-
Ultrasound in Obstetrics & Gynecology :... Apr 2022Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal...
OBJECTIVES
Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal morbidity and mortality. Our objectives were to assess the performance of classic ultrasound signs and to determine the value of novel ultrasound signs in the detection of PAS.
METHODS
This was a retrospective cohort study of women with second-trimester placenta previa who underwent third-trimester transvaginal ultrasound and all women with PAS in seven medical centers. A retrospective image review for signs of PAS was conducted by three maternal-fetal medicine physicians. Classic signs of PAS were defined as placental lacunae, bladder-wall interruption, myometrial thinning and subplacental hypervascularity. Novel signs were defined as small placental lacunae, irregular placenta-myometrium interface (PMI), vascular PMI, non-tapered placental edge and placental bulge towards the bladder. PAS was diagnosed based on difficulty in removing the placenta or pathological examination of the placenta. Multivariate regression analysis was performed and receiver-operating-characteristics (ROC) curves were generated to assess the performance of combined novel signs, combined classic signs and a model combining classic and novel signs.
RESULTS
A total of 385 cases with placenta previa were included, of which 55 had PAS (28 had placenta accreta, 11 had placenta increta and 16 had placenta percreta). The areas under the ROC curves for classic markers, novel markers and a model combining classic and novel markers for the detection of PAS were 0.81 (95% CI, 0.75-0.88), 0.84 (95% CI, 0.77-0.90) and 0.88 (95% CI, 0.82-0.94), respectively. A model combining classic and novel signs performed better than did the classic or novel markers individually (P = 0.03). An increasing number of signs was associated with a greater likelihood of PAS. With the presence of 0, 1, 2 and ≥ 3 classic ultrasound signs, PAS was present in 5%, 24%, 57% and 94% of cases, respectively.
CONCLUSIONS
We have confirmed the value of classic ultrasound signs of PAS. The use of novel ultrasound signs in combination with classic signs improved the detection of PAS. These findings have clinical implications for the detection of PAS and may help guide the obstetric management of patients diagnosed with these placental disorders. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34725869
DOI: 10.1002/uog.24804 -
AJOG Global Reports May 2022The incidence of placenta accreta spectrum is increasing in parallel with the growing number of cesarean deliveries performed. A shorter interpregnancy interval...
BACKGROUND
The incidence of placenta accreta spectrum is increasing in parallel with the growing number of cesarean deliveries performed. A shorter interpregnancy interval following cesarean delivery may prevent adequate scar healing, which could impact the risk of placenta accreta spectrum.
OBJECTIVE
We aimed to investigate the association between short interpregnancy intervals and placenta accreta spectrum.
STUDY DESIGN
We conducted a retrospective cohort study of patients at risk for placenta accreta spectrum at a tertiary academic center between 2002 and 2020. Our cohort was defined as pregnant individuals at risk for placenta accreta spectrum meeting the following criteria: placenta previa with previous cesarean delivery and/or uterine surgery, anterior low-lying placenta with previous cesarean delivery and/or uterine surgery, ≥3 previous cesarean deliveries, or any previous cesarean delivery with sonographic findings suspicious for placenta accreta spectrum. The primary outcome was surgically or histopathologically confirmed placenta accreta spectrum. Short interpregnancy interval was defined as <18 completed months from previous delivery and last menstrual period of the index pregnancy. Univariable analyses were performed with chi-square and Student's -test, as appropriate, and Kruskal-Wallis for nonparametric variables. The unadjusted and adjusted odds ratios were calculated using multivariate logistic regression models. Covariates were selected if <.2 in univariable analyses or defined a priori as clinically meaningful. The final models were derived using reverse stepwise selection of variables. We used Stata Statistical Software, version 15 (StataCorp, College Station, TX) to perform descriptive statistics.
