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Japanese Journal of Radiology Jun 2024This study aimed to clarify associations between subacute hematoma on placental magnetic resonance imaging (MRI), antenatal bleeding, and preterm deliveries in patients...
PURPOSE
This study aimed to clarify associations between subacute hematoma on placental magnetic resonance imaging (MRI), antenatal bleeding, and preterm deliveries in patients with placenta previa (PP) without placenta accreta spectrum (PAS).
MATERIALS AND METHODS
This retrospective study investigated 78 consecutive patients with PP (median age, 34.5 years; interquartile range [IQR], 31-37 years) who underwent placental MRI in the third trimester. Patients with PAS detected intraoperatively or pathologically were excluded. Two radiologists evaluated the presence of subacute hematomas and their locations on placental MRI. We examined associations between presence of subacute hematoma and antenatal bleeding, emergency cesarean section (CS), hysterectomy, gestational age (GA) at delivery, birth weight, and amount of blood loss at CS. We also examined the association between perinatal outcome and subacute hematoma location: marginal, retro-placental, or intra-placental. Inter-observer agreement for the detection of subacute hematoma was calculated using kappa analysis.
RESULTS
Subacute hematomas were identified on MRI in 39 of the 78 patients (50.0%). Antenatal bleeding and emergency CS were more prevalent in patients with subacute hematoma on MRI (20 patients [51.3%] and 18 patients [46.2%], respectively) than in patients without (7 patients [17.9%], Fisher's exact test, p = 0.004 and 7 patients [17.9%], p = 0.014, respectively). GA at delivery was significantly lower in patients with subacute hematoma (median 36w3d, IQR 35w4d-37w1d) than in patients without (median 37w1d, IQR 36w4d-37w2d; Mann-Whitney test: p = 0.048). Marginal hematoma was significantly associated with antenatal bleeding and emergency CS. Inter-observer agreement for the presence of subacute hematoma was moderate (κ = 0.573).
CONCLUSION
Subacute hematoma on placental MRI was associated with antenatal bleeding, emergency CS and shorter GA at delivery in patients with PP. Marginal hematoma was also associated with antenatal bleeding and emergency CS. Placental MRI appears useful for predicting antenatal bleeding and preterm delivery in patients with PP.
Topics: Humans; Female; Pregnancy; Placenta Previa; Magnetic Resonance Imaging; Adult; Retrospective Studies; Premature Birth; Hematoma; Placenta; Predictive Value of Tests; Uterine Hemorrhage
PubMed: 38369566
DOI: 10.1007/s11604-024-01541-3 -
Journal of Family Medicine and Primary... Dec 2023Antepartum hemorrhage (APH) is one of the deadliest complications in obstetrics. It can complicate about 2-5% of pregnancies. It contributes significantly to maternal...
INTRODUCTION AND AIM
Antepartum hemorrhage (APH) is one of the deadliest complications in obstetrics. It can complicate about 2-5% of pregnancies. It contributes significantly to maternal and perinatal mortality and morbidity during pregnancy and childbearing worldwide. The aim of this study was to determine maternal and fetal outcomes in patients presenting with APH.
MATERIALS AND METHODS
This was a retrospective study. Pregnant women with >28 weeks gestation reporting to the Department of Obstetrics and Gynecology from May 2021 to April 2022 were included in the study. Ethical approval from the institutional ethical committee was taken.
RESULT
This study included 76 patients of APH. Most patients in the analysis were found to be second gravida (30%). Anemia was the most common associated morbidity (51.31%). 58% of these patients were of placenta previa, 14% were of abruption, and 10% were of accreta. Among all patients, 94.74% recovered well. 2.63% of cases could not be saved and resulted in maternal mortality. The proportions of babies alive, intra-uterine death (IUD), and intubated were 86.84%, 11.84%, and 1.32%, respectively. 17.1% of patients required a lifesaving cesarean hysterectomy.
CONCLUSION
APH is an obstetrical emergency that requires timely diagnosis and early intervention. Swift management is required to improve maternal and fetal outcomes.
PubMed: 38361908
DOI: 10.4103/jfmpc.jfmpc_692_23 -
Pakistan Journal of Medical Sciences 2024The study aimed to demonstrate the efficacy and safety of an innovative hemostatic technique in managing Placenta Previa and Accreta Spectrum by S. Rao Spiral Suturing...
OBJECTIVE
The study aimed to demonstrate the efficacy and safety of an innovative hemostatic technique in managing Placenta Previa and Accreta Spectrum by S. Rao Spiral Suturing (SRSS) of a lower uterine segment.
