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Zeitschrift Fur Geburtshilfe Und... Jun 2024We present the original technique of compression hemostatic sutures on the lower uterine segment due to early postpartum hemorrhage during cesarean section, with a...
Lower Uterine Segment Corrugated Sutures in Hemorrhage during Cesarean Section because Previal and/or Placenta Accreta Spectrum: Case Reports Series and Literature Review.
OBJECTIVES
We present the original technique of compression hemostatic sutures on the lower uterine segment due to early postpartum hemorrhage during cesarean section, with a literature review.
METHODS
A retrospective clinical case study was conducted at the tertiary perinatal center. Twelve patients had nine planned and three urgent cesarean sections due to antenatally verified placenta previa and/or placenta accreta spectrum and defined early postpartum hemorrhage > 1000 mL during cesarean section. As the use of uterotonics failed to produce any effect and hemorrhage persisted, compression sutures of the lower uterine segment were made by our own technique, as follows: below the hysterotomy, a horizontal corrugated suture is placed from the right to the left corner and after 2-3 cm vertically and backwards at several sites from the left to the right corner, where it is tightened.
RESULTS
Seven patients had one cesarean section, three patients had two cesarean sections, and seven patients had pregnancy from the in vitro fertilization procedure in their history. There were six patients with placenta previa and six patients with anterior invasive placenta accreta or increta. Original hemostatic procedure was applied successfully in ten cases, and after placement of O'Leary suture and persistent bleeding in two cases. In this group, no hysterectomy was performed, and patients received blood transfusion of 440-880 mL. Three patients later had spontaneous pregnancies.
CONCLUSION
Our own hemostatic method with a simple technique, fast learning, and minimal logistics contributes to successful management of this currently global problem of morbidly adherent placenta previa.
PubMed: 38830385
DOI: 10.1055/a-2313-0948 -
European Journal of Obstetrics,... May 2024Prediction of intraoperative massive hemorrhage is still challenging in placenta previa. Radiomics analysis has been investigated as a new evaluation method for...
INTRODUCTION
Prediction of intraoperative massive hemorrhage is still challenging in placenta previa. Radiomics analysis has been investigated as a new evaluation method for analyzing medical images. We used radiomics analysis on placental magnetic resonance imaging (MRI) images to predict intraoperative hemorrhage in placenta previa.
METHODS
We used the sagittal MRI T2-weighted sequence in placenta previa. Using the rectangular region from the uterine os to the anterior wall, we extracted 97 radiomics features. We also collected patient demographics and blood test data as clinical variables. Combining these radiomics features and clinical variables, logistic regression models with a stepwise method were built to predict the risk of hemorrhage, defined as blood loss of > 2000 ml. We evaluated the prediction performance of the models using accuracy and area under the curve (AUC), also analyzing the important variables for the prediction by stepwise methods.
RESULTS
We enrolled a total of 63 placenta previa cases including 30 hemorrhage cases from two institutes. The model combining clinical variables and radiomics features showed the best prediction performance with an accuracy of 0.70 and an AUC of 0.69 in the internal validation data, and accuracy of 0.41 and an AUC of 0.70 in the external validation data, compared with human experts (accuracy of 0.62). Regarding variable selection, two radiomics features. 'original_glrlm_LowGrayLevelRunEmphasis,' and 'diagnostics_Image-original_Minimum,' were important predictors for hemorrhage by the stepwise method.
DISCUSSION
Radiomics features based on MRI could be used as effective predictive variables for hemorrhage in placenta previa. Radiomics analysis of placental imaging could lead to further analysis of quantitative variables related to obstetric diseases.
PubMed: 38830301
DOI: 10.1016/j.ejogrb.2024.05.033 -
Acta Obstetricia Et Gynecologica... May 2024Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and...
