is associated with an increased incidence of placenta previa that correlates with the severity of the disease. Pregnant women with endometriosis have higher rates of preeclampsia and postpartum hemorrhage, compared to women without endometriosis.
Topics: Infant, Newborn; Child; Female; Pregnancy; Humans; Pregnancy Outcome; Endometriosis; Retrospective Studies; Placenta Previa; Pre-Eclampsia; Postpartum Hemorrhage; Cesarean Section; Placenta; Pregnancy Complications; Hypertension
PubMed: 38039027
DOI: 10.26355/eurrev_202311_34465 -
Journal of Obstetrics and Gynaecology :... Dec 2024Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association... (Meta-Analysis)
Meta-Analysis Review
Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis. Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS). A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4). Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Stillbirth; Premature Birth; Abruptio Placentae; Placenta Previa; Placenta; Pregnancy Outcome; Abortion, Spontaneous; Uterine Hemorrhage
PubMed: 38305047
DOI: 10.1080/01443615.2023.2288224 -
BJOG : An International Journal of... Dec 2023To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal...
OBJECTIVE
To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS).
DESIGN
Population-based study in 176 maternity units in France.
POPULATION
All women with anterior low-lying (0-19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS.
METHODS
Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth.
MAIN OUTCOME MEASURES
Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment.
RESULTS
Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2-30.4) overall, 27.5% (95% CI 21.8-33.3) in women with placenta praevia and 15.4% (95% CI 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8).
CONCLUSION
Severe PPH is frequent among women with anterior low-lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low-lying placenta.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Postpartum Hemorrhage; Placenta Previa; Incidence; Prospective Studies; Cesarean Section; Risk Factors; Placenta Accreta; Placenta; Retrospective Studies
PubMed: 37226308
DOI: 10.1111/1471-0528.17554 -
The Journal of Maternal-fetal &... Dec 2023To explore the association between inter-pregnancy intervals and placenta previa and placenta accreta spectrum among women who had prior cesarean deliveries with respect...
OBJECTIVE
To explore the association between inter-pregnancy intervals and placenta previa and placenta accreta spectrum among women who had prior cesarean deliveries with respect to maternal age at first cesarean delivery.
METHODS
This retrospective study included clinical data from 9981 singleton pregnant women with a history of cesarean delivery at 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. The study population was divided into four groups (<2, 2-5, 5-10, ≥10 years of the interval) according to the inter-pregnancy interval. The rate of placenta previa and placenta accreta spectrum among the four groups was compared, and multivariate logistic regression was used to analyze the relationship between inter-pregnancy interval and placenta previa and placenta accreta spectrum with respect to maternal age at first cesarean delivery.
RESULTS
Compared to women aged 30-34 years old at first cesarean delivery, the risk of placenta previa (aRR, 1.48; 95% CI, 1.16-1.88) and placenta accreta spectrum (aRR, 1.74; 95% CI, 1.28-2.35) were higher among women aged 18-24. Multivariate regression results showed that women at 18-24 with <2 years intervals exhibited a 5.05-fold increased risk for placenta previa compared with those with 2-5-year intervals (aRR, 5.05; 95% CI, 1.13-22.51). In addition, women aged 18-24 with less than 2 years intervals had an 8.44 times greater risk of developing PAS than women aged 30-34 with 2 to 5 years intervals (aRR, 8.44; 95% CI, 1.82-39.26).
CONCLUSIONS
The findings of this study suggested that short inter-pregnancy intervals were associated with increased risks for placenta previa, and placenta accreta spectrum for women under 25 years at first cesarean delivery, which may be partly attributed to obstetrical outcomes.
Topics: Pregnancy; Female; Humans; Adult; Maternal Age; Placenta Previa; Retrospective Studies; Placenta Accreta; Birth Intervals; Risk Factors
PubMed: 36966813
DOI: 10.1080/14767058.2023.2192853 -
The Journal of Obstetrics and... Nov 2023To describe our individualized management protocol for women with an antenatal diagnosis of vasa previa (VP) and to report maternal and neonatal outcomes in patients...
OBJECTIVE
To describe our individualized management protocol for women with an antenatal diagnosis of vasa previa (VP) and to report maternal and neonatal outcomes in patients managed according to our protocol.