METHOD
In this retrospective study conducted at Department of Obstetrics & Gynecology Unit-II of Nishtar Medical University, Multan between December 2018 to January 2021, one hundred and thirty consenting patients' clinical records were reviewed with major degree placenta previa/placenta accrete spectrum, either operated electively or presented in an emergency, with or without a history of previous cesarean section. The enrolled patients underwent SRSS, procedure's efficacy and safety were measured by the number of obstetrical hysterectomies, the time required for the procedure, estimated blood loss, blood transfusion volume, need for any other hemostatic technique, bladder trauma, pelvic infection, scar site hematoma or abscess, sepsis, duration of hospital stay and maternal mortality.
RESULTS
Out of 130 patients, 17(12.6%) had Placenta Accreta, 86(66.3%) Increta, and 27(21%) Percreta. The Placenta location was anterior dominant in 102(78.4%) cases and posterior in 17(8.4%). Of the patients who underwent surgery, only two required obstetrical hysterectomy due to uncontrolled bleeding. The procedure took three to five minutes in 127 patients and five to seven minutes in three patients. Regarding intraoperative blood transfusion, 54.6% of patients were transfused 1000-2000 ml blood, and 5.38% required > 3000 ml. No blood transfusion was required postoperatively in any patient. Postpartum hemorrhage, infection, fever, and sepsis were not observed in any patient postoperatively. None of the patients suffered bladder injury. All patients were discharged as per routine.
CONCLUSION
SRSS is an innovative, safe, effective, and simple suturing technique for patients with Placenta Previa and Accreta spectrum.
PubMed: 38356810
DOI: 10.12669/pjms.40.3.7747 -
Maedica Dec 2023Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore...
Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore the diagnosis and management involve both the identification of etiological causes and other possible systemic interactions. Infertility is defined as a succession of unsuccessful attempts of unprotected intercourse within a couple for 12 months, during the reproductive life. Among the many causes related to infertility, uterine pathology has an important place and hysteroscopy is outstanding in diagnosing and treating various pathologies in this category. This descriptive study was conducted on a retrospective analysis of a group of patients from Bucur Clinical Hospital, Bucharest, Romania. The main data were obtained from medical electronic records and included the type of infertility, associated diagnoses and symptoms, previous investigations, hysteroscopic procedure and follow-up. In order to obtain the database, the above parameters were evaluated and processed in the IBM SPSS Statistics version 28, including other few graphs processed in Microsoft Office Excel 2007. The present study included 51 patients aged between 20 and 40 years, with a mean of 32.02 ± 3.7. Out of the total number of patients, 76.47% of participants to the present study were diagnosed with secondary infertility and 58.82% described menometrorrhagias as the most common symptom. Endometrial polyps were more frequently associated with menometrorrhagias (70% of patients), while synechiae and secondary amenorrhea were found together in 75% of cases. Previous ultrasound evaluation identified uterine cavity abnormalities as nonhomogeneous echo-pattern in 58.82% of cases, with some of them being suggestive of endometrial polyps (37.25%), intrauterine synechiae (3.92%) and uterine fibromas (9.8%). We noticed that 12% of cases required laparoscopy and 4% laparotomy. The outcomes of hysteroscopic management resulted in a conception rate of 39%. We found that 20% of pregnancies achieved were complicated with placenta praevia, 5% with gestational hypertension and 15% with imminence of abortion. Secondary infertility was more frequently encountered than primary infertility and the most common associated manifestations included menometrorrhagia, followed by secondary amenorrhea and pelvic-abdominal pain. Transvaginal ultrasound was correlated with hysteroscopic diagnosed pathology; posthysteroscopic results were favourable, regardless of the size and location of changes in the uterine cavity, thus highlighting the importance of hysteroscopic therapeutic techniques in increasing the chances of conception.
PubMed: 38348079
DOI: 10.26574/maedica.2023.18.4.631 -
Diagnostics (Basel, Switzerland) Feb 2024We previously reported that T2 dark bands and placental bulges observed in magnetic resonance imaging (MRI) can predict adverse maternal outcomes in patients with...
PURPOSE
We previously reported that T2 dark bands and placental bulges observed in magnetic resonance imaging (MRI) can predict adverse maternal outcomes in patients with placenta accreta spectrum (PAS) and placenta previa undergoing prophylactic balloon occlusion of the internal iliac artery. On the other hand, the risk factors associated with the use of prophylactic aortic balloon occlusion (PABO) have not been sufficiently investigated. This retrospective study aimed to identify MRI-based risk factors associated with adverse maternal outcomes in the context of PABO during a cesarean section (CS) for PAS and placenta previa.