RESULTS
Of 262 patients at risk of placenta accreta spectrum with complete records, 112 (42.7%) had placenta accreta spectrum. Pregnant individuals with short interpregnancy intervals of <18 months were no more likely than those with optimal interpregnancy intervals to have previa (58% [46/80] vs 46% [84/182]; =.09) or placenta accreta spectrum (49% [39/80] vs 40% [73/182]; =.19). Short interpregnancy interval of <18 months was not associated with placenta accreta spectrum (unadjusted odds ratio, 1.06; 95% confidence interval, 0.62-1.80). This association did not change when adjusting for previa and number of previous cesarean deliveries (adjusted odds ratio, 1.04; 95% confidence interval, 0.51-2.15). In a secondary analysis, an interpregnancy interval of <12 months was also not associated with placenta accreta spectrum (unadjusted odds ratio, 0.79; 95% confidence interval, 0.04-1.56; adjusted odds ratio, 0.52; 95% confidence interval, 0.21-1.27).
CONCLUSION
In patients at risk for placenta accreta spectrum, short interpregnancy intervals of <18 months or <12 months were not associated with placenta accreta spectrum, even when controlling for number of previous cesarean deliveries and previa. Short interpregnancy interval is not likely to be an important modifiable independent risk factor for placenta accreta spectrum.
PubMed: 36275493
DOI: 10.1016/j.xagr.2022.100051 -
Frontiers in Endocrinology 2023Placenta accreta spectrum (PAS) is one of the major causes of maternal morbidity and mortality worldwide with increasing incidence. PAS refers to a group of pathological...
Placenta accreta spectrum (PAS) is one of the major causes of maternal morbidity and mortality worldwide with increasing incidence. PAS refers to a group of pathological conditions ranging from the abnormal attachment of the placenta to the uterus wall to its perforation and, in extreme cases, invasion into surrounding organs. Among them, placenta accreta is characterized by a direct adhesion of the villi to the myometrium without invasion and remains the most common diagnosis of PAS. Here, we identify the potential regulatory miRNA and target networks contributing to placenta accreta development. Using small RNA-Seq followed by RT-PCR confirmation, altered miRNA expression, including that of members of placenta-specific miRNA clusters (e.g., C19MC and C14MC), was identified in placenta accreta samples compared to normal placental tissues. hybridization (ISH) revealed expression of altered miRNAs mostly in trophoblast but also in endothelial cells and this profile was similar among all evaluated degrees of PAS. Kyoto encyclopedia of genes and genomes (KEGG) analyses showed enriched pathways dysregulated in PAS associated with cell cycle regulation, inflammation, and invasion. mRNAs of genes associated with cell cycle and inflammation were downregulated in PAS. At the protein level, NF-κB was upregulated while PTEN was downregulated in placenta accreta tissue. The identified miRNAs and their targets are associated with signaling pathways relevant to controlling trophoblast function. Therefore, this study provides miRNA:mRNA associations that could be useful for understanding PAS onset and progression.
Topics: Pregnancy; Humans; Female; Placenta Accreta; MicroRNAs; Endothelial Cells; Placenta; Myometrium
PubMed: 36936174
DOI: 10.3389/fendo.2023.1021640 -
Frontiers in Medicine 2022To explore the feasibility of simple high-intensity focused ultrasound (HIFU) ablation for placenta increta.
OBJECTIVE
To explore the feasibility of simple high-intensity focused ultrasound (HIFU) ablation for placenta increta.
METHODS
Ninety-five patients after a vaginal delivery were enrolled in this retrospective cohort study, 53 patients were treated with simple HIFU ablation, and 42 patients were treated with HIFU followed by uterine curettage.
RESULTS
All 95 patients were successfully treated with a single-session HIFU procedure, and in the control group, the necrotic placental tissue was removed with curettage. Vaginal hemorrhage did not occur in either group. The duration of bloody lochia was 25.9 ± 8.6 days in the sHIFU group and 24.2 ± 8.8 days in the control group ( > 0.05). The median serum human chorionic gonadotropin (HCG) level was 3,222 mIU/mL and 2,838 mIU/mL in the sHIFU and control groups, respectively, which decreased and returned to normal within 30 days, and the differences were not significantly on comparing the blood HCG level in the two groups at 7, 15, and 30 days after HIFU (all > 0.05). Decreased menstrual volume occurred in 85.71% of patients in the control group, which was higher than that in the sHIFU group (23.08%) (χ = 6.839, < 0.001). During 2-8 years of follow-up, six pregnancies occurred in the sHIFU group without any recurrence of placenta increta, three pregnancies occurred in the control group, and one patient developed a repeat placenta increta.
