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The Journal of Maternal-fetal &... Dec 2023-fertilization (IVF) is an independent risk factor for placenta previa (PP). Our aim was to study this link by comparing the clinical characteristics and placental...
INTRODUCTION
-fertilization (IVF) is an independent risk factor for placenta previa (PP). Our aim was to study this link by comparing the clinical characteristics and placental histology of pregnancies complicated by PP in IVF versus unassisted pregnancies.
METHODS
A retrospective-cohort study of deliveries with PP between 2008 and 2021. Placental histology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA) >24.
RESULTS
A total of 182 pregnancies were included - 23 IVF pregnancies (IVF group) and 159 unassisted pregnancies (Control group). The control group was characterized by higher gravidity ( = .007) and parity ( < .001) and a trend of more past cesarean deliveries, whereas the IVF group- by a higher rate of nulliparity ( < .001) and diabetes mellitus ( = .04). The control group was characterized by a higher rate of placental weight below the 10th percentile (47.8 versus 13.9%, = .001) and by a trend of a lower overall placental weight. No differences were noted in maternal and fetal vascular lesions.
DISCUSSION
While PP in non-assisted pregnancies is probably associated with previous CDs, in IVF it is more "sporadic," and may complicate any index pregnancy. A lower placental weight was more prevalent in the control group, supporting the concept that pregnancies complicated by PP following IVF can be attributed to initial abnormal location of placentation, rather than an underlying pathological uterine segment of implantation. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Placenta; Placenta Previa; Pregnancy Outcome; Retrospective Studies; Cohort Studies; Fertilization in Vitro
PubMed: 37286205
DOI: 10.1080/14767058.2023.2221763 -
Archives of Gynecology and Obstetrics Jul 2021Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.
PURPOSE
Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.
METHODS
This study was conducted in The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital between January 2009 and 2019. PP was traditionally classified into four types, namely low-lying placenta, marginal, partial, and complete PP. Previous studies have classified PP into two types, namely low-lying placenta and PP. Based on our clinical experience, we proposed the classification of PP into three types, for the first time, which included low-lying placenta, "marpartial" (marginal and partial) PP, and complete PP. Multivariate logistic regression analysis was performed to determine the effects of different types of PP on maternal and neonatal outcomes.
RESULTS
In total, 4490 singleton pregnancies were complicated with PP. In the four-classification method, compared with women with low-lying placenta, women with complete PP had a risk of placenta accrete spectrum disorders, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and neonatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and neonatal outcomes, compared with low-lying placenta.
CONCLUSION
Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification of PP may be practical from the clinical perspective.
Topics: Adult; Female; Humans; Infant, Newborn; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors; Stillbirth
PubMed: 33386958
DOI: 10.1007/s00404-020-05912-9 -
Journal of Magnetic Resonance Imaging :... Mar 2020
Topics: Female; Hemorrhage; Humans; Magnetic Resonance Imaging; Placenta Accreta; Placenta Previa; Pregnancy; Risk Factors
PubMed: 31617637
DOI: 10.1002/jmri.26951 -
Abdominal Radiology (New York) Dec 2022This study aimed to identify if placental thickness measured from MRI images correlated with placenta percreta in patients with placenta previa.
INTRODUCTION
This study aimed to identify if placental thickness measured from MRI images correlated with placenta percreta in patients with placenta previa.
METHODS
Placental thickness was retrospectively measured in 161 patients from July 2018 to August 2020. The measurements were performed at the thickest part of the placenta in the lower uterine segment on the mid-sagittal plane MR images by two independent radiologists. Intraoperative and pathologic findings were the standard of reference. Univariate and multivariate analyses were performed to identify the relationship between clinical features, placental thickness, and placenta percreta. The predictive ability of placental thickness was demonstrated using receiver operating characteristic curve analysis.
RESULTS
Placental thickness in patients with placenta percreta was significantly higher than in patients with placenta increta, placenta accreta, and normal placentas (p < 0.05). Multivariate analysis revealed that placental thickness was the only independent risk factor for placenta percreta. The cutoff value of placental thickness was 4.35 cm for differentiating placenta percreta in patients with placenta previa.
DISCUSSION
Patients with placenta percreta had the highest placental thickness. Placental thickness was correlated with placenta percreta.
Topics: Humans; Female; Pregnancy; Placenta Previa; Placenta Accreta; Placenta; Retrospective Studies; Magnetic Resonance Imaging
PubMed: 36114883
DOI: 10.1007/s00261-022-03676-1 -
Archives of Gynecology and Obstetrics Dec 2019The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study...
PURPOSE
The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa.
METHODS
This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher's exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI).
RESULTS
We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8-3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1-9.6).
CONCLUSIONS
Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.
Topics: Adult; Female; Humans; Hysterectomy; Morbidity; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies
PubMed: 31691015
DOI: 10.1007/s00404-019-05338-y -
The Journal of Maternal-fetal &... Dec 2022Placenta previa is one of the causes of neonatal anemia. This condition is mainly explained by antenatal hemorrhage and incision of the anteriorly located placenta...
