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Reproductive Health Jan 2024Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE),...
Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort.
BACKGROUND
Being obese can lead to various complications during pregnancy, such as Gestational Diabetes Mellitus (GDM), pregnancy induced hypertension (PIH), Pre-Eclampsia (PE), and Large Gestational Age (LGA). Although bariatric surgery is an effective way to treat obesity, it can also result in complications and may be linked to having small for gestational age (SGA) babies. This cohort study protocol aims to compare the maternal and fetal/neonatal outcomes of two groups of Iranian pregnant women: those who have undergone bariatric surgery and those who are obese but have not had bariatric surgery.
METHODS
In this study Pregnant women (< 14 weeks' gestation) (n = 38 per group) are recruited either from one of the obesity clinic (exposure group = with a history of bariatric surgery) or primary healthcare clinics in Tehran city (comparison group = pregnant women with obesity and and no history of bariatric surgery). Dietary intake and nutrient status are assessed at < 14, 28, and 36 weeks. Maternal and fetal/neonatal outcomes are compared between the two groups, including gestational diabetes, preeclampsia, preterm labor, intrauterine growth restriction, severe nausea and vomiting, abortion, placenta previa and abruption, venous thrombosis, vaginal bleeding, cesarean delivery, meconium aspiration, and respiratory distress. Maternal serum levels of ferritin, albumin, zinc, calcium, magnesium, selenium, copper, vitamins A, B9, B12, and 25-hydroxy Vit D are checked during 24th to 28th weeks. Maternal and neonatal outcomes, including height, weight, head circumference, fetal abnormality, infection, small or large fetus, low birth weight, macrosomia, NICU admission, and total weight gain during pregnancy, are measured at birth. Maternal and offspring outcomes, including weight, height, head circumference, total weight gain during pregnancy, newborn diseases, postpartum bleeding, breastfeeding, and related problems, are assessed 6 weeks after delivery. Child's weight, height, and head circumference are followed at 2, 4, 6, 8, 10, and 12 months after birth. Maternal stress, anxiety, and depression are assessed with the DASS-21 questionnaire, and physical activity is evaluated using the PPAQ questionnaire in the first and third trimesters.
DISCUSSION
By assessing the levels of micronutrients in the blood of pregnant women along with the evaluation of pregnancy outcomes, it is feasible to gain a more accurate understanding of how bariatric surgery affects the health and potential complications for both the mother and the fetus/newborn. This information can help specialists and patients make more informed decisions about the surgery. Additionally, by examining issues such as stress, anxiety, and depression in women undergoing surgery, this study can contribute to recognizing these problems, which can also affect pregnancy outcomes.
Topics: Child; Pregnancy; Humans; Female; Infant, Newborn; Pregnant Women; Cohort Studies; Prospective Studies; Iran; Meconium Aspiration Syndrome; Obesity; Pregnancy Outcome; Postpartum Period; Diabetes, Gestational; Bariatric Surgery; Pre-Eclampsia; Weight Gain; Fetus
PubMed: 38233940
DOI: 10.1186/s12978-023-01736-3 -
Journal of Magnetic Resonance Imaging :... Oct 2023Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative...
BACKGROUND
Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa.
PURPOSE
To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal-fetal outcomes in women with complete placenta previa.
STUDY TYPE
Retrospective.
POPULATION
A total of 141 pregnant women (median age, 32; age range, 24-40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition.
FIELD STRENGTH/SEQUENCE
A 3 T with T -weighted imaging (T WI), T -weighted imaging (T WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence.
ASSESSMENT
The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal-fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups.
STATISTICAL TESTS
The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference.
RESULTS
The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941.
DATA CONCLUSION
Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal-fetal perinatal outcomes in patients with complete placenta previa.
TECHNICAL EFFICACY STAGE
2.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Adult; Young Adult; Placenta; Placenta Previa; Cervix Uteri; Retrospective Studies; Premature Birth; Hemorrhage
PubMed: 36847772
DOI: 10.1002/jmri.28617 -
American Journal of Obstetrics &... Dec 2023Placenta accreta spectrum can lead to uncontrollable massive hemorrhage in the perinatal period. Currently, the first-line treatment for placenta accreta spectrum...
BACKGROUND
Placenta accreta spectrum can lead to uncontrollable massive hemorrhage in the perinatal period. Currently, the first-line treatment for placenta accreta spectrum recommended worldwide is hysterectomy. However, adverse outcomes after hysterectomy, including surgical complications, such as difficulty in performing the procedure, and sequelae, such as infertility and psychological issues, cannot be ignored. Several surgical approaches for conservative treatment have been proposed. There are few reports on the effectiveness, safety, and long-term complications of conservative treatments, especially subsequent pregnancy outcomes.