CONCLUSION
Simple HIFU treatment is safe and effective for postpartum placenta increta and leaving the placenta . It is a promising option for patients who wish to preserve their fertility and conceive.
PubMed: 35463039
DOI: 10.3389/fmed.2022.871528 -
Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification.Medicine Nov 2022Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious...
Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious obstetric complication which could be detected by ultrasound prenatally. In order to compare our placenta accreta scoring system with prenatal ultrasound staging system and International Federation of Gynecology and Obstetrics (FIGO) clinical classification, we did a retrospective study including 105 patients diagnosed with PAS disorders by operation or pathology at Peking University First Hospital, Beijing, China, between January, 2019 and December, 2020. Placenta accreta scoring system, prenatal ultrasound staging system and FIGO clinical classification were used on each patient. Basic information and clinical outcomes including gestational weeks, intraoperative hemorrhage, hysterectomy rate and blood transfusion were also counted. Both of placenta accreta scoring system, prenatal ultrasound staging system can give a rather clear prediction of placenta percreta, with their area under curve were 0.872 (95% confidential interval [CI]: 0.793-0.951) and 0.864 (95%CI: 0.779-0.949), P value were .000 compared with clinical classification. Beside for ultrasound staging system was designed for placenta previa patients, all those 3 criteria showed their relationships with preterm birth, hysterectomy rate and intraoperative bleeding. PAS scoring system also had the ability to predict a gestational week of delivery ≤34 weeks, intraoperative massive bleeding ≥2000 mL and hysterectomy at over 12 points. Our placenta accreta scoring system had good accordance with pre-operational ultrasound staging and FIGO clinical classification, with higher universality for patients without placenta previa.
Topics: Humans; Infant, Newborn; Female; Pregnancy; Placenta Accreta; Placenta Previa; Retrospective Studies; Ultrasonography, Prenatal; Placenta; Premature Birth
PubMed: 36401394
DOI: 10.1097/MD.0000000000031622 -
Frontiers in Medicine 2021To evaluate the use of tourniquet and forceps to reduce bleeding during surgical treatment of severe placenta accreta spectrum (placenta increta and placenta percreta)....
To evaluate the use of tourniquet and forceps to reduce bleeding during surgical treatment of severe placenta accreta spectrum (placenta increta and placenta percreta). A tourniquet was used in the lower part of the uterus during surgical treatment of severe placenta accreta spectrum. Severe placenta accreta spectrum was classified into two types according to the relative position of the placenta and tourniquet during surgery: upper-tourniquet type, in which the entire placenta was above the tourniquet, and lower-tourniquet type, in which part or all of the placenta was below the tourniquet. The surgical effects of the two types were retrospectively compared. We then added forceps to the lower-tourniquet group to achieve further bleeding reduction. Finally, the surgical effects of the two types were prospectively compared. During the retrospective phase, patients in the lower-tourniquet group experienced more severe symptoms than did patients in the upper-tourniquet group, based on mean intraoperative blood loss (upper-tourniquet group 787.5 ml, lower-tourniquet group 1434.4 ml) intensive care unit admission rate (upper-tourniquet group 1.0%, lower-tourniquet group 33.3%), and length of hospital stay (upper-tourniquet group 10.2d, lower-tourniquet group 12.1d). During the prospective phase, after introduction of the revised surgical method involving forceps (in the lower-tourniquet group), the lower-tourniquet group exhibited improvements in the above indicators (intraoperative average blood loss 722.9 ml, intensive care unit admission rate 4.3%, hospital stays 9.0d). No increase in the rate of complications was observed. The relative positions of the placenta and tourniquet may influence the perioperative risk of severe placenta accreta spectrum. The method using a tourniquet (and forceps if necessary) can improve the surgical effect in cases of severe placenta accreta spectrum.
