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Ultrasound in Obstetrics & Gynecology :... Feb 2018The primary aim of this systematic review was to ascertain whether ultrasound signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary aim of this systematic review was to ascertain whether ultrasound signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester of pregnancy. Secondary aims were to ascertain the strength of association and the predictive accuracy of such signs in detecting AIP in the first trimester.
METHODS
An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane databases (2000-2016) was performed. Only studies reporting on first-trimester diagnosis of AIP that was subsequently confirmed in the third trimester either during operative delivery or by pathological examination were included. Meta-analysis of proportions, random-effects meta-analysis and hierarchical summary receiver-operating characteristics curve analysis were used to analyze the data.
RESULTS
Seven studies, involving 551 pregnancies at high risk of AIP, were included. At least one ultrasound sign suggestive of AIP was detected in 91.4% (95% CI, 85.8-95.7%) of cases with confirmed AIP. The most common ultrasound feature in the first trimester of pregnancy was low implantation of the gestational sac close to a previous uterine scar, which was observed in 82.4% (95% CI, 46.6-99.8%) of cases. Anechoic spaces within the placental mass (lacunae) were observed in 46.0% (95% CI, 10.9-83.7%) and a reduced myometrial thickness in 66.8% (95% CI, 45.2-85.2%) of cases affected by AIP. Pregnancies with a low implantation of the gestational sac had a significantly higher risk of AIP (odds ratio, 19.6 (95% CI, 6.7-57.3)), with a sensitivity and specificity of 44.4% (95% CI, 21.5-69.2%) and 93.4% (95% CI, 90.5-95.7%), respectively.
CONCLUSIONS
Ultrasound signs of AIP can be present during the first trimester of pregnancy, even before 11 weeks' gestation. Low anterior implantation of the placenta/gestational sac close to or within the scar was the most commonly seen early ultrasound sign suggestive of AIP, although its individual predictive accuracy was not high. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Female; Humans; Myometrium; Placenta; Placenta Accreta; Pregnancy; Pregnancy Trimester, First; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 28833750
DOI: 10.1002/uog.18840 -
Reproductive Biology and Endocrinology... Mar 2021Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS).
METHODS
In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2).
RESULTS
In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05).
CONCLUSION
The results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.
Topics: Balloon Occlusion; Blood Loss, Surgical; Female; Humans; Iliac Artery; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 33663536
DOI: 10.1186/s12958-021-00722-3 -
Fertility and Sterility Oct 2021To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Pregnancies achieved after PGT or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).
INTERVENTION(S)
Systematic search of databases until December 2020 with cross-checking of references from relevant articles in English.
MAIN OUTCOME MEASURE(S)
Obstetric and neonatal outcomes after PGT and IVF/ICSI, including mean birth weight, low birth weight, very low birth weight (VLBW), mean gestational age at birth, preterm birth, very preterm birth, birth defects, intrauterine growth retardation (IUGR), sex ratio, cesarean section, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta disorder (placenta previa, placenta abruption, placenta accreta), and preterm premature rupture of membranes.
RESULT(S)
Ultimately, a total of 785,445 participants were enrolled in this meta-analysis, and these participants were divided into a PGT group (n = 54,294) and an IVF/ICSI group (n = 731,151). The PGT pregnancies had lower rates of low birth weight (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.75 to 0.98), VLBW (RR 0.52, 95% CI 0.33 to 0.81), and very preterm births (RR 0.55, 95% CI 0.42 to 0.70) than those of IVF/ICSI pregnancies. However, the PGT group had a higher rate of the obstetric outcome of hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.08 to 1.57). The PGT did not increase the risk of other adverse obstetric and neonatal outcomes, such as those associated with mean birth weight, mean gestational age at birth, birth defects, IUGR, sex ratio, cesarean section, gestational diabetes mellitus, placental disorder (placenta previa, placenta abruption, placenta accreta), or preterm premature rupture of membranes. We performed subgroup analysis with only blastocyst biopsies and found that PGT with blastocyst biopsies was associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.95). The PGT with blastocyst biopsies did not increase the risk of other adverse obstetric and neonatal outcomes. Additionally, we performed subgroup analysis with only frozen-thawed embryo transfer cycles, and we found that PGT pregnancies were associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.97), a lower rate of cesarean birth (RR 0.90, 95% CI 0.82 to 0.99), a higher rate of preterm birth (RR 1.10, 95% CI 1.02 to 1.18), and a higher rate of IUGR (RR 1.21, 95% CI 1.06 to 1.38) than those of IVF/ICSI pregnancies. The PGT with frozen-thawed embryo transfer did not increase the risk of other adverse obstetric and neonatal outcomes.