OBJECTIVE
Placenta previa is one of the causes of neonatal anemia. This condition is mainly explained by antenatal hemorrhage and incision of the anteriorly located placenta during cesarean section. However, the mechanism of neonatal anemia in placenta previa has not been extensively studied or well elucidated. This study investigates whether placenta previa is associated with lower hematocrit levels in newborns with no antenatal hemorrhage and placental incision.
KEY FINDINGS
This prospective study investigated 47 patients with previa and 43 control patients who gave birth with a cesarean section at 34-38 weeks of gestation. Blood samples were obtained from the fetal end of the umbilical vein. The mean umbilical cord hematocrit value was 49.3% in the control patients and 46.7% in the patients with previa, and the difference was statistically significant ( = .029). No significant association was observed between hematocrit value and birth weight, gestational age, newborn gender, placenta position, or preoperative maternal hemoglobin level.
CONCLUSION
The study findings reveal that even if not complicated by antepartum or intrapartum hemorrhage, placenta previa may be associated with lower hematocrit values in newborns. Although in none of the cases, the umbilical cord hematocrit value was not as low as to be defined as anemia, this effect of previa on newborns should be considered because of the importance of iron status.
Topics: Pregnancy; Humans; Infant, Newborn; Female; Placenta Previa; Placenta; Cesarean Section; Hematocrit; Prospective Studies; Hemorrhage; Umbilical Cord; Anemia, Neonatal; Retrospective Studies
PubMed: 36176062
DOI: 10.1080/14767058.2022.2128651 -
Placenta Nov 2021Ultrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long... (Review)
Review
Ultrasound is widely used as the initial diagnostic imaging modality during pregnancy with both high spatial and temporal resolution. Although MRI in pregnancy has long focused on the fetus, its use in placental imaging has greatly increased over recent years. In addition to the possibilities of evaluating function, MRI with a wide field of view and high contrast resolution allows characterization of placental anatomy, particularly in situations that are difficult to specify with ultrasound, especially for suspected placenta accreta. MRI also appears to be a particularly useful examination for the anatomical evaluation of the placenta independent of maternal body habitus or fetal position. Indeed, surprisingly little attention is paid to the placenta in MRI when the indication for the examination is fetal. Thus, some aspects of the placenta seem to us to be important to be recognized by the radiologist and to be described on the MRI report. In this review, we will describe MRI sequences used for, and common features seen in, imaging of i) the normal placenta, ii) abnormal aspects of the placenta that should be identified on MRI performed for fetal reason, and iii) placental anomalies for which placental MRI may be indicated.
Topics: Female; Humans; Magnetic Resonance Imaging; Placenta; Placenta Accreta; Placenta Diseases; Placenta Previa; Placental Insufficiency; Pregnancy; Ultrasonography, Prenatal; Vasa Previa
PubMed: 34536809
DOI: 10.1016/j.placenta.2021.08.056 -
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 -
European Journal of Radiology Mar 2023Placental accreta spectrum (PAS) disorder with bladder involvement can be associated with maternal and neonatal morbidity. Magnetic resonance imaging (MRI) may provide...
BACKGROUND
Placental accreta spectrum (PAS) disorder with bladder involvement can be associated with maternal and neonatal morbidity. Magnetic resonance imaging (MRI) may provide accurate preoperative diagnoses.
OBJECTIVE
This study had 2 aims: to retrospectively review the MRI findings for bladder involvement in PAS with placental previa and to correlate bladder involvement with maternal and neonatal outcomes.
MATERIALS AND METHODS
MRI images of 48 patients with severe PAS (increta and percreta) with placenta previa/low-lying placenta were evaluated by 2 experienced radiologists blinded to the final diagnoses. Nine MRI findings and stepwise logistic regression analysis were assessed to identify predictive MRI findings for bladder involvement. The correlations between PAS patients with bladder involvement and clinical outcomes were analyzed using Fisher's exact test.
RESULTS
Of the 48 patients, 27 did not have bladder involvement, while 21 did. Logistic regression analysis identified 2 predictive MRI features for bladder involvement. They were abnormal vascularization (OR,6.94; 95 %CI,1.05-45.75) and loss of the chemical shift line at the uterovesical interface (OR, 4.41; 95 %CI, 0.63-30.98). The sensitivity and specificity of the combined MRI features were 38.1 % and 100 %, respectively (p = 0.001). A significant correlation was found between bladder involvement and massive blood loss during surgery (p = 0.022).
CONCLUSIONS
PAS with bladder involvement was significantly correlated with massive surgical blood loss. Prenatally, the disorder was predicted with high specificity by the combination of loss of chemical shift artifacts in the steady-state free precession sequence and abnormal vascularization at the uterovesical interface on MRI.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Placenta Accreta; Placenta Previa; Placenta; Retrospective Studies; Urinary Bladder; Magnetic Resonance Imaging
PubMed: 36657210
DOI: 10.1016/j.ejrad.2023.110695