PubMed: 34733857
DOI: 10.3389/fmed.2021.557678 -
Journal of Ayub Medical College,... 2019Placenta accreta is a serious obstetrical complication and is currently a very important indication for peripartum hysterectomy. The purpose of this study is to review...
BACKGROUND
Placenta accreta is a serious obstetrical complication and is currently a very important indication for peripartum hysterectomy. The purpose of this study is to review the frequency of Caesarean hysterectomies performed for placenta accreta and maternal, foetal outcome of these patient.
METHODS
In this cross-sectional study all the patients who underwent emergency hysterectomies for different obstetrical indications during this one year were included in this study. Among them the hysterectomies performed for massive antepartum haemorrhage due to placenta increta were reviewed in detail and risk factors were identified.
RESULTS
Caesarean hysterectomies performed for different obstetrical indications were 47 and 10 were due to placenta previa increta (21.2%). The mean age of the patients was 30±5.5 years. Majority of the patients were multigravidas between 26 and 35 years of age. 30% of patients were Para-3 and 70% of patients were Para-4 and above. One patient (10%) had previous one Caesarean section with placenta previa increta, 02 patients (20%) had previous 02 C-Sections and low-lying placenta adherent to it and 04 patients (40%) had previous 03 C-Sections and major degree placenta previa and 03 patients (30%) had 04 C-Sections with placenta increta. Among the foetal outcome 04 babies (40%) were delivered between 28-32 weeks of gestation. Five foetuses (50%) were delivered between 33-36 weeks of gestation and one foetus (10%) was delivered at term. 02 babies delivered at 28 weeks of gestation had early neonatal death due to prematurity. There were no maternal deaths in this time period.
CONCLUSION
placenta previa increta is a major obstetrical complication. Timely recognition and delivery in a tertiary care hospital with surgical expertise, blood bank facilities and intensive care facilities both for the mother and the baby are needed to improve maternal and foetal outcome.
Topics: Adult; Cesarean Section; Cross-Sectional Studies; Female; Humans; Hysterectomy; Placenta Accreta; Pregnancy; Pregnancy Outcome
PubMed: 31965771
DOI: No ID Found -
Nigerian Medical Journal : Journal of... 2022Placenta accreta spectrum (PAS) describes the abnormal adherence of the placenta trophoblast to the myometrium and is associated with high foeto-maternal morbidity and...
BACKGROUND
Placenta accreta spectrum (PAS) describes the abnormal adherence of the placenta trophoblast to the myometrium and is associated with high foeto-maternal morbidity and mortality. This study was aimed at determining the prevalence, and trend of placenta accreta spectrum (PAS), as well as its association with sociodemographic/obstetrics factors at the Rivers State University Teaching Hospital (RSUTH).
METHODOLOGY
An analytical cross-sectional study of all recorded cases of placenta accreta spectrum managed at RSUTH from 1 January 2016 to 31 December 2021. Descriptive and inferential statistics were derived using IBM, Statistical Product and Service Solution (SPSS) version 25.0 Armonk, NY.
RESULTS
There were 14195 deliveries, 137 cases of placenta praevia and 39 cases of placenta accreta spectrum. The prevalence of PAS at the RSUTH was 0.27% or 2.7 /1000 deliveries or 1in 370 deliveries. The rate of PAS among cases of placenta praevia was 28.5% or 1 in 4 cases. More than half of the variants of PAS were accreta 23 (59.0%) while 13(33.3%) and 3(7.7%) were increta and percreta respectively. The mean (SD) age and gestational age of the participants were 32.28 (± 5.13), [95% Confidence Interval (CI): 30.63, 33.92] and 36.43(±2.01), (95%CI: 35.18, 37.07) respectively. The modal age group was 35-39 years. The median blood loss was 650mls range of 450-2000mls. The majority of the study participants were booked 34(87.2%) and had secondary level education 17(43.6%). History of a previous caesarean section was statistically significantly associated with PAS <0.001 while other factors did not attain significance.