METHODS
A retrospective study of prospectively collected data of antenatally diagnosed VP managed at our hospital between 2014 and 2021. Obstetric and neonatal outcomes were reviewed and analyzed.
RESULTS
Fourteen cases of antenatally diagnosed VP in 5150 total deliveries were analyzed (0.3%) Five cases (36%) of VP were diagnosed during the routine fetal morphological ultrasound screening, and nine cases (64%) were referred to our hospital due to perinatal complications. There were nine cases that required hospitalization (due to fetal growth restriction [FGR] [1], preterm labor [3], patients' request [5]). The other five were asymptomatic. Eight patients were delivered by scheduled cesarean section at around 36 weeks and only three neonates were admitted to NICU with transient tachypnea of newborn. However, six patients required CS before the scheduled dates because of other complications (preterm labor [3], abnormal cardiotocogram patterns [1], FGR [1] and twin pregnancy [1]). Four neonates born by CS before their scheduled dates were admitted to NICU. No cases required prolonged hospitalization and there were no serious neonatal complications.
CONCLUSION
Individualized management may lead to favorable outcomes with VP. Outpatient management may be considered in patients without risk factors. However, maternal hospitalization and earlier scheduled CS should be considered in symptomatic patients or those at risk for preterm delivery.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Vasa Previa; Retrospective Studies; Cesarean Section; Prenatal Diagnosis; Ultrasonography, Prenatal; Premature Birth
PubMed: 37621145
DOI: 10.1111/jog.15775 -
The Journal of Maternal-fetal &... Dec 2023Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these...
BACKGROUND
Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these associations present in an urban environment in China. This study aimed to analyze the associations between maternal age and pregnancy outcomes among Chinese urban women.
METHODS
We performed a population-based study consisting of 60,209 singleton pregnancies of primiparous women whose newborns were delivered after 20 weeks' gestation between January 2012 and December 2015 in urban areas of China. Participants were divided into six groups (19 or younger, 20-24, 25-29, 30-34, 35-39, 40 or older). Pregnancy outcomes include gestational diabetes mellitus (GDM), preeclampsia, placental abruption, placenta previa, premature rupture of membrane (PROM), postpartum hemorrhage, preterm birth, low birthweight, small for gestational age (SGA), large for gestational age (LGA), fetal distress, congenital microtia, and fetal death. Logistic regression models were used to assess the role of maternal age on the risk of adverse pregnancy outcomes with women aged 25-29 years as the reference group.
RESULTS
The risks of GDM, preeclampsia, placenta previa, and postpartum hemorrhage were decreased for women at a young maternal age and increased for women with advanced maternal age. Both young and advanced maternal age increased the risk of preterm birth and low birthweight. Young maternal age was also associated with increased risk of SGA (aOR 1.64, 95% CI 1.46-1.83) and fetal death (aOR 2.08, 95% CI 1.35-3.20). Maternal age over 40 years elevated the odds of placental abruption (aOR 3.44, 95% CI 1.47-8.03), LGA (aOR 1.47, 95% CI 1.09-1.98), fetal death (aOR 2.67, 95% CI 1.16-6.14), and congenital microtia (aOR 13.92, 95% CI 3.91-49.57). There were positive linear associations between maternal age and GDM, preeclampsia, placental abruption, placenta previa, PROM, postpartum hemorrhage, preterm birth, LGA and fetal distress (all for linear trend < .05), and a negative linear association between maternal age and SGA ( for linear trend < .001). The analysis of the associations between maternal age and adverse fetal outcomes showed U-shape for preterm birth, low birth weight, SGA, fetal death and congenital microtia (all for quadratic trend < .001).
CONCLUSIONS
Advanced maternal age predisposes women to adverse obstetric outcomes. Young maternal age manifests a bidirectional effect on adverse pregnancy outcomes. The findings may contribute to improving women's antenatal care and management.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Outcome; Premature Birth; Fetal Distress; Abruptio Placentae; Birth Weight; Congenital Microtia; Maternal Age; Placenta Previa; Postpartum Hemorrhage; Pre-Eclampsia; Retrospective Studies; Placenta; China; Diabetes, Gestational; Fetal Death
PubMed: 37635092
DOI: 10.1080/14767058.2023.2250894