CONCLUSION(S)
The pooled analysis suggested that PGT did not increase the risk of adverse obstetric outcomes. The association between PGT and a higher risk of IUGR requires further investigation.
Topics: Birth Weight; Female; Fertilization in Vitro; Genetic Testing; Gestational Age; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infertility; Male; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Preimplantation Diagnosis; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 34373103
DOI: 10.1016/j.fertnstert.2021.06.040 -
Acta Obstetricia Et Gynecologica... Jan 2018Our objective was to elucidate the overall diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation (AIP). (Review)
Review
INTRODUCTION
Our objective was to elucidate the overall diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation (AIP).
MATERIAL AND METHODS
Medline, Embase, CINAHL and The Cochrane databases were searched. The ultrasound signs explored were: loss of hypoechoic (clear) zone in the placental-uterine interface, placental lacunae, bladder wall interruption, myometrial thinning, focal exophitic mass, placental lacunar flow, subplacental vascularity, and uterovesical hypervascularity.
RESULTS
Twenty studies (3209 pregnancies) were included. Ultrasound had an overall good diagnostic accuracy in identifying the depth of placental invasion with sensitivities of 90.6%, 93.0%, 89.5%, and 81.2% for placenta accreta, increta, accreta/increta, and percreta, respectively; the corresponding specificities were 97.1%, 98.4%, 94.7%, and 98.9%. Placental lacunae had sensitivities of 74.8%, 88.6%, and 76.3% for the detection of placenta accreta, increta, and percreta, respectively. Sensitivity and specificity of loss of the clear zone in identifying placenta accreta were 74.9% and 92.0%, whereas the corresponding figures for placenta increta and percreta were 91.6% and 76.9%, and 88.1% and 71.1%. Lacunar flow had sensitivities of 81.2%, 84.3%, and 45.2% for the detection of placenta accreta, increta, and percreta respectively; the corresponding figures for specificity were 84.0%, 79.7%, and 75.3%. Sensitivity of uterovesical hypervascularity was low for the detection of placenta accreta (12.3%) but high for placenta increta (94.4%) and percreta (86.2%); the corresponding figures for specificity were 90.8%, 88.0% and 88.2%, respectively.
CONCLUSIONS
Ultrasound has an overall good diagnostic accuracy in recognizing the depth and the topography of placental invasion.
Topics: Female; Humans; Myometrium; Placenta; Placenta Accreta; Pregnancy; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 28963728
DOI: 10.1111/aogs.13238 -
Ultrasound in Obstetrics & Gynecology :... Sep 2018To ascertain the impact of prenatal diagnosis on surgical outcome of women affected by abnormally invasive placenta (AIP). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To ascertain the impact of prenatal diagnosis on surgical outcome of women affected by abnormally invasive placenta (AIP).
METHODS
MEDLINE, EMBASE, CINAHL and Cochrane databases were searched. Observed outcomes included: gestational age at birth (weeks), amount of blood loss (L), units of red blood cells (RBC), platelets (PLT) and fresh frozen plasma (FFP) transfused, length of stay in hospital and the intensive care unit (ICU) (days), urinary tract injury and infection. Only studies reporting the occurrence of any of the explored outcomes in women with a prenatal compared with an intrapartum diagnosis of AIP were considered eligible for inclusion. Random-effect head-to-head meta-analyses were used to analyze the data.