INTRODUCTION
Accurate discrimination between placenta accreta spectrum (PAS) and scar dehiscence with underlying non-adherent placenta is challenging both on prenatal ultrasound and intraoperatively. This can lead to overdiagnosis of PAS and unnecessarily aggressive management of scar dehiscence which increases the risk of morbidity. Several scoring systems have been published which combine clinical and ultrasound information to help diagnose PAS in women at high risk. This research aims to provide insights into the reliability and utility of existing accreta scoring systems in differentiating these two closely related but different conditions to contribute to improved clinical decision making and patient outcomes.
MATERIAL AND METHODS
A literature search was performed in four electronic databases. The references of relevant articles were also assessed. The articles were then evaluated according to the predefined inclusion criteria. Primary data for testing each scoring system were obtained retrospectively from two hospitals with specialized PAS services. Each scoring system was used to evaluate the predicted outcome of each case.
RESULTS
The literature review yielded 15 articles. Of these, eight did not have a clearly described diagnostic criteria for accreta, hence were excluded. Of the remaining seven studies, one was excluded due to unorthodox diagnostic criteria and two were excluded as they differed from the other systems hindering comparison. Four scoring systems were therefore tested with the primary data. All the scoring systems demonstrated higher scores for high-grade PAS compared to scar dehiscence (p < 0.001) with an excellent Area Under the receiver operator characteristic Curve ranging from 0.82 (95% CI 0.71-0.92) to 0.87 (95% CI 0.79-0.96) in differentiating between these two conditions. However, no statistically significant differences were noted between the low-grade PAS and scar dehiscence on all scoring systems.
CONCLUSIONS
Most published scoring systems have no clearly defined diagnostic criteria. Scoring systems can differentiate between scar dehiscence with underlying non-adherent placenta from high-grade PAS with excellent diagnostic accuracy, but not for low-grade PAS. Hence, relying solely on these scoring systems may lead to errors in estimating the risk or extent of the condition which hinders preoperative planning.
PubMed: 38819580
DOI: 10.1111/aogs.14886 -
European Journal of Obstetrics,... May 2024To examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis.
OBJECTIVE
To examine pregnancy characteristics and maternal morbidity at delivery among pregnant patients with a diagnosis of endometriosis.
STUDY DESIGN
This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population was 17,796,365 hospital deliveries from 2016 to 2020, excluded adenomyosis and uterine myoma. The exposure was endometriosis diagnosis. Main outcome measures were clinical and pregnancy characteristics and severe maternal morbidity at delivery related to endometriosis, assessed with multivariable regression model.
RESULTS
Endometriosis was diagnosed in 17,590 patients. The prevalence of endometriosis increased by 24 % from one in 1,191 patients in 2016 to one in 853 patients in 2020 (adjusted-odds ratio [aOR] 1.24, 95% confidence interval [CI] 1.19-1.30). Clinical and pregnancy characteristics that had greater than two-fold association to endometriosis included polycystic ovary syndrome, placenta previa, cesarean delivery, maternal age of ≥30 years, prior pregnancy loss, and anxiety disorder. Pregnant patients with endometriosis were more likely to have the diagnosis of measured severe maternal morbidity during the index hospitalization for delivery (47.8 vs 17.3 per 1,000 deliveries, aOR 1.91, 95%CI 1.78-2.06); these associations were more prominent following vaginal (aOR 2.82, 95%CI 2.41-3.30) compared to cesarean (aOR 1.85, 95%CI 1.71-2.00) deliveries. Among the individual morbidity indicators, endometriosis was most strongly associated with thromboembolism (aOR 5.05, 95%CI 3.70-6.91), followed by sepsis (aOR 2.39, 95%CI 1.85-3.09) and hysterectomy (aOR 2.18, 95%CI 1.85-2.56). When stratified for endometriosis anatomical site, odds of thromboembolism was increased in endometriosis at distant site (aOR 9.10, 95%CI 3.76-22.02) and adnexa (aOR 7.37, 95%CI 4.43-12.28); odds of sepsis was most increased in endometriosis at multi-classifier locations (aOR 7.33, 95%CI 2.93-18.31) followed by pelvic peritoneum (aOR 5.54, 95%CI 2.95-10.40); and odds of hysterectomy exceeded three-fold in endometriosis at adnexa (aOR 3.00, 95%CI 2.30-3.90), distant site (aOR 5.36, 95%CI 3.48-8.24), and multi-classifier location (aOR 4.46, 95%CI 2.11-9.41).
