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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 -
Archives of Gynecology and Obstetrics Jul 2024Pregnancies complicated by placenta accreta spectrum (PAS) are associated with severe maternal morbidities. The aim of this study is to describe the neonatal outcomes in...
PURPOSE
Pregnancies complicated by placenta accreta spectrum (PAS) are associated with severe maternal morbidities. The aim of this study is to describe the neonatal outcomes in pregnancies complicated with PAS compared with pregnancies not complicated by PAS.
METHODS
A retrospective cohort study conducted at a single tertiary center between 03/2011 and 01/2022, comparing women with PAS who underwent cesarean delivery (CD) to a matched control group of women without PAS who underwent CD. We evaluated the following adverse neonatal outcomes: umbilical artery pH < 7.0, umbilical artery base excess ≤ - 12, APGAR score < 7 at 5 min, neonatal intensive care unit (NICU) admission, mechanical ventilation, hypoxic ischemic encephalopathy, seizures and neonatal death. We also evaluated a composite adverse neonatal outcome, defined as the occurrence of at least one of the adverse neonatal outcomes described above. Multivariable regression analysis was used to determine which adverse neonatal outcome were independently associated with the presence of PAS.
RESULTS
265 women with PAS were included in the study group and were matched to 1382 controls. In the PAS group compared with controls, the rate of composite adverse neonatal outcomes was significantly higher (33.6% vs. 18.7%, respectively, p < 0.001). In a multivariable logistic regression analysis, Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.
CONCLUSION
Neonates in PAS pregnancies had higher rates of adverse outcomes. Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.
Topics: Humans; Female; Placenta Accreta; Pregnancy; Retrospective Studies; Infant, Newborn; Adult; Apgar Score; Cesarean Section; Pregnancy Outcome; Case-Control Studies; Intensive Care Units, Neonatal; Perinatal Death
PubMed: 38260996
DOI: 10.1007/s00404-023-07353-6 -
International Journal of Molecular... Jan 2024Placenta accreta spectrum (PAS) is a severe complication of pregnancy associated with excessive invasion of cytotrophoblast cells at the sites of the...
Placenta accreta spectrum (PAS) is a severe complication of pregnancy associated with excessive invasion of cytotrophoblast cells at the sites of the endometrial-myometrial interface and the myometrium itself in cases of adherent (creta) and invasive (increta and percreta) forms, respectively. This leads to a high risk of massive blood loss, maternal hysterectomy, and preterm birth. Despite advancements in ultrasound protocols and found associations of alpha-fetoprotein, PAPP-A, hCG, PLGF, sFlt-1, IL-8, and IL-33 peripheral blood levels with PAS, there is a high need for an additional non-invasive test to improve the diagnostic accuracy and to select the real PAS from the suspected ones in the first-trimester screening. miRNA signatures of placental tissue, myometrium, and blood plasma from women with PAS in the third trimester of pregnancy, as well as miRNA profiles in exosomes from the blood serum of women in the first trimester with physiologically progressing pregnancy, complicated by PAS or pre-eclampsia, were obtained using deep sequencing. Two logistic regression models were constructed, both featuring statistically significant parameters related to the levels of miR-26a-5p, miR-17-5p, and miR-101-3p, quantified by real-time PCR in native blood serum. These models demonstrated 100% sensitivity in detecting PAS during the first pregnancy screening. These miRNAs were identified as specific markers for PAS, showing significant differences in their blood serum levels during the first trimester in the PAS group compared to those in physiological pregnancies, early- or late-onset pre-eclampsia groups. Furthermore, these miRNAs exhibited differential expression in the PAS placenta and/or myometrium in the third trimester and, according to data from the literature, control angiogenesis. Significant correlations were found between extracellular hsa-miR-101-3p and nuchal translucency thickness, hsa-miR-17-5p and uterine artery pulsatility index, and hsa-miR-26a-5p and hsa-miR-17-5p with PLGF. The developed test system for early non-invasive PAS diagnosis based on the blood serum level of extracellular miR-26a-5p, miR-17-5p, and miR-101-3p can serve as an auxiliary method for first-trimester screening of pregnant women, subject to validation with independent test samples.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Pregnancy Trimester, First; Placenta Accreta; Pre-Eclampsia; Placenta; Premature Birth; MicroRNAs
PubMed: 38255950
DOI: 10.3390/ijms25020871 -
The Journal of Maternal-fetal &... Dec 2024This study aims to detect the serum levels of IGF-1, bFGF, and PLGF and their expressions in placental bed tissues of patients with placenta previa complicated with PAS...
Assessment of serum levels and placental bed tissue expression of IGF-1, bFGF, and PLGF in patients with placenta previa complicated with placenta accreta spectrum disorders.
