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Biomedicines Feb 2022This study aimed to assess the relationship between placenta accreta spectrum disorder (PASD) and endometriosis. The relationships among pregnancy, assisted reproductive... (Review)
Review
This study aimed to assess the relationship between placenta accreta spectrum disorder (PASD) and endometriosis. The relationships among pregnancy, assisted reproductive technology (ART), placenta previa, ART-conceived pregnancy and PASD were also determined. A systematic literature review was conducted using multiple computerized databases. Forty-eight studies (1990-2021) met the inclusion criteria. According to the adjusted pooled analysis ( = 3), endometriosis was associated with an increased prevalence of PASD (adjusted odds ratio [OR] 3.39, 95% confidence interval [CI] 1.96-5.87). In the included studies, the ART rate ranged from 18.2% to 37.2% for women with endometriosis. According to the adjusted pooled analysis, women who used ART were more likely to have placenta previa ( = 13: adjusted OR 2.96, 95%CI, 2.43-3.60) and PASD ( = 4: adjusted OR 3.54, 95%CI 1.86-6.76) than those who did not use ART. According to the sensitivity analysis using an unadjusted analysis accounting for the type of ART, frozen embryo transfer (ET) was associated with an increased risk of PASD ( = 4: OR 2.79, 95%CI, 1.22-6.37) compared to fresh ET. Endometriosis may be associated with an increased rate of PASD. Women with placenta previa complicated with endometriosis who conceived using frozen ET may be a high risk for PASD.
PubMed: 35203599
DOI: 10.3390/biomedicines10020390 -
Journal of Gynecology Obstetrics and... Apr 2022To compare and evaluate the validity of the existing risk prediction models for severe postpartum hemorrhage (SPPH) in patients with placenta previa.
Systematic external evaluation of four preoperative risk prediction models for severe postpartum hemorrhage in patients with placenta previa: A multicenter retrospective study.
AIM
To compare and evaluate the validity of the existing risk prediction models for severe postpartum hemorrhage (SPPH) in patients with placenta previa.
METHODS
We conducted a systematic literature review to collect the existing risk prediction models for SPPH in patients with placenta previa, and recruited patients with placenta previa who underwent cesarean section in Tongji Hospital (Wuhan, China) and 4 cooperative hospitals from January 2018 to June 2021. We defined SPPH as total blood loss ≥1500 mL or transfusion packed red blood cell ≥4 U. The risk of SPPH of each patient was predicted by the collected models, respectively. Then we calculated the sensitivity, specificity, coincidence rate (CCR), positive predictive value (PPV), negative predictive value (NPV) and drawn the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) curve of each model.
RESULTS
This external cohort contained 1172 patients of whom 284 patients (24.23%) experienced SPPH, and 4 risk prediction models were collected in this study. After evaluated by this external cohort, the area under the ROC curve (AUC), sensitivity, specificity, CCR, PPV and NPV of the four models ranged from 0.644 to 0.755, 38.38% to 86.31%, 42.75% to 86.49%, 56.23% to 74.83%, 38.68% to 47.60%, 81.15% to 87.45%, respectively. The model established by Kim JW et al. had the highest sensitivity, NPV, AUC and net benefit, the model established by Lee JY et al. had the highest specificity, CCR and PPV.
CONCLUSIONS
The four prediction models showed moderate predictive performance, the discrimination indicators and benefit indicators of each model were not simultaneously ideal in this population. The prediction models should be further optimized to improve the discrimination ability and benefit, and prospective external validation studies should also be carried out before they are applied to clinical practice.
Topics: Cesarean Section; Female; Humans; Multicenter Studies as Topic; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Retrospective Studies
PubMed: 35151929
DOI: 10.1016/j.jogoh.2022.102333 -
Journal of Minimally Invasive Gynecology Jun 2022To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas. (Review)
Review
OBJECTIVE
To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas.
DATA SOURCES
A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and Embase, from database inception to October 2021.
METHODS OF STUDY SELECTION
Two reviewers conducted independent literature searches. Studies that met the criteria based on title and abstract underwent full-text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical RFA of myomas.
TABULATION, INTEGRATION, AND RESULTS
A total of 405 publications were initially identified and screened, 39 underwent full-text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range, 27-46 years). Most patients had between 1 and 3 myomas ablated, and myomas size ranged from <2 cm to 12.5 cm. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: one placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation and no fetal complications. The spontaneous abortion rate was comparable with the general obstetric population.
