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Journal of Obstetrics and Gynaecology :... Dec 2024Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association... (Meta-Analysis)
Meta-Analysis Review
Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis. Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS). A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4). Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Stillbirth; Premature Birth; Abruptio Placentae; Placenta Previa; Placenta; Pregnancy Outcome; Abortion, Spontaneous; Uterine Hemorrhage
PubMed: 38305047
DOI: 10.1080/01443615.2023.2288224 -
International Journal of Reproductive... Nov 2023Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between... (Review)
Review
Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between ART and maternal outcomes. In this systematic review, the electronic databases, including PubMed, MEDLINE, Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, Magiran, Irandoc, and Scientific Information Database were searched for maternal outcomes reported from 2010-2021. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality of studies. A total of 3362 studies were identified by searching the databases. After screening abstracts and full-text reviews, 19 studies assessing the singleton pregnancy-related complications of in vitro fertilization/intracytoplasmic sperm injection were included in the study. The results demonstrated that singleton pregnancies conceived through ART had higher risks of pregnancy-related complications and adverse maternal outcomes, such as vaginal bleeding, cesarean section, hypertension induced by pregnancy, pre-eclampsia, placenta previa, and premature membrane rupture than those conceived naturally. In conclusion, an increased risk of adverse obstetric outcomes was observed in singleton pregnancies conceived by ART. Therefore, obstetricians should consider these pregnancies as high-risk cases and should pay special attention to their pregnancy process.
PubMed: 38292514
DOI: 10.18502/ijrm.v21i11.14651 -
International Journal of Women's Health 2024To explore the prenatal diagnosis, clinical characteristics, and perinatal outcomes of placenta accreta spectrum in different placental locations.
OBJECTIVE
To explore the prenatal diagnosis, clinical characteristics, and perinatal outcomes of placenta accreta spectrum in different placental locations.
METHODS
This was a retrospective cohort study. Pregnant women who delivered at two tertiary referral hospitals from January 2013 to December 2022 and were ultimately pathologically diagnosed with placenta accreta spectrum were included. They were divided into three groups based on different placental locations (anterior, posterior, and lateral wall/fundus). The differences in prenatal diagnosis, clinical characteristics, and perinatal outcomes among the three groups were compared.
RESULTS
There were 115,470 deliveries in a ten-year period at the two hospitals, and 118 case patients were confirmed to have a pathologically diagnosed placenta accreta spectrum. The posterior placenta group had a lower rate of placenta previa (76.9% vs 94.9% vs 100%, p<0.05) and a higher gestational age at delivery (36.4±2.45 vs 34.91±1.76 vs 34.31±3.41, p<0.05) compared to the other two groups. The anterior placenta group had a significantly higher rate of invasive (increta/percreta) form placenta accreta spectrum (81.4% vs 36.5% vs 28.6%, p<0.05) and planned cesarean section (96.6% vs 80.8% vs 71.4%, p<0.05) compared to the other two groups. In terms of prenatal diagnosis, the anterior placenta group had a significantly higher rate of placenta accreta spectrum prenatal suspicion rate compared to the other two groups (86.4% vs 36.5% vs 57.1%, p<0.05). The posterior placenta group had a lower rate of preoperative abdominal aortic balloon placement compared to the other two groups (5.8% vs 28.8% vs 28.6%, p<0.05). There were no statistically significant differences among the three groups in primary perinatal outcomes, though the anterior placenta group had a longer postoperative hospital stay.
CONCLUSION
The prenatal diagnosis rate and proportion of invasive form of placenta accreta spectrum occurring in non-anterior placenta are relatively lower than anterior placenta. There were no significant differences in major perinatal outcomes among the three groups.
PubMed: 38292300
DOI: 10.2147/IJWH.S439654 -
Obstetric blood transfusion in placenta previa patients with prenatal anemia: a retrospective study.BMC Pregnancy and Childbirth Jan 2024The appropriate use of obstetric blood transfusion is crucial for patients with placenta previa and prenatal anemia. This retrospective study aims to explore the...
BACKGROUND
The appropriate use of obstetric blood transfusion is crucial for patients with placenta previa and prenatal anemia. This retrospective study aims to explore the correlation between prenatal anemia and blood transfusion-related parameters in this population.
METHODS
We retrieved the medical records of consecutive participants who were diagnosed with placenta previa and underwent cesarean section in our hospital. We compared the baseline demographics and clinical characteristics of patients with and without anemia. The correlation between prenatal anemia and obstetric blood transfusion-related parameters was evaluated using multivariate regression analysis.