CONCLUSION
The results of this nationwide analysis suggest that pregnancy with endometriosis is uncommon but gradually increasing over time in the United States. The data also suggest that endometriosis during pregnancy is associated with increased risk of severe maternal morbidity at delivery, especially for thromboembolism, sepsis, and hysterectomy. These morbidity risks differed by the anatomical location of endometriosis.
PubMed: 38815411
DOI: 10.1016/j.ejogrb.2024.05.011 -
Yonsei Medical Journal Jun 2024There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin...
PURPOSE
There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin pregnancies with endometriosis. This study aimed to compare the pregnancy outcomes and complications in twin pregnancies with or without endometriosis in a single institution.
MATERIALS AND METHODS
From January 2011 to July 2022, a retrospective analysis of twin pregnancies was conducted. The endometriosis group included patient with histological or visual confirmation before pregnancy or during cesarean section. Pregnancy outcomes and complications were compared between the two groups.
RESULTS
Out of 1714 patients examined, 127 (7.4%) were included in the endometriosis group. Maternal body mass index (BMI) was lower in the endometriosis group (<0.001). There were no significant differences in maternal age, mode of conception, chorionicity, and pregnancy outcomes, such as gestational age at delivery (=0.835) and the preterm birth rate (=0.579). The endometriosis group had a significantly higher rate of obstetrical complication: small for gestational age (SGA) <10% (=0.029). However, after adjustment for BMI, the endometriosis group showed no statistical significance in obstetrical complications, including SGA (adjusted odds ratio, 1.568; 95% confidence interval, 0.984-2.499; =0.059).
CONCLUSION
Twin pregnancies with endometriosis were not related to adverse effects on pregnancy outcomes and obstetrical complications. To confirm these outcomes, further large prospective studies are required.
Topics: Humans; Female; Pregnancy; Endometriosis; Pregnancy, Twin; Pregnancy Outcome; Adult; Retrospective Studies; Pregnancy Complications; Body Mass Index; Infant, Small for Gestational Age; Premature Birth; Infant, Newborn; Cesarean Section
PubMed: 38804030
DOI: 10.3349/ymj.2023.0099 -
Taiwanese Journal of Obstetrics &... May 2024Endometriosis is associated with higher risk of ectopic pregnancy, premature delivery, miscarriage, and other adverse maternal and fetal complications. This study aimed... (Observational Study)
Observational Study
OBJECTIVE
Endometriosis is associated with higher risk of ectopic pregnancy, premature delivery, miscarriage, and other adverse maternal and fetal complications. This study aimed to assess the impact of endometriosis on maternal and fetal outcomes of singleton pregnancies in a large nationally representative database.
MATERIALS AND METHODS
This population-based, retrospective observational study extracted the data of women aged 20-49 years with singleton, spontaneously conceived pregnancies from the US Nationwide Inpatient Sample (NIS) database from 2005 to 2018. Included subjects were divided into those with ICD codes for endometriosis and those without (non-endometriosis group). Data of maternal and fetal outcomes were compared between groups and analyzed using regression analysis.
RESULTS
After excluding 17,124 women who conceived with assisted reproductive technology (ART), 162,155 women with multiple pregnancies, and 27,847 with abnormal trend weight values (TRENDWT), a total of 8,584,269 women were eligible. After propensity score matching (PMS) case-control 1:4 by age, 45,560 remained (9112 (0.1%) with endometriosis, 36,448 without) and were included in the analysis. The mean age of women before matching was 28.7 years, and 30.5 years after matching. The most common comorbidity was chronic pulmonary disease (3.6%). Smoking frequency was higher in women with endometriosis compared to those without (4.8% vs. 2.4%). Multivariable analysis adjusted for confounders revealed that endometriosis was associated with significantly higher risk of maternal complications, including pre-eclampsia and eclampsia, antepartum hemorrhage, placenta previa, Cesarean delivery, post-partum hemorrhage, disseminated intravascular coagulation (DIC), transfusion, hemoperitoneum, and hospital stays ≥6 days. For fetal outcomes, endometriosis was associated with higher risk of intrauterine growth restriction (IUGR), premature birth, birth defects and abortion.
