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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 -
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 -
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 -
Current Opinion in Obstetrics &... Apr 2022Placenta accreta spectrum (PAS) is a major cause of severe maternal morbidity. Perinatal outcomes are significantly improved when PAS is diagnosed prenatally. However, a... (Review)
Review
PURPOSE OF REVIEW
Placenta accreta spectrum (PAS) is a major cause of severe maternal morbidity. Perinatal outcomes are significantly improved when PAS is diagnosed prenatally. However, a large proportion of cases of PAS remain undiagnosed until delivery.
RECENT FINDINGS
The prenatal diagnosis of PAS requires a high index of suspicion. The first step is identifying maternal risk factors. The most significant risk factor for PAS is the combination of a prior caesarean delivery and a placenta previa. Other major risk factors include a prior history of PAS, caesarean scar pregnancy (CSP), uterine artery embolization (UAE), intrauterine adhesions (Asherman syndrome) and endometrial ablation.Ultrasound is the preferred imaging modality for the prenatal diagnosis of PAS and can be highly accurate when performed by a provider with expertise. PAS can be diagnosed on ultrasound as early as the first trimester. MRI may be considered as an adjunct to ultrasound imaging but is not routinely recommended. Recent consensus guidelines outline the ultrasound and MRI markers of PAS.
SUMMARY
Patients with major risk factors for PAS warrant dedicated ultrasound imaging with a provider experienced in the prenatal diagnosis of PAS.
Topics: Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Trimester, First; Prenatal Diagnosis; Uterine Artery Embolization
PubMed: 35230992
DOI: 10.1097/GCO.0000000000000773 -
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 -
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 -
American Journal of Obstetrics and... Sep 2022
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Urinary Bladder
PubMed: 35577012
DOI: 10.1016/j.ajog.2022.05.011 -
Journal of Nepal Health Research Council Jun 2022Placenta previa is associated with poor maternal and fetal outcomes. Its complications are increasing due to the increased rate of cesarean deliveries. This study aimed...
BACKGROUND
Placenta previa is associated with poor maternal and fetal outcomes. Its complications are increasing due to the increased rate of cesarean deliveries. This study aimed to compare maternal and fetal outcomes in placenta previa with and without previous cesarean section.
METHODS
This study was conducted in the Department of Obstetrics and Gynecology at Patan Hospital, Nepal. Placenta previa cases were reviewed from 1st January 2010 to 31st December 2019, parted into Group 1 (placenta previa with previous cesarean section) and Group 2 (placenta previa with no prior cesarean section). Strength of association was measured as odds ratio and 95% confidence intervals. P-value at <0.05 was taken as statistically significant.
RESULTS
The total number of placenta previa were 348 (0.42%) of total deliveries (n=82,918) , but 72 charts/records were not found and six cases were excluded. Group 1 comprised 48 cases (0.86%) among prior cesarean section (n=5,581) and Group 2 consisted of 222 cases (0.28%) among those with no prior cesarean delivery (n=77,337) and it was statistically significant. Morbidly adherent placenta, postpartum hemorrhage, cesarean hysterectomy, and maternal deaths were higher in Group 1 and statistically significant. Preterm deliveries and neonatal intensive care unit admission were also more in Group 1 and statistically significant.
CONCLUSIONS
Maternal and fetal morbidity were higher in placenta previa with previous cesarean section than with no prior cesarean delivery. Therefore, it is advisable to try to reduce the rate of cesarean section as far as possible.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Nepal; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies
PubMed: 35945867
DOI: 10.33314/jnhrc.v20i01.3640 -
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 -
JAAPA : Official Journal of the... Jan 2021Third-trimester bleeding is an obstetric emergency and is associated with significant maternal and fetal morbidity and mortality. The two most common causes for... (Review)
Review
Third-trimester bleeding is an obstetric emergency and is associated with significant maternal and fetal morbidity and mortality. The two most common causes for third-trimester bleeding are placental abruption and placenta previa, which account for about half of all cases. Clinicians should have a thorough understanding of the risk factors, clinical presentation, and appropriate management of these conditions. Timely management is necessary for the survival of mother and fetus and to reduce the incidence of neonatal complications.
Topics: Abruptio Placentae; Emergencies; Female; Fetal Death; Humans; Infant, Newborn; Infant, Newborn, Diseases; Placenta Previa; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third; Risk Factors; Uterine Hemorrhage; Uterine Rupture
PubMed: 33332831
DOI: 10.1097/01.JAA.0000723928.28450.0a