RESULTS
A total of 749 patients were enrolled, with a mean prenatal hemoglobin level of 10.87 ± 1.37 g/dL. Among them, 54.87% (391/749) were diagnosed with anemia. The rate of obstetric blood transfusion was significantly higher in the anemia group (79.54%) compared to the normal group (44.41%). The median allogeneic red blood cell transfusion volume in the anemia group was 4.00 U (IQR 2.00-6.00), while in the normal group, it was 0.00 U (IQR 0.00-4.00). The prenatal hemoglobin levels had a non-linear relationship with intraoperative allogeneic blood transfusion rate, massive blood transfusion rate, red blood cell transfusion units, and fresh plasma transfusion volume in patients with placenta previa, with a threshold of 12 g/dL.
CONCLUSIONS
Our findings suggest that prenatal anemia is associated with a higher rate of blood transfusion-related parameters in women with placenta previa when the hemoglobin level is < 12 g/dL. These results highlight the importance of promoting prenatal care in placenta previa patients with a high requirement for blood transfusion.
Topics: Female; Humans; Pregnancy; Anemia; Blood Component Transfusion; Blood Transfusion; Cesarean Section; Hemoglobins; Placenta Accreta; Placenta Previa; Plasma; Retrospective Studies; Pregnancy Complications, Hematologic
PubMed: 38291360
DOI: 10.1186/s12884-024-06279-4 -
JNMA; Journal of the Nepal Medical... Sep 2023Induction of labour is the artificial initiation of uterine contraction by various means such as medical, surgical or mechanical with the aim of achieving vaginal...
INTRODUCTION
Induction of labour is the artificial initiation of uterine contraction by various means such as medical, surgical or mechanical with the aim of achieving vaginal delivery. Misoprostol, a prostaglandin E1 analogue is used popularly for the induction of labour in resource-limited health centres. The aim of the study was to find out the prevalence of induction of labour among pregnant women in the Department of Obstetrics and Gynaecology in a tertiary care centre.
METHODS
A descriptive cross-sectional study was conducted among pregnant women in a tertiary care centre from 3 February 2022 to 31 July 2022. Ethical approval was taken from the Institutional Review Committee. The women with a singleton pregnancy, reactive non-stress test, and adequate pelvis were included. Women with malpresentation, previous cesarean section, placenta previa, and cephalopelvic disproportion were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval.
RESULTS
Among 1355 pregnant women, the prevalence of induction of labour was found to be 135 (9.96%) (8.37-11.55, 95% Confidence Interval).
CONCLUSIONS
The prevalence of induction of labour among pregnant women was found to be similar to other studies done in similar settings.
KEYWORDS
induction of labour; misoprostol; pregnancy.
Topics: Pregnancy; Female; Humans; Misoprostol; Oxytocics; Pregnant Women; Labor, Induced; Gynecology; Cesarean Section; Cross-Sectional Studies; Tertiary Care Centers; Labor, Obstetric
PubMed: 38289805
DOI: 10.31729/jnma.8255 -
Inquiry : a Journal of Medical Care... 2024Pregnant women are at increased risk of influenza-related complications. However, the rate of influenza vaccination among pregnant women in Taiwan is low. By analyzing...
Pregnant women are at increased risk of influenza-related complications. However, the rate of influenza vaccination among pregnant women in Taiwan is low. By analyzing real-world data in this study, we investigated the factors associated with influenza vaccination during pregnancy in Taiwan. This study was a cross-sectional study. We collected real-world data from 2 databases in Taiwan: the Birth Certificate Database and the National Health Insurance Research Database. The study population was pregnant between October 2014 and December 2016 in Taiwan. The multivariate logistic regression was performed to identify factors associated with influenza vaccination, including maternal sociodemographics, trimester, comorbidities, and health-care utilization. The vaccination rate of among pregnant women was 8.2%. Factors significantly associated with a high likelihood of influenza vaccination were age between 30 and 34 years (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.10-1.19), second trimester (OR: 1.80; 95% CI: 1.75-1.85), income equal to or exceeding NT$ 38 201 (OR: 1.92; 95% CI: 1.86-1.99), hypertension (OR: 1.16; 95% CI: 1.05-1.29), cardiovascular disease (OR: 1.29; 95% CI: 1.17-1.42), autoimmune disease (OR: 1.47; 95% CI: 1.38-1.58), and chronic pulmonary disease (OR: 1.24; 95% CI: 1.18-1.31). A low level of urbanization, at least 1 hospitalization in the previous year, and the presence of pregnancy complications (eg, gestational diabetes, preeclampsia, and placenta previa) were associated with a lower likelihood rate of influenza vaccination. The influenza vaccination rate among pregnant women in Taiwan was low. Age, gestational age, income level, urbanization level, hypertension, cardiovascular disease, autoimmune disease, chronic pulmonary disease, and pregnancy complications may be associated with influenza vaccination among pregnant women.