CONCLUSION
Endometriosis during pregnancy is associated with maternal and fetal complications. Study findings may serve as a benchmark for expanding medical assistance for endometriosis-affected pregnant women.
Topics: Humans; Female; Pregnancy; Endometriosis; Adult; Retrospective Studies; United States; Pregnancy Complications; Middle Aged; Young Adult; Pregnancy Outcome; Databases, Factual; Premature Birth; Risk Factors; Case-Control Studies; Cesarean Section
PubMed: 38802198
DOI: 10.1016/j.tjog.2023.06.005 -
Discovery Medicine May 2024High-risk human papillomavirus (HR-HPV) infection is the primary reason for cervical cancer and precancerous lesions in females. Specific immune alterations in pregnancy... (Observational Study)
Observational Study
Genotype Distribution and Prevalence of High-Risk Human Papillomavirus among Pregnant Women and Maternal-Fetal Pregnancy Outcomes in a Tertiary Hospital in Beijing, China.
BACKGROUND
High-risk human papillomavirus (HR-HPV) infection is the primary reason for cervical cancer and precancerous lesions in females. Specific immune alterations in pregnancy led to greater HR-HPV replication and reduced clearance of HR-HPV infection. This study retrospectively obtained and analyzed data from a tertiary hospital in Beijing, China. We aimed to ascertain both the genotype distribution and prevalence of HR-HPV in pregnant females. Moreover, we sought to analyze the association of HR-HPV with maternal-fetal pregnancy outcomes.
METHODS
The retrospective observational cohort study was divided into two parts. Part I evaluated the genotype distribution and prevalence of HR-HPV. It encompassed 6285 pregnant women who underwent a routine pregnancy check-up, Thin Prep cytology test (TCT), and HR-HPV diagnosis during weeks 12-14 of gestation between January 1, 2013, and December 31, 2021. Part II analyzed the association between HR-HPV infection and maternal-fetal pregnancy outcome. Through a nearest-neighbor 1:1 propensity score matching (PSM), we matched HR-HPV-positive and HR-HPV-negative pregnant women using caliper width equal to 0.02. After PSM, 171 HR-HPV-positive and 171 HR-HPV-negative pregnant women were included to analyze the association between HR-HPV infection and maternal-fetal pregnancy outcome.
RESULTS
In total 737 (11.73%) pregnant women were HR-HPV positive. The five most common genotypes of HR-HPV were HPV-52 (2.90%), HPV-58 (2%), HPV-16 (1.94%), HPV-51 (1.38%), and HPV-39 (1.29%). As for age-specific HPV prevalence, a "U-shaped" pattern was observed. The first and second peaks were detected in pregnant females aged <25 years and those aged ≥35 years, respectively. Our study found no significant difference between the HR-HPV-positive and the HR-HPV-negative pregnant females in the following maternal-fetal pregnancy outcomes: spontaneous abortion (1.2% for HR-HPV positive, 0% for HR-HPV negative, = 0.478), preterm delivery (4.7% for HR-HPV positive, 5.3% for HR-HPV negative, = 0.804), premature rupture of membrane (28.8% for HR-HPV positive, 22.8% for HR-HPV negative, = 0.216), preeclampsia (7.6% for HR-HPV positive, 7.6% for HR-HPV negative, = 1), oligohydramnios (8.2% for HR-HPV positive, 7% for HR-HPV negative, = 0.683), fetal growth restriction (1.8% for HR-HPV positive, 0.6% for HPV negative, = 0.615), placenta previa (1.2% for HR-HPV positive, 0.6% for HR-HPV negative, = 1), postpartum hemorrhage (8.9% for HR-HPV positive, 11.2% for HR-HPV negative, = 0.47). There was also no significant difference in delivery mode or birth weight between the two groups.