RESULTS
Thirteen studies were included. Women with a prenatal diagnosis of AIP had less blood loss during surgery (mean difference (MD), -0.87; 95% CI, -1.5 to -0.23), had fewer units of RBC (MD, -1.45; 95% CI, -2.9 to -0.04) and FFP (MD, -1.73; 95% CI, -3.3 to -0.2) transfused, and delivered earlier (MD, 1.33 weeks; 95% CI, -2.23 to -0.43) compared with those with an intrapartum diagnosis. The risk of admission to an ICU and length of in-hospital and in-ICU stay were not different between the groups. Prenatal diagnosis of AIP was associated with a higher risk of urinary-tract injury (odds ratio, 2.5; 95% CI, 1.3-4.6), mainly due to the higher prevalence of placenta percreta in the group with AIP diagnosed prenatally.
CONCLUSION
Prenatal diagnosis of AIP is associated with reduced hemorrhagic morbidity compared with cases in which such anomalies are detected at delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Blood Loss, Surgical; Female; Humans; Magnetic Resonance Imaging; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Prospective Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Ultrasonography, Prenatal
PubMed: 29660186
DOI: 10.1002/uog.19070 -
BMC Pregnancy and Childbirth Jan 2019Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with placenta accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies.
METHODS
We used a three-check subset including placenta accreta (placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding placenta previa or placenta accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments.
RESULTS
We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD - 1480 ml, 95% CI -1806 to - 1154 ml, P < 0.001) and blood transfusion volume (MD - 1125 ml, 95% CI -1264 to - 987 ml, P < 0.001). Similarly, obvious reductions in the hysterectomy rate (OR 0.30, 95% CI 0.19 to 0.48, P < 0.001), hospitalization duration (MD - 1.35 days, 95% CI -2.40 to - 0.31 days, P = 0.01), and operative time (MD - 29.23 min, 95% CI -46.04 to - 12.42 min, P < 0.001) were observed in the AABO group.
CONCLUSION
The prophylactic use of AABO in patients with placenta accreta is safe and effective.
Topics: Adult; Aorta, Abdominal; Balloon Occlusion; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Length of Stay; Operative Time; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Treatment Outcome
PubMed: 30646863
DOI: 10.1186/s12884-019-2175-0 -
Insights Into Imaging Mar 2022Accurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic...
Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: a systematic review and meta-analysis.
OBJECTIVES
Accurate prenatal diagnosis of placenta accrete spectrum disorder (PAS) remains a challenge, and the reported diagnostic value of ultrasonography (US) and magnetic resonance imaging (MRI) varies widely. This study aims to systematically evaluate the diagnostic accuracy of US as compared with MRI in the detection of PAS within the identical patient population.
METHODS
Medline, EMBASE, Google scholar and Cochrane library were searched. Pooled sensitivity, specificity, diagnostic odds ratio (DOR) and the area under the summary receiver operating characteristic (SROC) curve were calculated. Subgroup analysis was also performed to elucidate the heterogeneity of results.
RESULTS
A total of 18 articles comprising 861 pregnancies were included in the study. The overall diagnostic accuracy of US for identification of PAS was as follows: sensitivity [0.90 (0.86-0.93)], specificity [0.83 (0.79-0.86)], DOR [39.5 (19.6-79.7)]. The overall diagnostic accuracy of MRI for identification of PAS was as follows: sensitivity [0.89 (0.85-0.92)], specificity [0.87 (0.83-0.89)], DOR [37.4 (17.0-82.3)]. The pooled sensitivity (p = 0.808) and specificity (p = 0.413) between US and MRI are not significantly different. SROC analysis revealed that there was no statistical difference (p = 0.552) in US and MRI for the overall predictive accuracy of PAS. Furthermore, in the subgroup analysis of between retrospective and prospective studies, between earlier and most recent studies, there was no statistical difference (p > 0.05) in diagnostic accuracy of US and MRI for the detection of PAS.
CONCLUSIONS
Both ultrasonography (US) and magnetic resonance imaging (MRI) showed comparable accuracy in the prenatal diagnosis of placenta accrete spectrum disorder (PAS). Routine employment of MRI with relatively high expense in the prenatal identification of PAS should not be recommended.
PubMed: 35316430
DOI: 10.1186/s13244-022-01192-w -
NIH Consensus and State-of-the-science...To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
PARTICIPANTS
A non-DHHS, nonadvocate 18-member panel representing the fields of obstetrics and gynecology, preventive medicine, biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.