MATERIALS AND METHODS
Ethical approval was obtained for a data analysis of 40 patients diagnosed with PAS and placenta previa undergoing PABO during a CS. Clinical records, MRI features, and procedural details were examined. The inclusion criteria for the massive bleeding group were as follows: an estimated blood loss (EBL) > 2500 mL, packed red blood cell (pRBC) transfusion (>4 units), and the need for a hysterectomy or transcatheter arterial embolization after delivery. The massive and nonmassive bleeding groups were compared.
RESULTS
Among the 22 patients, those in the massive bleeding group showed significantly longer operative durations, a higher EBL ( < 0.001), an increased number of pRBC transfusions ( < 0.001), and prolonged postoperative hospital stays ( < 0.05). T2 dark bands on MRI were significant predictors of adverse outcomes ( < 0.05).
CONCLUSION
T2 dark bands on MRI were crucial predictors of adverse maternal outcomes in patients undergoing PABO for PAS or placenta previa during a CS. Recognizing these MRI features proactively indicates the need for effective management strategies during childbirth and emphasizes the importance of further prospective studies to validate and enhance these findings.
PubMed: 38337849
DOI: 10.3390/diagnostics14030333 -
Journal of Clinical Medicine Jan 2024We investigated the association between placental location and pregnancy outcomes in placenta previa. This multi-center retrospective study enrolled 781 women who...
We investigated the association between placental location and pregnancy outcomes in placenta previa. This multi-center retrospective study enrolled 781 women who delivered between May 1999 and February 2020. We divided the dataset into anterior ( = 209) and posterior ( = 572) groups and compared the baseline characteristics and obstetric and neonatal outcomes. The adverse obstetric outcomes associated with placenta location were evaluated using a multivariate logistic analysis. Gestational age at delivery in the anterior group (253.0 ± 21.6) was significantly lower than that in the posterior group (257.6 ± 19.1) ( = 0.008). The anterior group showed significantly higher parity, rates of previous cesarean section, non-vertex fetal positions, admissions for bleeding, emergency cesarean sections, transfusions, estimated blood loss, and combined placenta accrete spectrum ( < 0.05). In the multivariate analysis, the anterior group had higher rates of transfusion (OR 2.23; 95% CI 1.50-3.30), placenta accreta spectrum (OR 2.16; 95% CI 1.21-3.97), and non-vertex fetal positions (OR 2.47; 95% CI 1.09-5.88). These findings suggest that more caution is required in the treatment of patients with anterior placenta previa. Therefore, if placenta previa is diagnosed prenatally, it is important to determine the location of the body and prepare for massive bleeding in the anterior group.
PubMed: 38337369
DOI: 10.3390/jcm13030675 -
Medicine Feb 2024To explore the expression and the diagnostic value of ADAM17 in pernicious placenta previa (PPP) combined placental accreta. A total of 148 PPP patients were enrolled...
To explore the expression and the diagnostic value of ADAM17 in pernicious placenta previa (PPP) combined placental accreta. A total of 148 PPP patients were enrolled and divided into 2 groups: 62 patients with placenta accrete (PPP with PA group) and 86 patients without placenta accrete (PPP without PA group). In the same period, 74 pregnant women without PPP who had undergone cesarean section were selected as controls. The levels of ADAM17 were detected by qt-PCR. Diagnostic efficiency of ADAM17 were evaluated by receiver operating characteristics curve. ADAM17 was higher expression in PPP patients. Multivariate analysis showed that ADAM17 was related to gravida times (HR = 2.43 95% CI, 1.25-3.31), history of cesarean delivery (HR = 3.44, 95% CI = 2.24-4.28), history of abortions (HR = 2.22, 95% CI = 1.57-3.06) for PPP with PA patients and gravida times (HR = 2.01, 95% CI = 1.45-2.86), history of cesarean delivery (HR = 1.89, 95% CI = 1.33-2.48) for PPP patients without PA. Diagnostic efficiency of ADAM17 indicated that the sensitivity and specificity of ADAM17 detection for PPP with PA were 74.41% and 67.21% and for PPP without PA were 89.29% and 85.52%. Area under curve were 0.7876 (0.7090-0.8661) for PPP with PA and 0.9443 (0.9136-0.9750) for PPP without PA. Insummary, ADAM17 was higher expression in patients with PPP. ADAM17 was associated with gravida times, history of cesarean delivery, history of abortions. It also indicated a better diagnostic efficiency for patients with PPP. Further larger sample, multicenter studies should be conducted to confirm the conclusion from our study.