OBJECTIVE
This study aims to detect the serum levels of IGF-1, bFGF, and PLGF and their expressions in placental bed tissues of patients with placenta previa complicated with PAS disorders.
METHODS
This case and control study included 40 multiparous pregnant women with complete placenta previa between 34 weeks and 38 weeks of gestation and they were divided into two groups: 25 patients with PAS (case group) and 15 patients without PAS (control group). The venous blood samples were collected 2 h before the cesarean section, and the placental bed tissues were taken intraoperatively at the placental implantation site and then were histologically examined to evaluate the gravity of the myometrial invasion of the placenta. According to FIGO PAS increasing grading, the 25 patients were also divided into three groups: PAS grade I group, PAS grade II group, and PAS grade III group. The concentrations of IGF-1, bFGF, and PLGF in serum were measured using ELISA, and the mean ratio of the relative mRNA expression of each biomarker in placental bed tissues was calculated using qRT-PCR. The staining intensity and the positive cells were quantitatively measured and expressed as means by using Image J software for IHC analysis.
RESULTS
IGF-1 had low serum levels and high placental bed expression in placenta previa patients with PAS disorders compared to those without PAS (all < 0.0001). PLGF had high serum levels ( = 0.0200) and high placental bed expression ( < 0.0001) in placenta previa patients with PAS disorders compared to those without PAS. IGF-1 serum levels decreased up to PAS grade II (means were 24.3 ± 4.03, 21.98 ± 3.29, and 22.03 ± 7.31, respectively for PAS grade I, PAS grade II, PAS grade III groups, = 0.0006). PLGF serum levels increased up to PAS grade II (means were 12.96 ± 2.74, 14.97 ± 2.56, and 14.89 ± 2.14, respectively for the three groups, = 0.0392). However, IGF-1 and PLGF mRNA placental bed expression increased up to PAS grade III. The relative expression of mRNA means for the three groups was 3.194 ± 1.40, 3.509 ± 0.63, and 3.872 ± 0.70, respectively for IGF-1; and 2.784 ± 1.14, 2.810 ± 0.71, and 2.869 ± 0.48, respectively for PLGF (all < 0.0001). Their IHC (immunohistochemical) staining also had increasing trends, but > 0.05. bFGF was not significantly expressed in placenta previa with PAS disorders in most of the analysis sections ( > 0.05).
CONCLUSIONS
Low serum levels and high expression in placental bed tissues of IGF-1, or high serum levels and high expression in placental bed tissues of PLGF, may differentiate placenta previa patients with FIGO PAS grade I and PAS grade II from those without PAS disorders. However, they could not significantly predict the degree of placental invasiveness in FIGO PAS grades II and III.
Topics: Female; Humans; Pregnancy; Cesarean Section; Insulin-Like Growth Factor I; Placenta; Placenta Accreta; Placenta Previa; RNA, Messenger; Placenta Growth Factor; Fibroblast Growth Factor 2
PubMed: 38247274
DOI: 10.1080/14767058.2024.2305264 -
Journal of Global Health Jan 2024Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal and maternal complications. However, there is still a lack of robust evidence on the pathogenesis and adverse outcomes of the diseases. Through this umbrella review, we aimed to systematically review existing meta-analyses exploring the factors and outcomes for pregnancy women with placental anomalies.
METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2023. We used AMSTAR 2 to assess the quality of the reviews and estimated the pooled risk and 95% confidence intervals (CIs) for each meta-analysis.
RESULTS
We included 34 meta-analyses and extracted 55 factors (27 for PP, 22 for PAS, and 6 for VP) and 16 outcomes (12 for PP, and 4 for VP) to assess their credibility. Seven factors (maternal cocaine use (for PP), uterine leiomyoma (for PP), prior abortion (spontaneous) (PP), threatened miscarriage (PP), maternal obesity (PP), maternal smoking (PAS), male foetus (PAS)) had high epidemiological evidence. Twelve factors and six outcomes had moderate epidemiological evidence. Twenty-two factors and eight outcomes showed significant association, but with weak credibility.
CONCLUSIONS
We found varying levels of evidence for placental anomalies of different factors and outcomes in this umbrella review.
REGISTRATION
PROSPERO: CRD42022300160.
Topics: Female; Pregnancy; Placenta; Placenta Previa; Pregnancy Complications; Prenatal Care; Systematic Reviews as Topic
PubMed: 38236697
DOI: 10.7189/jogh.14.04013 -
European Review For Medical and... Jan 2024This study aims to evaluate the diagnostic efficiency of diffusion-weighted imaging (DWI) in patients with placenta accreta spectrum (PAS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aims to evaluate the diagnostic efficiency of diffusion-weighted imaging (DWI) in patients with placenta accreta spectrum (PAS).
