-
Comparison between placenta accreta scoring system, ultrasound staging, and clinical classification.Medicine Nov 2022Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious...
Placenta accreta spectrum (PAS) is a series of disorders, which means that the placental trophoblast invades into the myometrium of the uterine wall. It is a serious obstetric complication which could be detected by ultrasound prenatally. In order to compare our placenta accreta scoring system with prenatal ultrasound staging system and International Federation of Gynecology and Obstetrics (FIGO) clinical classification, we did a retrospective study including 105 patients diagnosed with PAS disorders by operation or pathology at Peking University First Hospital, Beijing, China, between January, 2019 and December, 2020. Placenta accreta scoring system, prenatal ultrasound staging system and FIGO clinical classification were used on each patient. Basic information and clinical outcomes including gestational weeks, intraoperative hemorrhage, hysterectomy rate and blood transfusion were also counted. Both of placenta accreta scoring system, prenatal ultrasound staging system can give a rather clear prediction of placenta percreta, with their area under curve were 0.872 (95% confidential interval [CI]: 0.793-0.951) and 0.864 (95%CI: 0.779-0.949), P value were .000 compared with clinical classification. Beside for ultrasound staging system was designed for placenta previa patients, all those 3 criteria showed their relationships with preterm birth, hysterectomy rate and intraoperative bleeding. PAS scoring system also had the ability to predict a gestational week of delivery ≤34 weeks, intraoperative massive bleeding ≥2000 mL and hysterectomy at over 12 points. Our placenta accreta scoring system had good accordance with pre-operational ultrasound staging and FIGO clinical classification, with higher universality for patients without placenta previa.
Topics: Humans; Infant, Newborn; Female; Pregnancy; Placenta Accreta; Placenta Previa; Retrospective Studies; Ultrasonography, Prenatal; Placenta; Premature Birth
PubMed: 36401394
DOI: 10.1097/MD.0000000000031622 -
International Journal of Obstetric... Aug 2022Anaesthetic management strategies for Placenta Accreta Spectrum (PAS) remain diverse, and literature interpretation is complicated by a range of terminology. The... (Review)
Review
BACKGROUND
Anaesthetic management strategies for Placenta Accreta Spectrum (PAS) remain diverse, and literature interpretation is complicated by a range of terminology. The International Federation for Gynaecology and Obstetrics (FIGO) published guidance in 2018 to improve PAS diagnosis and management by standardising definitions. We mapped the range, clarity and consistency of terminology in literature pertaining to both PAS and anaesthesia, and determined whether this changed followed FIGO guidance.
METHODS
A literature search of four medical databases was performed. Papers included had PAS (or any 'synonym') in the title, and mode of anaesthesia in the title or abstract. Narrative reviews, and papers not containing original data, were excluded. Diagnostic terms, and evidence supporting their use, were described.
RESULTS
Among 680 abstracts identified, 62 papers were included. Thirty distinct terms were used to describe PAS and subtypes. Terminology was clearly defined 46% of the time and used consistently within a paper 47% of the time. Nine papers (15%) provided no diagnostic evidence to support the terminology used. In 14 (23%) papers published after FIGO guidelines, 14 terms were used to describe PAS. Two papers (14%) specified the diagnostic criteria used. Six (43%) confirmed diagnoses using pathology. Four (29%) were consistent in use of terminology throughout the paper.
CONCLUSIONS
Despite international consensus criteria for reporting PAS, the language pertaining to PAS and anaesthesia remains heterogeneous, inconsistent and variably defined. Reporting of PAS should adhere to FIGO criteria to allow unambiguous interpretation of work, and generation of evidence that is transferrable into clinical practice.
Topics: Female; Humans; Placenta Accreta; Pregnancy
PubMed: 35868995
DOI: 10.1016/j.ijoa.2022.103572 -
Acta Obstetricia Et Gynecologica... Jul 2022A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to...
INTRODUCTION
A peripartum hysterectomy is typically performed as a lifesaving procedure in obstetrics to manage severe postpartum hemorrhage. Severe hemorrhages that lead to peripartum hysterectomies are mainly caused by uterine atony and placenta accreta spectrum disorders. In this study, we aimed to estimate the incidence, risk factors, causes and management of severe postpartum hemorrhage resulting in peripartum hysterectomies, and to describe the complications of the hysterectomies.
MATERIAL AND METHODS
Eligible women had given birth at gestational week 23+0 or later and had a postpartum hemorrhage ≥1500 mL or a blood transfusion, due to postpartum hemorrhage, at Oslo University Hospital, Norway, between 2008 and 2017. Among the eligible women, this study included those who underwent a hysterectomy within the first 42 days after delivery. The Norwegian Medical Birth Registry provided the reference group. We used Poisson regression to estimate adjusted incidence rate ratios with 95% confidence intervals to identify clinical factors associated with peripartum hysterectomy.
RESULTS
The incidence of hysterectomies with severe postpartum hemorrhage was 0.44/1000 deliveries (42/96313). Among the women with severe postpartum hemorrhage, 1.6% ended up with a hysterectomy (42/2621). Maternal age ≥40, previous cesarean section, multiple pregnancy and placenta previa were associated with a significantly higher risk of hysterectomy. Placenta accreta spectrum disorders were the most frequent cause of hemorrhage that resulted in a hysterectomy (52%, 22/42) and contributed to most of the complications following the hysterectomy (11/15 women with complications).
CONCLUSIONS
The rate of peripartum hysterectomies at Oslo University Hospital was low, but was higher than previously reported from Norway. Risk factors included high maternal age, previous cesarean section, multiple pregnancy and placenta previa, well known risk factors for placenta accreta spectrum disorders and severe postpartum hemorrhage. Placenta accreta spectrum disorders were the largest contributor to hysterectomies and complications.