CONCLUSION
Placenta accreta spectrum is not uncommon among women with pregnancies complicated by placenta praevia at the RSUTH. PAS occurred more among booked multiparous women with secondary level education and with an increasing trend. History of previous caesarean section is strongly associated with PAS.
PubMed: 38884036
DOI: No ID Found -
Cureus Apr 2022The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman....
The third stage of labor (delivery of the placenta), per current definition, takes place within 30 minutes of fetal delivery in a nulliparous or multiparous woman. According to the American Pregnancy Association, a retained placenta is diagnosed if the placenta is not delivered within 30 minutes following delivery of the fetus. Retained placenta can be caused by placenta accreta, increta, or percreta. There are several complications of a retained placenta, including postpartum hemorrhage, which can lead to maternal death if not treated promptly. We report the case of a 32-year-old female, gravida 4 para 3, who was diagnosed with a retained placenta after delivering at term (39 weeks gestation). The retained placenta was complicated by postpartum hemorrhage and was treated within 15 minutes of fetal delivery with several uterotonics (misoprostol, oxytocin, carboprost, and tranexamic acid) and several passes of ultrasound-guided suction curettage. Sharp curettage was also used with ultrasound to confirm that the uterus was empty, followed by one more suction curettage to remove any products of conception that were scraped off with sharp curettage. Vaginal bleeding was significantly reduced; minor bleeding was noted from a first-degree vaginal laceration, which was repaired by suture. The patient recovered from surgery and was discharged on postpartum day 3 with her neonate in stable condition. In conclusion, this case highlights that retained placenta is a serious obstetric complication that can cause life-threatening postpartum hemorrhage. More data are needed to define the period of time correlating with the greatest chance of encountering a retained placenta in order to improve obstetric care and reduce maternal morbidity and mortality. Future research should consider challenging the current definition of retained placenta, defined as a placenta undelivered after 30 minutes, in favor of a shorter time period, 15 minutes undelivered, in order to mobilize the obstetric team, anesthesiologist, and blood bank to prevent catastrophic postpartum hemorrhage.
PubMed: 35619843
DOI: 10.7759/cureus.24389 -
International Journal of Obstetric... Aug 2022Anaesthetic management strategies for Placenta Accreta Spectrum (PAS) remain diverse, and literature interpretation is complicated by a range of terminology. The... (Review)
Review
BACKGROUND
Anaesthetic management strategies for Placenta Accreta Spectrum (PAS) remain diverse, and literature interpretation is complicated by a range of terminology. The International Federation for Gynaecology and Obstetrics (FIGO) published guidance in 2018 to improve PAS diagnosis and management by standardising definitions. We mapped the range, clarity and consistency of terminology in literature pertaining to both PAS and anaesthesia, and determined whether this changed followed FIGO guidance.
METHODS
A literature search of four medical databases was performed. Papers included had PAS (or any 'synonym') in the title, and mode of anaesthesia in the title or abstract. Narrative reviews, and papers not containing original data, were excluded. Diagnostic terms, and evidence supporting their use, were described.
RESULTS
Among 680 abstracts identified, 62 papers were included. Thirty distinct terms were used to describe PAS and subtypes. Terminology was clearly defined 46% of the time and used consistently within a paper 47% of the time. Nine papers (15%) provided no diagnostic evidence to support the terminology used. In 14 (23%) papers published after FIGO guidelines, 14 terms were used to describe PAS. Two papers (14%) specified the diagnostic criteria used. Six (43%) confirmed diagnoses using pathology. Four (29%) were consistent in use of terminology throughout the paper.
CONCLUSIONS
Despite international consensus criteria for reporting PAS, the language pertaining to PAS and anaesthesia remains heterogeneous, inconsistent and variably defined. Reporting of PAS should adhere to FIGO criteria to allow unambiguous interpretation of work, and generation of evidence that is transferrable into clinical practice.
Topics: Female; Humans; Placenta Accreta; Pregnancy
PubMed: 35868995
DOI: 10.1016/j.ijoa.2022.103572