CONCLUSION
Almost all pregnancies after RFA of myomas were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency myoma ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
Topics: Abortion, Spontaneous; Adult; Catheter Ablation; Female; Humans; Infant, Newborn; Leiomyoma; Myoma; Pregnancy; Pregnancy Outcome; Uterine Neoplasms
PubMed: 35123041
DOI: 10.1016/j.jmig.2022.01.015 -
Birth (Berkeley, Calif.) Jun 2022Studies have suggested that cesarean birth in pregnant women with COVID-19 may decrease maternal adverse events and perinatal transmission. This systematic review aimed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies have suggested that cesarean birth in pregnant women with COVID-19 may decrease maternal adverse events and perinatal transmission. This systematic review aimed to evaluate variations in clinical presentation, laboratory findings, and maternal/neonatal outcomes in COVID-19 patients who delivered vaginally versus via cesarean.
METHODS
A comprehensive search following PRISMA guidelines was performed for studies published up to May 23, 2020, using PubMed, Web of Science, Scopus, Embase, Cochrane, Science Direct, and clinicaltrials.gov. Original retrospective and prospective studies, case reports, or case series with sufficient data for estimating the association of COVID-19 with different pregnancy outcomes with no language restriction and published in peer-reviewed journals were included. Pooled mean and arcsine transformation proportions were applied. Next, a two-arm meta-analysis was performed comparing the perinatal outcomes between the study groups.
RESULTS
Forty-two studies with a total of 602 pregnant women with COVID-19 were included. The mean age was 31.8 years. Subgroup analysis showed that Americans had the lowest gestational age (mean = 32.7, 95%CI = 27.0-38.4, P < 0.001) and the highest incidence of maternal ICU admission (95%CI = 0.45%-2.20, P < 0.001) of all nationalities in the study. There was no significant difference in perinatal complications, premature rupture of membrane, placenta previa/accreta, or gestational hypertension/pre-eclampsia between women who delivered vaginally versus by cesarean. Importantly, there were also no significant differences in maternal or neonatal outcomes.
CONCLUSION
Vaginal delivery was not associated with worse maternal or neonatal outcomes when compared with cesarean. The decision to pursue a cesarean birth should be based on standard indications, not COVID-19 status.
Topics: Adult; COVID-19; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Prospective Studies; Retrospective Studies; SARS-CoV-2
PubMed: 34997608
DOI: 10.1111/birt.12609 -
American Journal of Obstetrics and... Jun 2022Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the...
BACKGROUND
Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the literature.
OBJECTIVE
We investigated the hypothesis that placenta percreta, which has been described clinically as placental tissue invading through the full thickness of the uterus, is a heterogeneous category with most cases owing to primary or secondary uterine abnormality rather than an abnormally invasive form of placentation.
STUDY DESIGN
We have evaluated the agreement between the intraoperative findings using the International Federation of Gynecology and Obstetrics classification with the postoperative histopathology diagnosis in a prospective cohort of 101 consecutive singleton pregnancies presenting with a low-lying placenta or placenta previa, a history of at least 1 prior cesarean delivery and ultrasound signs suggestive of placenta accreta spectrum. Furthermore, a systematic literature review of case reports of placenta percreta, which included histopathologic findings and gross images, was performed.
RESULTS
Samples for histologic examination were available in 80 of 101 cases of the cohort, which were managed by hysterectomy or partial myometrial resection. Microscopic examination showed evidence of placenta accreta spectrum in 65 cases (creta, 9; increta, 56). Of 101 cases included in the cohort, 44 (43.5%) and 54 (53.5%) were graded as percreta by observer A and observer B, respectively. There was a moderate agreement between observers. Of note, 11 of 36 cases that showed no evidence of abnormal placental attachment at delivery and/or microscopic examination were classified as percreta by both observers. The systematic literature review identified 41 case reports of placenta percreta with microscopic images and presenting symptomatology, suggesting that most cases were the consequence of a uterine rupture. The microscopic descriptions were heterogeneous, and all descriptions demonstrated histology of placenta creta rather than percreta.
CONCLUSION
Our study supported the concept that placenta accreta is not an invasive disorder of placentation but the consequence of postoperative surgical remodeling or a preexisting uterine pathology and found no histologic evidence supporting the existence of a condition where the villous tissue penetrates the entire uterine wall, including the serosa and beyond.
Topics: Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Prospective Studies; Ultrasonography, Prenatal
PubMed: 34973177
DOI: 10.1016/j.ajog.2021.12.030 -
Obstetrics and Gynecology Jan 2022To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3... (Meta-Analysis)
Meta-Analysis
Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis.
OBJECTIVE
To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy).
DATA SOURCES
MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles.
METHODS OF STUDY SELECTION
Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers.
TABULATION, INTEGRATION, AND RESULTS
Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption.