OBJECTIVE
This study aimed to investigate the clinical outcomes and identify risk factors of subsequent pregnancies among patients with placenta accreta spectrum who had undergone conservative surgery.
STUDY DESIGN
This was a retrospective cohort study of subsequent pregnancy cases after cesarean delivery with conservative treatment for placenta accreta spectrum from 2011 to 2019 at The First Affiliated Hospital of Zhengzhou University to identify clinical outcomes of subsequent pregnancies and the risk factors of adverse pregnancy outcomes.
RESULTS
A total of 883 patients undergoing conservative surgery were included in this study, among which 604 (68.4%) were successfully followed up. There were 75 successful pregnancies in 72 patients, including 22 full-term or near-term deliveries, 1 induced labor in the second trimester of pregnancy, 6 cesarean scar pregnancies (8.0%), 2 ectopic pregnancies, and 44 first-trimester pregnancies (3 miscarriages and 41 elective abortions and 12 medical abortions and 32 vacuum aspirations). All newborns survived in the 22 full-term or near-term deliveries. Moreover, 5 placenta accreta spectrum cases (22.7%) and 6 placenta previa cases were observed. Postpartum hemorrhage was observed in 2 cases, with an incidence rate of 9.1%. All parameters, including age at subsequent pregnancy, gravidity, number of cesarean deliveries, type of previous placenta accreta spectrum, gestational week of pregnancy termination, interpregnancy interval, and the use of vascular occlusion techniques, were not found to be associated with recurrent placenta accreta spectrum and cesarean scar pregnancy.
CONCLUSION
Our findings show that treatment for placenta accreta spectrum does not automatically preclude a subsequent pregnancy. However, patients should be fully informed about the risk of recurrent placenta accreta spectrum, scar pregnancy, and postpartum hemorrhage.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Placenta Accreta; Conservative Treatment; Retrospective Studies; Postpartum Hemorrhage; Cicatrix; Risk Factors
PubMed: 37832645
DOI: 10.1016/j.ajogmf.2023.101189 -
The Australian & New Zealand Journal of... Oct 2023Distinguishing between urinary bladder varices and retroplacental neovascularization in placenta accreta spectrum in high-risk patients with placental previa is a...
Distinguishing between urinary bladder varices and retroplacental neovascularization in placenta accreta spectrum in high-risk patients with placental previa is a diagnostic challenge since they have similar appearances on prenatal ultrasound. Placenta accreta spectrum is associated with massive obstetric haemorrhage while the presence of urinary bladder varices in pregnancy poses a lower surgical risk. Since the clinical implications and management approach for both conditions are entirely different, false positive diagnoses have iatrogenic consequences. In this article, we share our experiences in differentiating these two phenomena on prenatal ultrasound supported by ultrasound and intraoperative images.
Topics: Pregnancy; Humans; Female; Placenta Accreta; Placenta; Urinary Bladder; Placenta Previa; Ultrasonography, Prenatal; Varicose Veins; Retrospective Studies
PubMed: 37872717
DOI: 10.1111/ajo.13703 -
American Journal of Obstetrics &... Dec 2023The number of cases of placenta accreta spectrum disorder has been increasing with the increase in in vitro fertilization and cesarean deliveries. In addition, placenta...
Tourniquet, Uterine Inversion, and Placental dissection (TURIP) procedure as a novel hemostatic technique to preserve fertility for placenta accreta spectrum disorders without placenta previa.
The number of cases of placenta accreta spectrum disorder has been increasing with the increase in in vitro fertilization and cesarean deliveries. In addition, placenta accreta spectrum without placenta previa is difficult to diagnose before delivery and sometimes requires a hysterectomy because of heavy bleeding. We have devised a uterus-preserving technique (referred to as the tourniquet, uterine inversion, and placental dissection procedure) for such cases. First, the bleeding is stopped by the tourniquet method, the uterus is relaxed with nitroglycerin, and the uterus is inverted to expose the adhesion site. After that, the placenta is detached by sharp dissection under direct visualization, and the detached areas are sutured, and then the tourniquet and internal rotation are released. This technique does not require advanced skills. Thus, a surgeon could avoid performing a hysterectomy and have a greater chance of uterus preservation when encountering massive hemorrhage caused by unpredictable placenta accreta spectrum without placenta previa in either cesarean deliveries or vaginal deliveries.