EVIDENCE
Presentations by experts and a systematic review of the literature prepared by the RTI International-University of North Carolina Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
CONFERENCE PROCESS
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.
CONCLUSIONS
The incidence of cesarean delivery without medical or obstetric indications is increasing in the United States, and a component of this increase is cesarean delivery on maternal request. Given the tools available, the magnitude of this component is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles. Given that the risks of placenta previa and accreta rise with each cesarean delivery, cesarean delivery on maternal request is not recommended for women desiring several children. Cesarean delivery on maternal request should not be performed prior to 39 weeks of gestation or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Maternal request for cesarean delivery should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women. NIH or another appropriate Federal agency should establish and maintain a Web site to provide up-to-date information on the benefits and risks of all modes of delivery.
Topics: Cesarean Section; Decision Making; Ethics, Clinical; Female; Humans; Mothers; Needs Assessment; Outcome Assessment, Health Care; Practice Guidelines as Topic; Pregnancy; United States
PubMed: 17308552
DOI: No ID Found -
Acta Obstetricia Et Gynecologica... Oct 2020To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP).
MATERIAL AND METHODS
MEDLINE, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non-surgical) was also performed. Random effect meta-analyses of proportions were used to analyze the data.
RESULTS
Forty-four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non-surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively.
CONCLUSIONS
Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non-surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long-term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.
Topics: Abortion, Spontaneous; Cesarean Section; Cicatrix; Female; Humans; Placenta Accreta; Pregnancy; Pregnancy, Ectopic; Premature Birth; Recurrence
PubMed: 32419158
DOI: 10.1111/aogs.13918 -
Scientific Reports Apr 2021Increasing evidence suggests a relationship between in vitro fertilization-embryo transfer (IVF-ET) and placenta accreta spectrum (PAS). Some studies have reported a... (Meta-Analysis)
Meta-Analysis
Increasing evidence suggests a relationship between in vitro fertilization-embryo transfer (IVF-ET) and placenta accreta spectrum (PAS). Some studies have reported a lower rate of antenatal diagnosis of PAS after IVF-ET compared to PAS with spontaneous conception. This study aimed to review the diagnostic accuracy of PAS after IVF-ET and to explore the relationship between IVF-ET pregnancy and PAS. According to the PRISMA guidelines, a comprehensive systematic review of the literature was conducted through August 31, 2020 to determine the effects of IVF-ET on PAS. In addition, a meta-analysis was conducted to explore the relationship between IVF-ET pregnancy and PAS. Twelve original studies (2011-2020) met the inclusion criteria. Among these, 190,139 IVF-ET pregnancies and 248,534 spontaneous conceptions met the inclusion criteria. In the comparator analysis between PAS after IVF-ET and PAS with spontaneous conception (n = 2), the antenatal diagnosis of PAS after IVF-ET was significantly lower than that of PAS with spontaneous conception (22.2% versus 94.7%, P < 0.01; < 12.9% versus 46.9%, P < 0.01). The risk of PAS was significantly higher in women who conceived with IVF-ET than in those with spontaneous conception (odds ratio [OR]: 5.03, 95% confidence interval [CI]: 3.34-7.56, P < 0.01). In the sensitivity analysis accounting for the type of IVF-ET, frozen ET was associated with an increased risk of PAS (OR: 4.60, 95%CI: 3.42-6.18, P < 0.01) compared to fresh ET. Notably, frozen ET with hormone replacement cycle was significantly associated with the prevalence of PAS compared to frozen ET with normal ovulatory cycle (OR: 5.76, 95%CI 3.12-10.64, P < 0.01). IVF-ET is associated with PAS, and PAS after IVF-ET was associated with a lower rate of antenatal diagnosis. Therefore, clinicians can pay more attention to the presence of PAS during antenatal evaluation in women with IVF-ET, especially in frozen ET with hormone replacement cycle.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Placenta Accreta; Pregnancy; Prenatal Diagnosis
PubMed: 33911134
DOI: 10.1038/s41598-021-88551-7