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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 -
Best Practice & Research. Clinical... Apr 2021Antenatal diagnosis of placenta accreta spectrum (PAS) disorders allows planned management by a multidisciplinary team in a tertiary center, and thus can reduce... (Review)
Review
Antenatal diagnosis of placenta accreta spectrum (PAS) disorders allows planned management by a multidisciplinary team in a tertiary center, and thus can reduce hemorrhagic morbidity, compared with intrapartum diagnosis. Previous Cesarean section and placenta previa are the two most common risk factors. Prenatal ultrasound is a promising diagnostic tool for PAS in the second or third trimester. Recent evidence shows sonographic markers of PAS can be present in the first trimester. Prenatal ultrasound may help predict the depth and topography of placental invasion which are the major determinants of maternal morbidity. The presence of increased vascularity in the inferior part of the lower uterine segment and the parametrial region is associated with a more severe disorder according to a newly proposed staging system. In this chapter, we will discuss how to improve the prediction of PAS, the depth, and topography of placental invasion.
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 32747328
DOI: 10.1016/j.bpobgyn.2020.06.010 -
Journal of Midwifery & Women's Health May 2022With a growing number of states legalizing recreational use, cannabis consumption during pregnancy is increasing. Population-based data and rigorous studies examining... (Review)
Review
With a growing number of states legalizing recreational use, cannabis consumption during pregnancy is increasing. Population-based data and rigorous studies examining the association of cannabis use in pregnancy with perinatal outcomes are limited, but trends include preterm prelabor rupture of membranes, placenta previa, and an increased length of hospital stay. Neonates of pregnant persons who used cannabis during their pregnancy can be at increased risk of low birth weight, preterm birth, neonatal intensive care unit admission, neurocognitive deficits, and infectious and neurologic morbidity and mortality. This state of the science review examines the prevalence of cannabis use in pregnancy, its pharmacodynamics and how that is influenced by pregnancy, and associated adverse perinatal and neonatal outcomes. Implications for health care providers caring for pregnant persons using cannabis, especially in legalized states, are discussed.
Topics: Cannabis; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Placenta Previa; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 34841645
DOI: 10.1111/jmwh.13293 -
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 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =...To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP.
OBJECTIVES
To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP.
METHODS
A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018. Two hundred and fifty cases of PPP with placenta accreta were treated as a case group, and 160 cases of PPP without placenta accreta were treated as a control group. The relationship between clinical data and placenta accreta was analyzed, and the pregnancy outcomes of PPP was observed according to different types of placenta previa.
RESULTS
Logistic regression showed that delivery times were more than 2 (OR=3.221), cesarean section times were more than 2 (OR=3.048), central placenta previa (OR=3.607), placental attachment site (anterior wall) (OR=4.592) were independent risk factors for PPP with placenta accrete (<0.05). Living in cities (OR=0.614), systematic prenatal examination (OR=0.590) were protective factors (<0.05). Average intraoperative blood loss, postpartum bleeding rate, hysterectomy rate in the central group were all higher than those in the marginal and low-set group. The incidence rates of ICU transfer, complications, and hospital stay were higher or longer than those in the marginal group (<0.008). There was no significant difference in stillbirth rate among the 4 groups (>0.05). Preterm delivery rate was higher than that of the marginal and low-set group, and the birth weight was lower than that of the low-set group. Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups, respectively (<0.008).
CONCLUSIONS
Delivery times (>2), cesarean section times (≥2), central placenta previa, placenta attachment site (anterior wall) are independent risk factors for PPP with placenta accreta. Living in cities, systematic prenatal examination were protective factors. The central PPP is more likely to lead to postpartum hemorrhage, hysterectomy, and increases in the risk of preterm birth, low birth weight as well as asphyxia of fetus, which seriously threatens maternal and fetal life.
Topics: Case-Control Studies; Cesarean Section; Female; Humans; Infant, Newborn; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 33051421
DOI: 10.11817/j.issn.1672-7347.2020.190656 -
European Journal of Radiology Nov 2023To build and validate a predictive model of placental accreta spectrum (PAS) in patients with placenta previa (PP) combining clinical risk factors (CRF) with US and MRI...
PURPOSE
To build and validate a predictive model of placental accreta spectrum (PAS) in patients with placenta previa (PP) combining clinical risk factors (CRF) with US and MRI signs.