MATERIALS AND METHODS
The present study searched on PubMed, Embase, OVID, Cochrane, Scopus and CNKI, Chinese Bio-Medical Literature, VIP, Wanfang, Duxiu, databases for studies related to the diagnostic performance of DWI for PAS from inception to December 2022. The pooled sensitivity, the pooled specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnosis odds ratios (DOR) were calculated by Meta-disc 1.4 and STATA 16.0.
RESULTS
A total of 11 studies met the criteria and were included in the meta-analysis. The effect indexes of DWI in combined PAS were as follows. The pooled sensitivity was 0.670 (0.619-0.719). The pooled specificity was 0.720 (0.661-0.773). The pooled LR+ was 2.161 (1.454-3.211). The pooled LR- was 0.413 (0.280-0.609). The pooled AUC was 0.7841, and Q* was 0.7221. The pooled diagnostic ratio DOR was 6.713 (2.981-15.118). Subgroup analysis showed that four studies used T2-weighted imaging (T2WI) + DWI to diagnose PAS, and the pooled AUC was 0.9822.
CONCLUSIONS
The results showed that DWI had high sensitivity and specificity in the diagnosis of PAS. Furthermore, T2WI+DWI has higher diagnostic efficacy than DWI alone in the diagnosis of PAS. Therefore, it is necessary to set T2WI+DWI as a routine sequence for PAS, and T2WI+DWI should be a routine method for the daily diagnosis of PAS.
Topics: Female; Humans; Pregnancy; Diffusion Magnetic Resonance Imaging; Magnetic Resonance Imaging; Placenta Accreta; Sensitivity and Specificity
PubMed: 38235857
DOI: 10.26355/eurrev_202401_34890 -
BMC Surgery Jan 2024Placenta accreta spectrum (PAS) cesarean hysterectomy is performed under conditions of shock and can result in serious complications. This study aimed to evaluate the...
BACKGROUND
Placenta accreta spectrum (PAS) cesarean hysterectomy is performed under conditions of shock and can result in serious complications. This study aimed to evaluate the usefulness of the "Holding-up uterus" surgical technique with a shock index (S.I.) > 1.5.
METHODS
Twelve patients who underwent PAS cesarean hysterectomy were included in the study.
RESULTS
Group I had S.I. > 1.5, and group II had S.I. ≤ 1.5. Group I had more complications, but none were above Grade 3 or fatal. Preoperative scheduled uterine artery embolization did not result in serious complications, but three patients who had emergency common iliac artery balloon occlusion (CIABO) and a primary total hysterectomy with S.I. > 1.5 had postoperative Grade 2 thrombosis. Two patients underwent manual ablation of the placenta under CIABO to preserve the uterus, both with S.I. > 1.5.
CONCLUSIONS
The study found that the "Holding-up uterus" technique was safe, even in critical situations with S.I. > 1.5. CIABO had no intervention effect. The study also identified assisted reproductive technology pregnancies with a uterine cavity length of less than 5 cm before conception as a critical factor.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Blood Loss, Surgical; Balloon Occlusion; Iliac Artery; Uterus; Hysterectomy; Retrospective Studies
PubMed: 38218800
DOI: 10.1186/s12893-024-02311-8 -
Taiwanese Journal of Obstetrics &... Jan 2024
Topics: Pregnancy; Female; Humans; Placenta Accreta; Pregnant Women; Blood Transfusion; Postpartum Hemorrhage; Hysterectomy; Placenta Previa; Placenta
PubMed: 38216258
DOI: 10.1016/j.tjog.2023.10.015 -
Journal of Clinical Medicine Dec 2023To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS).
BACKGROUND
To report on prophylactic therapy for hyperfibrinolysis with tranexamic acid (TXA) during expectant management (EM) in the placenta accreta spectrum (PAS).
METHODS
This is a monocentric retrospective study of women with PAS presenting at our hospital between 2005 and 2021. All data were retrospectively collected through the departmental database.
RESULTS
35 patients with PAS were included. EM was planned in 25 patients prior to delivery. Complete absorption of the retained placenta was seen in two patients (8%). Curettage was performed in 14 patients (56%). A hysterectomy (HE) was needed in seven (28%) patients; 18 patients (72%) underwent uterus-preserving treatment without severe complications. The mean duration of EM was 107 days. The mean day of onset of hyperfibrinolysis and beginning of TXA treatment was day 45. The mean nadir of fibrinogen level before TXA was 242.4 mg/dL, with a mean drop of 29.7% in fibrinogen level.
CONCLUSIONS
Our data support EM as a safe treatment option in PAS. Hyperfibrinolysis can be a cause of hemorrhage during EM and can be treated with TXA. To our knowledge, this is the first cohort of patients with EM of PAS in whom coagulation monitoring and use of TXA have been shown to successfully treat hyperfibrinolysis.
PubMed: 38202142
DOI: 10.3390/jcm13010135