CONCLUSION
Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42021244487.
Topics: Delivery, Obstetric; Europe; Female; Gynecology; Humans; Obstetrics; Pregnancy; Pregnancy Complications; Societies, Medical; Urogenital Abnormalities; Uterus
PubMed: 34856567
DOI: 10.1097/AOG.0000000000004627 -
Hormones (Athens, Greece) Mar 2022To assess maternal and neonatal outcomes in women with or without preexisting diabetes mellitus (DM) undergoing assisted reproduction technology (ART) treatment. (Review)
Review
OBJECTIVE
To assess maternal and neonatal outcomes in women with or without preexisting diabetes mellitus (DM) undergoing assisted reproduction technology (ART) treatment.
METHODS
Prospective or retrospective controlled trials reporting on women with or without preexisting DM undergoing ART treatment were considered eligible. Twelve electronic databases were systematically searched up to December 2020. The risk of bias was assessed by the Cochrane Risk OF Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Each primary outcome was extracted and pooled as maternal- or neonatal-related.
RESULTS
Two studies were included in the systematic review, reporting on both maternal- and neonatal-related parameters after ART treatment. Due to the limited data, no meta-analysis was conducted. Preterm birth, placenta previa, and excessive bleeding during pregnancy were observed more often in pregnancies complicated by preexisting DM conceived by ART compared with pregnancies without DM. There was no difference in the risk for placental abruption between the groups. Regarding the neonatal outcomes, large-for-gestational-age (LGA) embryos and neonatal intensive care unit (NICU) admission were more commonly reported for women with preexisting DM. In one study, preexisting DM was marginally associated with infant mortality.
CONCLUSIONS
Despite the scarce data, preexisting DM in pregnancies conceived by ART is associated with increased risk for maternal and neonatal complications.
TRIAL REGISTRATION
Registered in PROSPERO (registration number: 143187).
Topics: Diabetes Mellitus; Female; Humans; Infant, Newborn; Infertility; Placenta; Pregnancy; Pregnancy Outcome; Premature Birth; Prospective Studies; Retrospective Studies; Technology
PubMed: 34668169
DOI: 10.1007/s42000-021-00329-8 -
Transfusion Clinique Et Biologique :... Feb 2022The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care.
MATERIAL AND METHODS
We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3.
RESULTS
The search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD=-3.71 [-4.46, -2.96]; p<0.00001; I=88%). Placenta previa (OR=9.54 [7.23, 12.59]; p<0.00001; I=88%), placental abruption (OR=6.77 [5.25, 8.73]; p<0.00001; I=72%), emergency C-section (OR=1.92 [1.42, 2.60]; p<0.0001; I=75%), general anesthesia (OR=8.43 [7.90, 9.00]; p<0.00001; I=72%), multiple gestations (OR=1.60 [1.24, 2.06]; p=0.0003; I=85%), preterm labor (OR=3.34 [2.75, 4.06]; p<0.00001; I=85%), prolonged labor (OR=1.68 [1.44, 1.96]; p<0.00001; I=78%), unbooked cases (OR=2.42 [1.22, 4.80]; p=0.01; I=80%), hypertensive disorders of pregnancy (OR=1.81 [1.72, 1.90]; p<0.00001; I=71%), and fibroids (OR=2.32 [1.55, 3.47]; p<0.0001; I=72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR=0.67 [0.29, 1.55]; p=0.36; I=90%), maternal age (MD=0.09 [-0.27, 0.45]; p=0.62; I=50%), maternal body mass index (MD=-0.14 [-0.81, 0.53]; p=0.67, I=86%), diabetes (OR=0.93 [0.75, 1.15]; p=0.51; I=52%), and malpresentation (OR=0.65 [0.38, 1.11]; p=0.13; I=64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups.
CONCLUSION
Placenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion.
Topics: Blood Transfusion; Cesarean Section; Female; Humans; Infant, Newborn; Placenta; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 34634456
DOI: 10.1016/j.tracli.2021.09.010 -
Ginekologia Polska Sep 2021This study aimed at assessing the adverse outcomes of pregnancy in women with endometriosis.
OBJECTIVES
This study aimed at assessing the adverse outcomes of pregnancy in women with endometriosis.
MATERIAL AND METHODS
The Cochrane, Embase and PubMed databases were searched for identifying the required studies published before June 2019. Meta-analyses of relative risk (RR) were performed under the random-effects model to estimate the risk of selected adverse outcomes of pregnancy in females with endometriosis.
