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American Journal of Obstetrics &... Dec 2023This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum.
DATA SOURCES
A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022.
STUDY ELIGIBILITY CRITERIA
Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa.
METHODS
Study screening was performed 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
Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21-0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% confidence interval, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% confidence interval, -3.25 to -0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10-0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12-11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06-0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24-7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12-11.25) showed statistical significance. No significant difference was found for the other outcomes.
CONCLUSION
Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Placenta Accreta; Placenta Previa; Cesarean Section; Intensive Care Units; Maternal Mortality
PubMed: 37865220
DOI: 10.1016/j.ajogmf.2023.101197 -
Fertility and Sterility Sep 2023To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy that progressed...
OBJECTIVE
To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy that progressed beyond 24 weeks.
DESIGN
Retrospective cohort study.
SETTING
A large tertiary maternity hospital.
PATIENT(S)
All women who booked for antenatal care and delivery between January 2014 and August 2021 were recorded. The study was limited to women with a singleton pregnancy, and to avoid intraperson correlation, we selected the first record of delivery from each mother in the study, leaving 108,792 deliveries for analysis. Obstetric and perinatal outcomes were compared among 1994 women (1.83%) with a history of ≥2 miscarriages (RM), 11,477 women (10.55%) with a history of 1 miscarriage, and 95,321 women (87.62%) with no history of miscarriage, respectively.
INTERVENTION(S)
Women with a history of ≥2 miscarriages or RM.
MAIN OUTCOME MEASURE(S)
Obstetric complications included gestational diabetes mellitus, preeclampsia (subclassified as preterm and term preeclampsia), placenta previa, placenta accreta, and fetal distress. Perinatal outcomes included emergency cesarean section, elective cesarean section, induction, postpartum hemorrhage, preterm birth, stillbirth, Apgar score <7 at 5 minutes, neonatal asphyxia, neonatal sex, congenital; malformation, low birth weight, and neonatal death.
RESULT(S)
After adjusting for relevant confounders, there was an increased risk of adverse obstetric and perinatal outcomes in a subsequent pregnancy for women with a history of RM, specifically for placental dysfunction disorders: preterm preeclampsia (risk ratio [RR] = 1.58; 95% confidence interval [CI], 1.03-2.32), preterm birth (RR = 1.34; 95% CI, 1.15-1.54)], and abnormal placentation, that is placenta previa (RR = 1.78; 95% CI, 1.36-2.28), and placenta accreta (RR = 4.19; 95% CI, 2.75-6.13).
CONCLUSION(S)
Significant associations existed between a history of RM and the occurrence of adverse obstetric and perinatal outcomes including placental dysfunction disorders and abnormal placentation. These findings may contribute to the early detection and appropriate intervention for placenta-associated diseases in women with a history of RM, with the goal of avoiding or reducing the associated detrimental effects.
Topics: Pregnancy; Female; Humans; Infant, Newborn; Cesarean Section; Premature Birth; Placenta Previa; Retrospective Studies; Placenta Accreta; Pre-Eclampsia; Placenta; Abortion, Habitual
PubMed: 37121567
DOI: 10.1016/j.fertnstert.2023.04.028 -
Archives of Gynecology and Obstetrics Mar 2021Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta... (Review)
Review
PURPOSE
Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies by a retrospective cohort analysis.
METHODS
A total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of BMI and age matched, healthy pregnant controls. PAPP-A multiples of the median (MoM) were acquired from laboratory data files in 1 January 2017-30 September 2019. The probable maternal serum biochemical predictor of placenta accreta was analyzed by using multiple logistic regression analysis.
RESULTS
PAPP-A MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.009 < 0.05, p < 0.001). Serum PAPP-A was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, age, smoking, and previous cesarean section history (OR: 3.51; 95% CI: 1.77-6.94; p = 0.0003 < 0.05). In addition, smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) and previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) were also significantly associated with placenta accreta.