Topics: Female; Pregnancy; Humans; Placenta Accreta; Placenta Previa; Uterine Inversion; Placenta; Tourniquets; Hemostatic Techniques; Fertility
PubMed: 37832647
DOI: 10.1016/j.ajogmf.2023.101185 -
Journal of Assisted Reproduction and... Apr 2024In this first of two companion papers, we critically review the evidence recently published in the primary literature, which addresses adverse maternal and neonatal... (Review)
Review
PURPOSE
In this first of two companion papers, we critically review the evidence recently published in the primary literature, which addresses adverse maternal and neonatal pregnancy outcomes associated with programmed embryo transfer cycles. We next consider whether these pathological pregnancy outcomes might be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation. Finally, in the second companion article, we explore potential etiologies and suggest strategies for prevention.
METHODS
Comprehensive review of primary literature.
RESULTS
The preponderance of retrospective and prospective observational studies suggests that increased risk for hypertensive disorders of pregnancy (HDP) and preeclampsia in assisted reproduction involving autologous embryo transfer is associated with programmed cycles. For autologous frozen embryo transfer (FET) and singleton live births, the risk of developing HDP and preeclampsia, respectively, was less for true or modified natural and stimulated cycles relative to programmed cycles: OR 0.63 [95% CI (0.57-0.070)] and 0.44 [95% CI (0.40-0.50)]. Though data are limited, the classification of preeclampsia associated with programmed autologous FET was predominantly late-onset or term disease. Other adverse pregnancy outcomes associated with autologous FET, especially programmed cycles, included increased prevalence of large for gestational age infants and macrosomia, as well as higher birth weights. In one large registry study, FET was associated with fetal overgrowth of a symmetrical nature. Postterm birth and placenta accreta not associated with prior cesarean section, uterine surgery, or concurrent placenta previa were also associated with autologous FET, particularly programmed cycles. The heightened risk of these pathologic pregnancy outcomes in programmed autologous FET does not appear to be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation, although the latter may contribute a modest degree of increased risk for fetal overgrowth and perhaps HDP and preeclampsia in FET irrespective of the endometrial preparation.
CONCLUSIONS
Programmed autologous FET is associated with an increased risk of several, seemingly diverse, pathologic pregnancy outcomes including HDP, preeclampsia, fetal overgrowth, postterm birth, and placenta accreta. Though the greater risk for preeclampsia specifically associated with programmed autologous FET appears to be well established, further research is needed to substantiate the limited data currently available suggesting that the classification of preeclampsia involved is predominately late-onset or term. If substantiated, then this knowledge could provide insight into placental pathogenesis, which has been proposed to differ between early- and late-onset or term preeclampsia (see companion paper for a discussion of potential mechanisms). If a higher prevalence of preeclampsia with severe features as suggested by some studies is corroborated in future investigations, then the danger to maternal and fetal/neonatal health is considerably greater with severe disease, thus increasing the urgency to find preventative measures. Presupposing significant overlap of these diverse pathologic pregnancy outcomes within subjects who conceive by programmed embryo transfer, there may be common etiologies.
Topics: Humans; Female; Pregnancy; Embryo Transfer; Pregnancy Outcome; Pre-Eclampsia; Infant, Newborn; Fertilization in Vitro; Cryopreservation; Hypertension, Pregnancy-Induced; Risk Factors
PubMed: 38536594
DOI: 10.1007/s10815-024-03041-9 -
International Journal of Gynaecology... Nov 2023To assess whether prophylactic intraoperative abdominal aortic balloon occlusion (IAABO) is indeed beneficial in pregnancies with placenta previa (PP) and placenta...
Is prophylactic intraoperative abdominal aortic balloon occlusion beneficial in pregnancies with placenta previa and placenta accreta spectrum during cesarean section? A 5-year retrospective study.
OBJECTIVE
To assess whether prophylactic intraoperative abdominal aortic balloon occlusion (IAABO) is indeed beneficial in pregnancies with placenta previa (PP) and placenta accreta spectrum (PAS) during cesarean section.
METHODS
A retrospective case-control study included 251 pregnancies with PP and/or PAS. All enrolled patients were divided into a PP/PAS group, a PP + PAS group, and an IAABO group. The demographic characteristics and maternal and neonatal outcomes were compared.
RESULTS
There was no significant difference in blood loss and transfusion between the IAABO group and the PP + PAS group (P > 0.05). However, blood loss and red blood cell and fresh frozen plasma transfusion in the above two groups were significantly higher than in the PP/PAS group (P < 0.05). More pregnancies in the IAABO group had to undergo uterine artery embolization (29.2%) or hysterectomy (20.8%), and this percentage was significantly higher than that in the other two groups (P < 0.001). All neonatal characteristics did not show differences between the IAABO group and PP + PAS group (P > 0.05). IAABO led to femoral artery thrombosis in three cases and minor postoperative renal injury in one case.