Topics: Pregnancy; Female; Humans; Adult; Pregnancy Complications, Infectious; Influenza, Human; Cross-Sectional Studies; Cardiovascular Diseases; Vaccination; Lung Diseases; Hypertension; Autoimmune Diseases
PubMed: 38288548
DOI: 10.1177/00469580241229635 -
International Journal of Emergency... Jan 2024Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the...
Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review.
BACKGROUND
Cardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital.
CASE PRESENTATION
A full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications.
CONCLUSIONS
The diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.
PubMed: 38287235
DOI: 10.1186/s12245-024-00587-4 -
The Journal of Maternal-fetal &... Dec 2024The relationship between placental location in pregnancies without previa and adverse pregnancy outcomes has not been well studied. Additionally, the impact of abnormal...
OBJECTIVE
The relationship between placental location in pregnancies without previa and adverse pregnancy outcomes has not been well studied. Additionally, the impact of abnormal cord insertion sites remains controversial. Therefore, the objective of this study was to explore the adverse outcomes associated with placental location and abnormal cord insertion in nulliparous women and to assess their impact on pregnancy outcomes.
METHODS
This retrospective cohort study was conducted at a single tertiary hospital between January 2019 and June 2022. The study included nulliparous women with singleton pregnancies who delivered live infants and had available data on placental location and umbilical cord insertion site from a second- or third-trimester ultrasound. Placental location was categorized as anterior or posterior using transabdominal ultrasonography. The association between placental location/cord insertion site and pre-eclampsia was evaluated using multivariate logistic regression analysis. We compared the area under the curve to evaluate the impact of placental location and cord insertion site on pre-eclampsia.
RESULTS
A total of 2219 pregnancies were included in the study. Pre-eclampsia occurred significantly more frequently in the anterior group than in the posterior group (8.21% vs. 3.04%, < .001). In multivariate analysis investigating the association between placental location and pre-eclampsia, anterior placenta and marginal cord insertion showed increased odds ratios for pre-eclampsia of 3.05 (95% confidence interval [CI] 1.68-6.58) and 3.64 (95% CI 1.90-6.97), respectively. Receiver operating characteristic (ROC) curves were constructed to predict pre-eclampsia using independent factors from multivariate analyses. Model I, including maternal age, pre-pregnancy body mass index, fertilization, chronic hypertension, overt diabetes, kidney disease, and hematologic diseases, achieved an area under the ROC curve of 0.70 (95% CI 0.65-0.75). Adding cord insertion site and placental location to the model (Model II) improved its predictive performance, resulting in an area under the ROC curve of 0.749 (95% CI 0.70-0.79, = .02).
CONCLUSIONS
Anterior placenta and marginal cord insertion were associated with an increased risk of pre-eclampsia. Further studies on prospective cohorts are necessary to validate these findings.
Topics: Pregnancy; Female; Humans; Placenta; Pre-Eclampsia; Retrospective Studies; Prospective Studies; Pregnancy Outcome
PubMed: 38272651
DOI: 10.1080/14767058.2024.2306189 -
Frontiers in Medicine 2023The rates of twin pregnancies and cesarean section have increased in recent years, and both of them are at high risks of postpartum hemorrhage (PPH). However, few...