CONCLUSION
Increased first trimester serum PAPP-A was significantly positively associated with placenta accreta, suggesting that the potential role of PAPP-A in identifying pregnancies at high risk for placenta accreta. Smoking and previous cesarean section history may be the risk factors for accreta in placenta previa patients.
Topics: Adult; Cesarean Section; Female; Gestational Age; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A; Retrospective Studies; Risk Factors
PubMed: 33515274
DOI: 10.1007/s00404-020-05960-1 -
Placenta Jun 2022Our study aimed to distinguish patients with placenta accreta (crete, increta, and percreta) from those with placenta previa using maternal plasma levels of soluble...
INTRODUCTION
Our study aimed to distinguish patients with placenta accreta (crete, increta, and percreta) from those with placenta previa using maternal plasma levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PLGF) and the sFlt-1/PLGF ratio.
METHODS
We obtained maternal plasma from 185 women in late pregnancy and sorted them into three groups: 72 women with normal placental imaging results (control group), 50 women with placenta previa alone (PP group), and 63 women with placenta previa and placenta accreta (PAS group). The concentrations of sFlt-1 and PLGF in the maternal plasma were measured using ELISA kits and the sFlt-1/PLGF ratio was calculated.
RESULT
The median (min-max) sFlt-1 levels and the sFlt-1/PLGF ratio in the PAS group (12.8 ng/ml, 3.8-34.2 ng/ml) (133, 14-361) were lower than in the PP group (28.7 ng/ml, 13.1-60.3 ng/ml) (621, 156-2013) (p < 0.0001 and P < 0.0001, respectively). The median (min-max) PLGF levels in the PAS group (108 pg/ml, 38-679 pg/ml) was higher than that in the PP group (43 pg/ml, 12-111 pg/ml) (p < 0.0001 and p < 0.0001, respectively). The area under the ROC of the sFlt-1 levels, PLGF levels, and sFlt-1/PLGF ratio were 0.91, 0.90, and 0.99, respectively; the cut-off values were 18.9 ng/ml, 75.9 pg/ml, and 229.5, respectively. The concentration of sFlt-1 and sFlt-1/PLGF ratio were associated with the volume of blood loss (-.288*, -.301*).
DISCUSSION
The concentrations of sFlt-1 and PLGF and ratio of plasma sFlt-1/PLGF may distinguish patients with placenta accreta from those with placenta previa.
Topics: Biomarkers; Diagnosis, Differential; Female; Humans; Placenta; Placenta Accreta; Placenta Growth Factor; Placenta Previa; Pre-Eclampsia; Pregnancy; Receptor Protein-Tyrosine Kinases; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1
PubMed: 35635854
DOI: 10.1016/j.placenta.2022.05.009 -
Journal of the College of Physicians... Jul 2020To investigate the effectiveness and success rate of Bakri balloon tamponade (BBT) for postpartum haemorrhage (PPH) in patients with placenta previa and placenta accreta...
OBJECTIVE
To investigate the effectiveness and success rate of Bakri balloon tamponade (BBT) for postpartum haemorrhage (PPH) in patients with placenta previa and placenta accreta spectrum (PAS).
STUDY DESIGN
Descriptive study.
PLACE AND DURATION OF STUDY
Department of Obstetrics and Gynaecology, Bursa Yüksek Ihtisas Education and Research Hospital, Bursa, Turkey, from June 2016 to June 2019.
METHODOLOGY
Patients treated with BBT for severe PPH and uncontrollable bleeding due to treatment failure with uterotonic agents were retrospectively analysed. Exclusion criteria were age <18 years and >46 years, having multiple pregnancies, less amount of bleeding than indicated in the definition of PPH and requiring no BBT and those with hemodynamic instability before BBT requiring emergency postpartum hysterectomy, and having missing obstetric and laboratory data. The main outcome was the rate of surgical exploration and peripartum hysterectomy following the use of BBT as an adjunct treatment for refractory PPH. Secondary outcome was the need for blood transfusion. The BBT was considered to fail, if the bleeding from drainage catheter was continued and more than 100 mL during failure was 10 minutes. In case of BBT failure, C-section hysterectomy was performed.