Topics: Female; Humans; Pregnancy; ADAM17 Protein; Cesarean Section; Placenta; Placenta Accreta; Placenta Previa; Retrospective Studies
PubMed: 38335437
DOI: 10.1097/MD.0000000000032848 -
Journal of Ovarian Research Feb 2024The present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET).
BACKGROUND
The present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET).
METHODS
All twin births that were conceived following FET from 2007 to 2021 at Shanghai Ninth People's Hospital in Shanghai, China were retrospectively reviewed. The exposure variable was twin type (monozygotic and dizygotic). The primary outcome was the incidence of neonatal death while secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, weight discordance, stillbirth, birth defects, pneumonia, respiratory distress syndrome, necrotizing enterocolitis, and neonatal jaundice. Analysis of the outcomes was performed using logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The causal mediation analysis was conducted. A doubly robust estimation model was used to validate the results. Kaplan-Meier method was used to calculate survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model.
RESULTS
Of 6101 dizygotic twin (DZT) and 164 MZT births conceived by FET, MZT showed an increased risk of neonatal death based on the multivariate logistic regression models (partially adjusted OR: 4.19; 95% CI, 1.23-10.8; fully adjusted OR: 4.95; 95% CI, 1.41-13.2). Similar results were obtained with the doubly robust estimation. Comparing MZT with DZT, the neonatal survival probability was lower for MZT (P < 0.05). The results were robust in the sensitivity analysis. Females with MZT pregnancies exhibited an elevated risk of preterm premature rupture of the membranes (adjusted OR: 2.42; 95% CI, 1.54-3.70). MZT were also associated with higher odds of preterm birth (prior to 37 weeks) (adjusted OR: 2.31; 95% CI, 1.48-3.67), low birth weight (adjusted OR: 1.92; 95% CI, 1.27-2.93), and small for gestational age (adjusted OR: 2.18; 95% CI, 1.21-3.69) in the fully adjusted analyses. The effect of MZT on neonatal death was partially mediated by preterm birth and low birth weight (P < 0.05).
CONCLUSIONS
This study indicates that MZT conceived by FET are related to an increased risk of neonatal death, emphasizing a potential need for comprehensive antenatal surveillance in these at-risk pregnancies.
Topics: Female; Humans; Infant, Newborn; Pregnancy; China; Embryo Transfer; Fetal Membranes, Premature Rupture; Perinatal Death; Placenta; Premature Birth; Retrospective Studies; Twins, Monozygotic
PubMed: 38326864
DOI: 10.1186/s13048-024-01349-9 -
The Nigerian Postgraduate Medical... Jan 2024We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean...
We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean hysterectomy on account of uncontrollable bleeding, and histopathology revealed a placental site trophoblastic tumour.
Topics: Pregnancy; Female; Humans; Adult; Placenta; Placenta Previa; Trophoblastic Tumor, Placental Site; Nigeria; Uterine Neoplasms; Hysterectomy
PubMed: 38321801
DOI: 10.4103/npmj.npmj_236_23 -
European Review For Medical and... Jan 2024This retrospective study explored the potential connection between adenomyosis and pregnancy outcomes.
OBJECTIVE
This retrospective study explored the potential connection between adenomyosis and pregnancy outcomes.
PATIENTS AND METHODS
A study included data from a total of 1,208 pregnancies. The adenomyosis group included 334 pregnant women with adenomyosis, and women in the control group (n=874) had uncomplicated pregnancies. Data on pregnancy complications and maternal and neonatal outcomes were compared.
RESULTS
The incidence of gestational hypertension, gestational diabetes, and placenta previa was higher in the adenomyosis group compared to the control group (p<0.05). Adenomyosis was linked to a higher risk of postpartum hemorrhage (1,000-1,500 ml) but a lower risk of premature rupture of membranes (PROM) (p<0.05). Diagnosis of adenomyosis correlated with increased incidence of low fetal weight (20.3% vs. 21.3%, p<0.05) and a low APGAR score at 1 min (p<0.05).
CONCLUSIONS
Adenomyosis correlated with a higher incidence of gestational hypertension, placenta previa, and gestational diabetes. At the same time, adenomyosis correlated with a significantly lower incidence of PROM compared to uncomplicated pregnancy. There was a significant increase in the incidence of postpartum hemorrhage and a higher risk of low fetal weight and lower APGAR score at 1 min in pregnancies with adenomyosis.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Retrospective Studies; Adenomyosis; Placenta Previa; Postpartum Hemorrhage; Cohort Studies; Fetal Weight; Pregnancy Outcome; Diabetes, Gestational; Hypertension, Pregnancy-Induced
PubMed: 38305602
DOI: 10.26355/eurrev_202401_35055