METHOD
Our retrospective study included patients with PP from two institutions. All patients underwent US and MRI examinations for suspicion of PAS. CRF consisting of maternal age, cesarean section number, smoking and hypertension were retrieved. US and MRI signs suggestive of PAS were evaluated. Logistic regression analysis was performed to identify CRF and/or US and MRI signs associated with PAS considering histology as the reference standard. A nomogram was created using significant CRF and imaging signs at multivariate analysis, and its diagnostic accuracy was measured using the area under the binomial ROC curve (AUC), and the cut-off point was determined by Youden's J statistic.
RESULTS
A total of 171 patients were enrolled from two institutions. Independent predictors of PAS included in the nomogram were: 1) smoking and number of previous CS among CRF; 2) loss of the retroplacental clear space at US; 3) intraplacental dark bands, focal interruption of the myometrial border and placental bulging at MRI. A PAS-prediction nomogram was built including these parameters and an optimal cut-off of 14.5 points was identified, showing the highest sensitivity (91%) and specificity (88%) with an AUC value of 0.95 (AUC of 0.80 in the external validation cohort).
CONCLUSION
A nomogram-based model combining CRF with US and MRI signs might help to predict PAS in PP patients, with MRI contributing more than US as imaging evaluation.
Topics: Pregnancy; Humans; Female; Placenta Accreta; Placenta Previa; Placenta; Retrospective Studies; Cesarean Section; Magnetic Resonance Imaging
PubMed: 37801998
DOI: 10.1016/j.ejrad.2023.111116 -
Journal of Obstetrics and Gynaecology :... Jul 2020In this study, we conducted a retrospective investigation of all cases of placenta previa and accreta that were treated at a tertiary-level hospital to assess the...
In this study, we conducted a retrospective investigation of all cases of placenta previa and accreta that were treated at a tertiary-level hospital to assess the effectiveness of balloon catheterisation at different levels. We evaluated the surgical and neonatal outcomes of 586 cases of placenta previa and accreta that were treated at our facility. This is the largest study of its kind. Depending on the severity and position of accreta, patients underwent balloon catheter placement in the aorta ( = 252) or common iliac artery ( = 38) before delivery by caesarean section. Data were collected regarding the duration of the surgery, number of cases (percentage) of balloon occlusion, and annual rate of hysterectomy. The blood loss (2207.89 ± 2044.95 ml) and transfusion volume (7.42 ± 7.872 U) in the common iliac occlusion group was greater than those in the aortic occlusion group (1967.66 ± 1466.64 ml and 6.54 ± 5.67 U, respectively); however, this difference did not reach statistical significance ( > .05). With the increase in the number of procedures performed over the years of study, the surgeons' skills improved significantly. The choice of balloon catheterisation must be made with careful consideration. Our results highlight the significance of suture skill and the experience level of surgeons.IMPACT STATEMENT The optimal method for the management of placenta accreta remains debateable. Prophylactic balloon catheters placed within arteries to control intraoperative bleeding play an important role in the management of patients with placenta accreta. The common iliac artery occlusion group tended to have a greater amount of blood loss and a higher requirement of transfusion than the aortic occlusion group; however, this difference was not statistically significant. We also analysed the difference in the complications across different periods of the study period and observed a clear improvement in the operative procedures over time. Our study revealed that the surgeons' proficiency increases over time, leading to improved results and a lower rate of hysterectomy over the course of several years. We recommend that the choice for balloon catheter occlusion be made with caution and after careful consideration.
Topics: Adult; Aorta; Balloon Occlusion; Case-Control Studies; Cesarean Section; China; Female; Humans; Hysterectomy; Iliac Artery; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Severity of Illness Index
PubMed: 31476941
DOI: 10.1080/01443615.2019.1634019 -
Archives of Gynecology and Obstetrics Mar 2022To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa.
PURPOSE
To clarify risk factors and clinical outcomes for placenta accreta spectrum (PAS) stratified by placenta previa.
METHODS
We conducted registry-based multicenter cross-sectional study including 472,301 singleton deliveries between 2013 and 2015. PAS was considered as a primary outcome, as well as maternal age, parity, history of cesarean section, history of miscarriage, and assisted reproductive technology (ART) were considered as potential exposures. A multivariable Poisson regression analysis was conducted to assess the risk for PAS, stratified by placenta previa. In addition, the risk for subsequent blood transfusion and hysterectomy by each exposure using multivariable Poisson regression analysis was conducted.