RESULTS
Of the 128 patients, 14 (10.9%) had vaginal birth and 109 (85.2%) had Cesarean section delivery. Of patients with cesarean section delivery, 84 (65.6%) had multiple repeat cesarean deliveries and 22 (17.2%) were previous cesarean cases. Ninety-one patients (71.1%) had placental site abnormality. Twenty patients (15.6%) underwent hypogastric and uterine artery ligation. Eleven patients (8.7%) with persistent uterine bleeding and hemodynamic instability underwent hysterectomy. Success rate of BBT was found to be 91.3% in PPH. No mortality was observed.
CONCLUSION
BBT is an effective tool for management of postpartum uterine atony and prevention of persistent PPH in patients with placenta previa and placenta accreta spectrum due to increased cesarean section and uterine surgeries in recent years. Key Words: Placenta previa, Placenta accreta spectrum, Postpartum haemorrhage, Balloon tamponade, Bakri balloon.
Topics: Adolescent; Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Treatment Outcome; Turkey; Uterine Balloon Tamponade
PubMed: 32811599
DOI: 10.29271/jcpsp.2020.07.707 -
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 -
Medical Science Monitor : International... Sep 2022BACKGROUND The incidence of placenta previa is gradually increasing. The major risk factor is a history of cesarean section (CS). Such patients may experience severe...
BACKGROUND The incidence of placenta previa is gradually increasing. The major risk factor is a history of cesarean section (CS). Such patients may experience severe bleeding during pregnancy and surgery. Patients with placenta previa were classified based on risk factors in this study. This retrospective study from a single center in Turkey aimed to evaluate the factors associated with placenta previa in 151 women. MATERIAL AND METHODS Patients with placenta previa were grouped by the presence/absence of prior CS. Group 1 (123 patients) had undergone at least 1 CS, and Group 2 (28 patients) had not undergone CS. The diagnosis of placenta previa was made by ultrasound. Placenta previa was defined as cases where the placenta crossed the internal os. Duration of surgery, bleeding during surgery, and the amounts of erythrocyte suspensions required were compared between groups. RESULTS Of Group 1 patients, 67.5% had anterior placenta previa compared to 46.4% in Group 2. The mean duration of surgery was: 52.0±19.2 and 28.5±4.6 min (P<0.001); the number of sutures was 8.4±2.4 and 5.9±0.9 (P<0.001); the bleeding volumes were 720.3±536.2 and 344±137.0 mL (P<0.001); and the amount of erythrocyte suspension administered intraoperatively was 0.2±0.7 and 0.0±0.0 unit (P=0.032). CONCLUSIONS Mean duration of surgery, number of sutures, bleeding volume, and intraoperatively applied ES volumes were significantly different between groups. Identification of placenta previa patients who have undergone prior CS is vitally important in terms of preoperative preparation.
Topics: Cesarean Section; Female; Humans; Placenta; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors; Turkey
PubMed: 36155611
DOI: 10.12659/MSM.938023 -
European Review For Medical and... Mar 2022The aim of this study was to assess the association between maternal weight gain and placenta morphology in the complete placenta previa pregnancies.
OBJECTIVE
The aim of this study was to assess the association between maternal weight gain and placenta morphology in the complete placenta previa pregnancies.
PATIENTS AND METHODS
This was a prospective clinical cohort study. Pregnancy weight gain was defined as the difference between delivery and at first trimester. Morphological parameters, including placenta length, breadth, thickness, length-breadth, surface area, weight, and fetoplacental weight ratio, were direct measured delivery.