The rates of twin pregnancies and cesarean section have increased in recent years, and both of them are at high risks of postpartum hemorrhage (PPH). However, few studies have concentrated on the risks of PPH in twin pregnancies and cesarean deliveries. In this study, we aimed to identify the risk factors for PPH among twin-pregnant women with cesarean section. This was a retrospective observational study including 1,649 women with twin pregnancies delivered by cesarean section from 2016 to 2022 in the Second Affiliated Hospital of Wenzhou Medical University, China. The eligible women were divided into PPH group ( = 116) and non-PPH group ( = 1,533) according to the blood loss after delivery within 24 h. The baseline maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was conducted to identify the potential risk factors for PPH. We found nulliparity, assisted reproductive technology (ART) usage, preeclampsia or HELLP syndrome, placenta previa, placenta accreta and general anesthesia were more common in PPH group than non-PPH group ( < 0.05). Women in PPH group had higher maternal body mass index at delivery and higher combined birthweight of the twins than non-PPH group, but had lower parity ( < 0.05). Seven independent risk factors for PPH were identified after logistic regression analysis: ART usage (OR 2.354 95% CI 1.357-4.083, = 0.002), preeclampsia or HELLP syndrome (OR 2.605, 95% CI 1.471-4.616, = 0.001), placenta previa (OR 7.325, 95% CI 3.651-14.697, < 0.001), placenta accreta (OR 6.296, 95% CI 1.316-30.12, = 0.021), thrombocytopenia (OR 1.636, 95% CI 1.056-2.535, = 0.027), general anesthesia (OR 2.394, 95% CI 1.223-4.686, = 0.011), and combined birthweight (OR 1.00032, 95% CI 1.00005-1.00059, = 0.020). Collectively, in women with twin pregnancies delivered by cesarean section, the use of ART, preeclampsia or HELLP syndrome, placenta previa, placenta accreta, thrombocytopenia, general anesthesia and the combined birthweight were identified as independent risk factors for PPH. More attention should be paid to women with these risk factors.
PubMed: 38264042
DOI: 10.3389/fmed.2023.1301807 -
BMC Pregnancy and Childbirth Jan 2024To identify incidence and underlying risk factors for unsuspected placenta accreta spectrum (PAS) and compare the maternal outcomes between suspected and unsuspected...
BACKGROUND
To identify incidence and underlying risk factors for unsuspected placenta accreta spectrum (PAS) and compare the maternal outcomes between suspected and unsuspected cases in three large academic referral centers.
METHODS
A retrospective cohort study was conducted in three university-based tertiary referral centers from Jan 1st, 2013, to Dec 31st, 2022. All cases of PAS confirmed by pathology were included in the study. Unsuspected PAS cases were diagnosed at the time of delivery, while suspected cases served as the control group. Potential risk factors were compared between the two groups. Multivariable regression model was also performed to identify risk factors. Maternal outcomes were also evaluated.
RESULTS
A total of 339 pathology-confirmed PAS cases were included in the study out of 415,470 deliveries, of which 35.4% (n = 120) were unsuspected cases. Unsuspected PAS cases were 7.9 times more likely to have a history of intrauterine adhesions (adjusted odds ratio [aOR] 7.93; 95% confidence interval [CI] 2.35-26.81), 7.0 times more likely to have a history of clinically confirmed PAS (aOR, 6.99; 95% CI 2.85-17.18), 6.3 times more likely to have a posterior placenta (aOR, 6.30; 95% CI 3.48-11.40), and 3.4 times more likely to have a history of placenta previa (aOR, 3.41; 95% CI 1.18-9.82). On the other hand, cases with gravidity > 3, placenta previa, and/or a history of previous cesarean delivery were more likely to be diagnosed antenatally (aOR 0.40, 0.19, 0.36; 95% CI 0.22-0.74, 0.09-0.40, 0.19-0.70). Although the suspected PAS group had a higher proportion of invasive cases and abdominal and pelvic organ injuries (74.4% vs. 25.8%, p < 0.001; 6.8% vs. 1.7%, p = 0.037), the maternal outcomes were more favorable in the sPAS group, with a lower median volume of 24-hour blood loss and blood product transfusion (estimated blood loss in 24 h, 1000 [800-2000] vs. 2000 [1400-2400], p < 0.001; RBC unit transfusion, 0 [0-800] vs. 800 [600-1000], p < 0.001; fresh-frozen plasma transfusion, 0 [0-450] vs. 600 [400-800], p < 0.001).
CONCLUSIONS
Our findings indicate that 35% of patients with PAS were unsuspected prior to delivery. Factors associated with PAS being unsuspected prior to delivery include a history of intrauterine adhesions, a history of clinically confirmed PAS, a posterior placenta, and a history of placenta previa. Additionally, gravidity > 3, a history of previous cesarean delivery, and placenta previa increase the likelihood of antenatal diagnosis.
Topics: Female; Humans; Pregnancy; Blood Component Transfusion; Incidence; Placenta Accreta; Placenta Previa; Plasma; Retrospective Studies; Uterine Diseases
PubMed: 38262978
DOI: 10.1186/s12884-024-06254-z