CONCLUSIONS
HPV-16, 52, and 58 were the most prevalent infection genotypes in pregnant females. The study showed no significant differences between HR-HPV-positive and HR-HPV-negative groups in the maternal-fetal pregnancy outcomes.
Topics: Humans; Female; Pregnancy; Adult; Papillomavirus Infections; Retrospective Studies; Tertiary Care Centers; Prevalence; Pregnancy Outcome; Genotype; Papillomaviridae; Pregnancy Complications, Infectious; Beijing; China; Young Adult; Human Papillomavirus Viruses
PubMed: 38798257
DOI: 10.24976/Discov.Med.202436184.91 -
F&S Science May 2024To investigate potential differences in pregnancy, delivery, and neonatal outcomes between 2 hyperandrogenic conditions in reproductive-aged women: polycystic ovary...
OBJECTIVE
To investigate potential differences in pregnancy, delivery, and neonatal outcomes between 2 hyperandrogenic conditions in reproductive-aged women: polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH).
DESIGN
Retrospective population-based study with data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample Database from 2004-2014.
SETTING
Not applicable.
PATIENT(S)
A total of 14,881 women with PCOS and 298 women with CAH.
INTERVENTION(S)
Not applicable.
MAIN OUTCOME MEASURE(S)
Gestational diabetes mellitus, placenta previa, pregnancy-induced hypertension (HTN), gestational HTN, preeclampsia, eclampsia, preeclampsia and eclampsia superimposed on HTN, preterm birth, preterm premature rupture of membrane, abruptio placenta, chorioamnionitis, mode of delivery, maternal infection, hysterectomy, blood transfusion, venous thromboembolism (deep vein thrombosis and pulmonary embolism during pregnancy, intrapartum, or postpartum), maternal death, chorioamnionitis, septicemia during labor, postpartum endometritis, septic pelvic, peritonitis, small for gestational age, congenital anomalies, and intrauterine fetal demise.
RESULT(S)
After adjusting for potential confounders, we found that women with PCOS were at increased risk of developing pregnancy-induced HTN (adjusted odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.12-2.77) and gestational diabetes (adjusted OR = 1.68; 95% CI: 1.12-2.52) when compared with women with CAH. Contrary women with CAH were at increased risk for delivery via cesarean section (adjusted OR = 0.59; 95% CI: 0.44-0.80) and small for gestational age neonates (adjusted OR = 0.32; 95% CI: 0.20-0.52).
CONCLUSION(S)
To our knowledge, this study is the first to directly compare obstetric and neonatal outcomes between patients with PCOS and CAH. Despite the similar phenotypes and some common hormonal and biochemical profiles, such as insulin resistance, hyperinsulinemia, and hyperandrogenism, our results suggest the existence of additional metabolic pathways implicated in the pathogenesis of pregnancy complications.
PubMed: 38795844
DOI: 10.1016/j.xfss.2024.05.001 -
International Journal of Molecular... May 2024Placenta Accreta Spectrum (PAS) is a life-threatening condition in which placental trophoblastic cells abnormally invade the uterus, often up to the uterine serosa and,...