RESULTS
Eighty-five women were included in this study. Maternal weight gain was 11.12 ± 3.95 kg. Placenta length, breadth, thickness, length-breadth, surface area, weight and fetoplacental weight ratio were 19.42 ± 1.97 cm, 18.29 ± 1.80 cm, 2.18 ± 0.38 cm, 1.13 ± 0.80 cm, 281.60 ± 57.23 cm2, 569.05 ± 118.77 g, and 4.88 ± 0.88, respectively. Correlation analysis showed that there was a positive correlation between maternal weight gain and placenta length (r = 0.261, p = 0.016), placenta breadth (r = 0.239, p = 0.028), and placenta surface area (r = 0.254, p = 0.019). In the linear regression model, maternal weight gain was significantly associated with placenta length [β (95% CI): 0.130 (0.025-0.236)], breadth [β (95% CI): 0.109 (0.012-0.205)], and surface area [β (95%CI): 3.677 (0.615-6.739)]. The results were still stable after adjusting for pre-pregnancy weight.
CONCLUSIONS
Maternal weight gain in pregnancy was associated with placental length, placental breadth, and placental surface area in a complete placenta previa pregnancies. Considering the single center data, further studies are needed to recognize the significance of the association analyzed in our study.
Topics: Cohort Studies; Female; Humans; Placenta; Placenta Previa; Pregnancy; Prospective Studies; Weight Gain
PubMed: 35363348
DOI: 10.26355/eurrev_202203_28346 -
Nigerian Journal of Clinical Practice Apr 2023Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known high-risk condition associated with placental previa.
BACKGROUND
Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known high-risk condition associated with placental previa.
AIM
The morbidity of nulliparous women with placenta previa without PAS disorders is unknown.
PATIENTS AND METHODS
The data from nulliparous women who underwent cesarean delivery were collected retrospectively. The women were dichotomized into malpresentation (MP) and placenta previa groups. The placenta previa group was categorized into previa (PS) and low-lying (LL) groups. When the placenta covers the internal cervical os, it is called placenta previa, when the placenta is near the cervical os, it is called the low-lying placenta. Their maternal hemorrhagic morbidity and neonatal outcomes were analyzed and adjusted using multivariate analysis based on univariate analysis.
RESULTS
A total of 1269 women were enrolled: 781 women in the MP group and 488 women in the PP-LL group. Regarding packed red blood cell transfusion, PP and LL had adjusted odds ratio (aOR) of 14.7 (95% confidence interval (CI): 6.6 - 32.5), and 11.3 (95% CI: 4.9 - 26) during admission, and 51.2 (95% CI: 22.1 - 122.7) and 10.3 (95% CI: 3.9 - 26.6) during operation, respectively. For intensive care unit admission, PS and LL had aOR of 15.9 (95% CI: 6.5 - 39.1) and 3.5 (95% CI: 1.1 - 10.9), respectively. No women had cesarean hysterectomy, major surgical complications, or maternal death.
CONCLUSION
Despite placenta previa without PAS disorders, maternal hemorrhagic morbidity was significantly increased. Thus, our results highlight the need for resources for those women with evidence of placenta previa including a low-lying placenta, even if those women do not meet PAS disorder criteria. In addition, placenta previa without PAS disorder was not associated with critical maternal complications.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Placenta; Placenta Previa; Retrospective Studies; Placenta Accreta; Morbidity
PubMed: 37203107
DOI: 10.4103/njcp.njcp_456_22 -
Annals of Saudi Medicine 2023Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa...
BACKGROUND
Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis.
OBJECTIVES
Evaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP.
DESIGN
A 10-year retrospective cohort study.
SETTING
Tertiary care hospital.
PATIENTS AND METHODS
We report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US).
MAIN OUTCOME MEASURES
Risk factors for PAS in major PP and maternal complications.
SAMPLE SIZE
299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding.
CONCLUSION
MRI may be a valuable adjunct in the evaluation of PAS in major PP; as a complement, but not substitute US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or deep/extra-uterine extension on US.
LIMITATION
Single center, small sample size, lack of complete histopathological diagnosis.
CONFLICT OF INTEREST
None.
Topics: Child; Pregnancy; Female; Humans; Placenta Accreta; Placenta Previa; Incidence; Retrospective Studies; Risk Factors; Magnetic Resonance Imaging
PubMed: 37554027
DOI: 10.5144/0256-4947.2023.219