RESULTS
Twenty-eight studies (53,141 women with and 2,355,923 women without endometriosis data) were selected for meta-analysis. Endometriosis bearing females had a significantly higher risk placenta previa (RR 3.92 [95% CI 2.48-6.20]), miscarriage (RR 1.31 [95% CI 1.06-1.61), gestational hypertension (RR 1.30 [95% CI 1.02-1.65]), cesarean section (RR 1.48 [95% CI 1.33-1.65]) and preeclampsia (RR 1.18 [95% CI 1.09-1.28]). The incidence of placental abruption was not statistically significant between the groups (RR 3.62 [95% CI [0.99-13.28]).
CONCLUSIONS
Women suffering from endometriosis are at higher risks of miscarriage, preterm birth, gestational hypertension, placenta previa, cesarean section, and preeclampsia.
PubMed: 34541648
DOI: 10.5603/GP.a2021.0081 -
Human Reproduction Update Oct 2021Preimplantation genetic testing (PGT) includes methods that allow embryos to be tested for severe inherited diseases or chromosomal abnormalities. In addition to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preimplantation genetic testing (PGT) includes methods that allow embryos to be tested for severe inherited diseases or chromosomal abnormalities. In addition to IVF/ICSI and repeated freezing and thawing of the embryos, PGT requires a biopsy to obtain embryonic genetic material for analysis. However, the potential effects of PGT on obstetric and neonatal outcomes are currently uncertain.
OBJECTIVE AND RATIONALE
This study aimed to investigate whether pregnancies conceived after PGT were associated with a higher risk of adverse obstetric and neonatal outcomes compared with spontaneously conceived (SC) pregnancies or pregnancies conceived after IVF/ICSI.
SEARCH METHODS
PubMed, EMBASE, MEDLINE, Web of Science and The Cochrane Library entries from January 1990 to January 2021 were searched. The primary outcomes in this study were low birth weight (LBW) and congenital malformations (CMs), and the secondary outcomes included gestational age, preterm delivery (PTD), very preterm delivery (VPTD), birth weight (BW), very low birth weight (VLBW), neonatal intensive care unit (NICU) admission, hypertensive disorders of pregnancy (HDP), gestational diabetes, placenta previa and preterm premature rupture of membranes (PROM). We further pooled the results of PGT singleton pregnancies. Subgroup analyses included preimplantation genetic diagnosis (PGD), preimplantation genetic screening (PGS), cleavage-stage biopsy combined with fresh embryo transfer (CB-ET) and blastocyst biopsy combined with frozen-thawed embryo transfer (BB-FET).
OUTCOMES
This meta-analysis included 15 studies involving 3682 babies born from PGT pregnancies, 127 719 babies born from IVF/ICSI pregnancies and 915 222 babies born from SC pregnancies. The relative risk (RR) of LBW was higher in PGT pregnancies compared with SC pregnancies (RR = 3.95, 95% confidence interval [CI]: 2.32-6.72), but the risk of CMs was not different between the two groups. The pooled results for the risks of LBW and CMs were similar in PGT and IVF/ICSI pregnancies. The risks of PTD (RR = 3.12, 95% CI: 2.67-3.64) and HDP (RR = 3.12, 95% CI: 2.18-4.47) were significantly higher in PGT pregnancies compared with SC pregnancies. Lower gestational age (mean difference [MD] = -0.76 weeks, 95% CI -1.17 to -0.34) and BW (MD = -163.80 g, 95% CI: -299.35 to -28.24) were also noted for PGT pregnancies compared with SC pregnancies. Nevertheless, compared with IVF/ICSI pregnancies, the risks of VPTD and VLBW in PGT pregnancies were significantly decreased by 41% and 30%, respectively, although the risk of HDP was still significantly increased by 50% in PGT pregnancies compared with IVF/ICSI pregnancies. The combined results of obstetric and neonatal outcomes of PGT and IVF/ICSI singleton pregnancies were consistent with the overall results. Further subgroup analyses indicated that both PGD and PGS pregnancies were associated with a higher risk of PTD and a lower gestational age compared with SC pregnancies.
WIDER IMPLICATIONS
This meta-analysis showed that PGT pregnancies may be associated with increased risks of LBW, PTD and HDP compared with SC pregnancies. The overall obstetric and neonatal outcomes of PGT pregnancies are favourable compared with those of IVF/ICSI pregnancies, although PGT pregnancies were associated with a higher risk of HDP. However, because the number of studies that could be included was limited, more randomised controlled trials and prospective cohort studies are needed to confirm these conclusions.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Genetic Testing; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Preimplantation Diagnosis; Prospective Studies; Retrospective Studies
PubMed: 34473268
DOI: 10.1093/humupd/dmab027