Placenta Accreta Spectrum (PAS) is a life-threatening condition in which placental trophoblastic cells abnormally invade the uterus, often up to the uterine serosa and, in extreme cases, tissues beyond the uterine wall. Currently, there is no clinical assay for the non-invasive detection of PAS, and only ultrasound and MRI can be used for its diagnosis. Considering the subjectivity of visual assessment, the detection of PAS necessitates a high degree of expertise and, in some instances, can lead to its misdiagnosis. In clinical practice, up to 50% of pregnancies with PAS remain undiagnosed until delivery, and it is associated with increased risk of morbidity/mortality. Although many studies have evaluated the potential of fetal biomarkers circulating in maternal blood, very few studies have evaluated the potential of circulating placental extracellular vesicles (EVs) and their miRNA contents for molecular detection of PAS. Thus, to purify placental EVs from maternal blood, we customized our robust ultra-sensitive immuno-purification assay, termed EV-CATCHER, with a monoclonal antibody targeting the membrane Placental Alkaline Phosphatase (PLAP) protein, which is unique to the placenta and present on the surface of placental EVs. Then, as a pilot evaluation, we compared the miRNA expression profiles of placental EVs purified from the maternal plasma of women diagnosed with placenta previa (controls, = 16); placenta lying low in uterus but not invasive) to those of placental EVs purified from the plasma of women with placenta percreta (cases, = 16), PAS with the highest level of invasiveness. Our analyses reveal that miRNA profiling of PLAP EVs purified from maternal plasma identified 40 differentially expressed miRNAs when comparing these two placental pathologies. Preliminary miRNA pathway enrichment and gene ontology analysis of the top 14 upregulated and top nine downregulated miRNAs in PLAP EVs, purified from the plasma of women diagnosed with placenta percreta versus those diagnosed with placenta previa, suggests a potential role in control of cellular invasion and motility that will require further investigation.
Topics: Humans; Female; Extracellular Vesicles; Pregnancy; Placenta; Placenta Accreta; Biomarkers; Adult; MicroRNAs; Placenta Previa; Alkaline Phosphatase; Isoenzymes; GPI-Linked Proteins
PubMed: 38791142
DOI: 10.3390/ijms25105102 -
American Journal of Obstetrics and... May 2024Asherman syndrome refers to the presence of intrauterine adhesions, which have clinical implications, including infertility. There are few studies assessing the effect...
BACKGROUND
Asherman syndrome refers to the presence of intrauterine adhesions, which have clinical implications, including infertility. There are few studies assessing the effect of serial hysteroscopies for adhesiolysis on reproductive and pregnancy outcomes among women who subsequently undergo in vitro fertilization, and none have looked at maternal, neonatal, or placental pregnancy complications.
OBJECTIVE
This study aimed to explore the effect of hysteroscopic adhesiolysis among a cohort of patients who subsequently undergo in vitro fertilization.
STUDY DESIGN
This was a retrospective cohort study of all patients who underwent hysteroscopic adhesiolysis for intrauterine adhesions at our center between 2005-2020 and subsequently attempted conception by in vitro fertilization. A control group of patients who underwent in vitro fertilization for nonuterine factor infertility and had no history of intrauterine adhesions was chosen for comparison.
RESULTS
There were 691 patients included in this study, of whom 168 were intrauterine adhesion cases. The implantation rate (41.3% in both groups) and live birth rate (adjusted relative risk, 0.93 [95% confidence interval, 0.76-1.14]) were not statistically different between cases and controls. When grouped by number of previous adhesiolysis surgeries, patients who underwent ≥2 adhesiolysis surgeries had a lower live birth rate than controls (adjusted relative risk, 0.53 [95% confidence interval, 0.28-0.99]). Endometrial thickness before the transfer was significantly reduced in cases vs controls (8.23 vs 10.25 mm; adjusted relative risk, 0.84 [95% confidence interval, 0.78-0.90]). Adverse placental outcomes, including placenta accreta spectrum, placenta previa, or vasa previa, were significantly more likely to occur in cases than controls (adjusted relative risk, 2.08 [95% confidence interval, 1.25-3.46]). When grouped by the number of adhesiolysis surgeries, the risk appeared to increase as the number of prior surgeries increased. This is likely because of the increased severity of these adhesions.
CONCLUSION
Overall, patients with a history of treated intrauterine adhesions have the same live birth rate as patients undergoing in vitro fertilization for nonuterine factor indications. However, the subgroup of patients who require multiple surgeries for correction of intrauterine adhesions had a lower live birth rate after in vitro fertilization than controls. Patients with a history of treated intrauterine adhesions are at significantly greater risk of placenta accreta syndrome disorder than control patients who underwent in vitro fertilization for nonuterine factor indications.
PubMed: 38777163
DOI: 10.1016/j.ajog.2024.05.026