RESULTS
There were 426 and 1827 cases of PAS with and without placenta previa. Among cases with placenta previa, the number of previous cesarean sections was the most powerful predictor for PAS [adjusted risk ratio (aRR) for one previous cesarean section 5.34, 95% confidence interval (CI) 3.70-7.71; aRR for two or more previous cesarean section 16.5, 95% CI 11.5-23.6]. Among cases without placenta previa, previous cesarean section was not a significant predictor, whereas the strongest predictor was conception through ART (aRR 5.05, 95% CI 4.50-5.66). Although the risks of PAS for blood transfusion and hysterectomy were higher among cases with placenta previa, those without placenta previa also demonstrated non-negligible risks.
CONCLUSION
The current study demonstrated that history of cesarean section was the strongest risk factor for PAS among women with placenta previa. Among those without placenta previa, ART was an important predictor, but not cesarean section.
Topics: Cesarean Section; Cross-Sectional Studies; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 34448037
DOI: 10.1007/s00404-021-06189-2 -
Annals of Medicine Dec 2021This study was designed to explore the expression and the diagnostic value of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)...
This study was designed to explore the expression and the diagnostic value of vascular endothelial growth factor (VEGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in pernicious placenta previa (PPP) combined placental accreta/increta. A total of 140 PPP patients were enrolled and divided into two groups: 56 patients with placenta accreta/increta (PA group), and 84 patients without placenta accreta/increta (non-PA group). In the same period, 46 pregnant women without PPP who had undergone caesarean section were selected as controls. The levels of VEGF and sFlt-1 in serum were detected by enzyme-linked immunosorbent assay. Diagnostic efficiency of VEGF and sFlt-1 in serum were evaluated by receiver operating characteristics curve. It was found that both VEGF and sFlt-1 had diagnostic value for PPP and placenta accreta/increta combined PPP. In addition, the levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta. VEGF was negatively correlated with sFlt-1 in PPP patients. In summary, the levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.KEY POINTSThe levels of VEGF and sFlt-1 could be used to distinguish placenta accreta from placenta increta.VEGF is negatively correlated with sFlt-1 in PPP patients.The levels of VEGF and sFlt-1 could be used as auxiliary indicators to diagnose PPP and distinguish between placenta accreta and increta.
Topics: Cesarean Section; Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1
PubMed: 34927512
DOI: 10.1080/07853890.2021.1999492 -
The Journal of Obstetrics and... Mar 2024We aimed to investigate the associations of endometriosis and adenomyosis with pregnancy complications by using a large-scale Japanese database.
Increased risk of placenta previa and preterm birth in pregnant women with endometriosis/adenomyosis: A propensity-score matching analysis of a nationwide perinatal database in Japan.
AIM
We aimed to investigate the associations of endometriosis and adenomyosis with pregnancy complications by using a large-scale Japanese database.
METHODS
We retrospectively analyzed 145 590 singleton pregnancies from the Japan Perinatal Registry Network Database. Pregnant women registered as having endometriosis or adenomyosis were designated as the case group (EA), whereas the control group (non-EA) was selected using propensity-score matching adjusted for variables such as age, parity, BMI, smoking history, and the use of assisted reproductive technology. The main outcomes included placental malposition, preterm birth, and hypertensive disorders of pregnancy (HDP).
RESULTS
In total, 1203 patients from both the EA and non-EA groups were matched and evaluated. The EA group showed significantly higher rates of placenta previa (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.84-4.92), low-lying placenta (OR, 2.02; 95% CI, 1.06-3.86), and preterm birth (OR, 1.44; 95% CI, 1.13-1.84) than the non-EA group. However, no significant difference was observed in the incidence of HDP (OR, 1.22; 95% CI, 0.90-1.66).
CONCLUSION
The use of propensity-score matching to analyze a nationwide perinatal database in Japan clarified that EA was associated with increased pregnancy complications, specifically placental malposition, including placenta previa and low-lying placenta, and preterm birth, but not with HDP.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Endometriosis; Placenta Previa; Premature Birth; Adenomyosis; Pregnant Women; Japan; Retrospective Studies; Placenta; Pregnancy Complications; Pre-Eclampsia
PubMed: 38072834
DOI: 10.1111/jog.15849