CONCLUSION
IAABO only acted as a less important supporting technique during cesarean section. There was no evidence suggesting that IAABO could significantly control the massive hemorrhage in pregnancies with PP and PAS during cesarean delivery.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Balloon Occlusion; Blood Component Transfusion; Blood Loss, Surgical; Case-Control Studies; Cesarean Section; Hysterectomy; Placenta Accreta; Placenta Previa; Plasma; Retrospective Studies
PubMed: 37183630
DOI: 10.1002/ijgo.14852 -
European Journal of Obstetrics,... Jan 2024This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database.
OBJECTIVE
This study aimed to investigate the relationship between endometriosis and adverse obstetric outcomes using data from the National Inpatient Sample (NIS) database.
METHODS
The ICD-10 coding system was used to identify codes for endometriosis and obstetric outcomes, and data from the NIS (2016-2019) were analyzed. Descriptive statistics were used to summarize variables, while the chi-square test was used to detect significant differences for categorical variables. Univariate and multivariate regression analyses were conducted to assess the association between endometriosis and obstetric outcomes. On multivariate analysis, adjustment was done for age, race, hospital region, smoking status, and alcohol misuse. Forest plots were used to visualize odds ratios and their 95% confidence intervals.
RESULTS
Overall, 2,854,149 women were included in this analysis, of whom 4,006 women had endometriosis. The post-hoc Bonferroni correction was applied to account for multiple comparisons, and our analyses revealed several statistically significant associations (p < 0.004). Specifically, on univariate analysis, significant associations with endometriosis were identified for ruptured uterus, placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, gestational diabetes, preterm labor, and multiple gestation. On multivariate analysis, significant associations with endometriosis were observed for placenta previa, placental abruption, postpartum hemorrhage, preeclampsia, amniotic fluid abnormality, preterm labor, premature rupture of membranes, and multiple gestation.
CONCLUSION
The present findings provide important insights into the potential relationship between endometriosis and various adverse obstetric outcomes and may help inform clinical practice and future research. Further studies that use more detailed clinical data and longitudinal designs are needed to solidify the presented conclusions.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Endometriosis; Placenta Previa; Abruptio Placentae; Postpartum Hemorrhage; Pre-Eclampsia; Inpatients; Placenta; Pregnancy Complications; Premature Birth; Obstetric Labor, Premature; Pregnancy Outcome
PubMed: 37976766
DOI: 10.1016/j.ejogrb.2023.11.009 -
Journal of Global Health Jan 2024Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal and maternal complications. However, there is still a lack of robust evidence on the pathogenesis and adverse outcomes of the diseases. Through this umbrella review, we aimed to systematically review existing meta-analyses exploring the factors and outcomes for pregnancy women with placental anomalies.
METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2023. We used AMSTAR 2 to assess the quality of the reviews and estimated the pooled risk and 95% confidence intervals (CIs) for each meta-analysis.
RESULTS
We included 34 meta-analyses and extracted 55 factors (27 for PP, 22 for PAS, and 6 for VP) and 16 outcomes (12 for PP, and 4 for VP) to assess their credibility. Seven factors (maternal cocaine use (for PP), uterine leiomyoma (for PP), prior abortion (spontaneous) (PP), threatened miscarriage (PP), maternal obesity (PP), maternal smoking (PAS), male foetus (PAS)) had high epidemiological evidence. Twelve factors and six outcomes had moderate epidemiological evidence. Twenty-two factors and eight outcomes showed significant association, but with weak credibility.
CONCLUSIONS
We found varying levels of evidence for placental anomalies of different factors and outcomes in this umbrella review.
REGISTRATION
PROSPERO: CRD42022300160.
Topics: Female; Pregnancy; Placenta; Placenta Previa; Pregnancy Complications; Prenatal Care; Systematic Reviews as Topic
PubMed: 38236697
DOI: 10.7189/jogh.14.04013 -
Journal of Ultrasound in Medicine :... Jun 2024Our systematic review highlights that multiparametric PAI score assessment is a consistent tool with high sensitivity and specificity for prenatal prediction for... (Review)
Review
Our systematic review highlights that multiparametric PAI score assessment is a consistent tool with high sensitivity and specificity for prenatal prediction for placenta accreta spectrum (PAS) in high-risk population with anterior placenta previa or low-lying placenta and prior cesarean deliveries. A systematic search was conducted on November 1, 2022, of MEDLINE via PubMed, Scopus, Web of Science Core Collection, Cochrane Library, and Google Scholar to identify relevant studies (PROSPERO ID # CRD42022368211). A total of 11 articles met our inclusion criteria, representing the data of a total of 1,044 cases. Women with PAS had an increased mean PAI total score, compared to those without PAS. Limitations of the PAI are most studies were conducted in developing countries in high-risk population which limit the global generalizability of findings. Heterogeneity of reported data did not allow to perform meta-analysis.
PubMed: 38888042
DOI: 10.1002/jum.16509