Topics: Cesarean Section; Female; Hospitals, University; Humans; Hysterectomy; Peripartum Period; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35388907
DOI: 10.1111/aogs.14358 -
Clinical and Applied... 2022To analyze the association between pre-operational coagulation indicators and the severity of placenta accreta spectrum (PAS), as well as blood loss volume during...
OBJECTIVES
To analyze the association between pre-operational coagulation indicators and the severity of placenta accreta spectrum (PAS), as well as blood loss volume during operation.
METHODS
Hospitalized patients of the obstetric department in a major hospital from 2018 to 2020 who were clinically and/or pathologically diagnosed with invasive PAS were included. Univariate and multivariate logistic regression and Poisson regression models were used to quantify the association between each of the 6 coagulation indicators and PAS severity (measured by FIGO grade) as well as maternal outcomes.
RESULTS
Ninety-five patients (46 FIGO grade 2 and 49 FIGO grade 3) were included. Higher PT [adjusted OR (aOR): 5.54; 95% CI, 1.80 to 17.07] and FDP (aOR: 1.19; 95% CI, 1.01-1.42) levels were associated with an increased risk of FIGO grade 3 after adjusting for covariates. D-dimer [incidence rate ratio (IRR): 1.19; 95% CI, 1.05 to 1.35)] and FDP (IRR: 1.03; 95% CI, 1.01-1.04) levels were significantly associated with higher blood loss volume after adjusting for covariates.
CONCLUSION
Preoperative coagulation indicators, especially PT, D-dimer and FDP, are associated with disease severity and blood loss volume during operation of invasive PAS. The underlying mechanism for the coagulation profile of PAS patients warrants further analysis.
SYNOPSIS
Preoperative coagulation indicators, especially PT, D-dimer and FDP, are associated with disease severity and blood loss volume during operation among invasive placenta accreta spectrum patients.
Topics: Blood Coagulation; Blood Loss, Surgical; Cesarean Section; Female; Gynecologic Surgical Procedures; Humans; Infant, Newborn; Placenta Accreta; Pregnancy; Preoperative Period; Retrospective Studies; Severity of Illness Index
PubMed: 34994211
DOI: 10.1177/10760296211070580 -
Ultrasound in Obstetrics & Gynecology :... Apr 2014To determine, by evaluation of histological slides, images and descriptions of early (second-trimester) placenta accreta (EPA) and placental implantation in cases of... (Review)
Review
OBJECTIVE
To determine, by evaluation of histological slides, images and descriptions of early (second-trimester) placenta accreta (EPA) and placental implantation in cases of Cesarean scar pregnancy (CSP), whether these are pathologically indistinguishable and whether they both represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester.
METHODS
The database of a previously published review of CSP and EPA was used to identify articles with histopathological descriptions and electronic images for pathological review. When possible, microscopic slides and/or paraffin blocks were obtained from the original researchers. We also included from our own institutions cases of CSP and EPA for which pathology specimens were available. Two pathologists examined all the material independently and, blinded to each other's findings, provided a pathological diagnosis based on microscopic appearance. Interobserver agreement in diagnosis was determined.
RESULTS
Forty articles were identified, which included 31 cases of CSP and 13 cases of EPA containing histopathological descriptions and/or images of the pathology. We additionally included six cases of CSP and eight cases of EPA from our own institutions, giving a total of 58 cases available for histological evaluation (37 CSP and 21 EPA) containing clear definitions of morbidly adherent placenta. In the 29 cases for which images/slides were available for histopathological evaluation, both pathologists attested to the various degrees of myometrial and/or scar tissue invasion by placental villi with scant or no intervening decidua, consistent with the classic definition of morbidly adherent placenta. Based on the reviewed material, cases with a diagnosis of EPA and those with a diagnosis of CSP showed identical histopathological features. Interobserver correlation was high (kappa = 0.93).
CONCLUSIONS
EPA and placental implantation in CSP are histopathologically indistinguishable and may represent different stages in the disease continuum leading to morbidly adherent placenta in the third trimester.
Topics: Cesarean Section; Cicatrix; Early Diagnosis; Female; Humans; Placenta; Placenta Accreta; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Pregnancy, Ectopic; Ultrasonography
PubMed: 24357257
DOI: 10.1002/uog.13282 -
BioMed Research International 2022This is the first meta-analysis that assessed the association between maternal smoking and the risk of placenta accreta spectrum (PAS), so this study was aimed at... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is the first meta-analysis that assessed the association between maternal smoking and the risk of placenta accreta spectrum (PAS), so this study was aimed at investigating the association between maternal smoking and PAS based on observational studies. PAS is defined as a severe obstetric complication due to the abnormal invasion of the chorionic villi into the myometrium and uterine serosa.
METHODS
We searched electronic bibliographic databases including PubMed, Web of Science, Scopus, Science Direct, and Google Scholar until January 2022. The results were reported using a random effect model. The chi-square test and the statistic were used to assess heterogeneity. Egger's and Begg's tests were used to examine the probability of publication bias. All statistical analyses were performed at a significance level of 0.05 using Stata software, version 11.
RESULTS
Based on the random effect model, the estimated OR of the risk of PAS associated with smoking was 1.21 (95% CI: 1.02, 1.41; = 4.7%). Subgroup analysis was conducted based on study design, and the result showed that the association between smoking and PAS among cohort studies was significant 1.35 (95% CI: 1.15, 1.55; = 0.0%).
CONCLUSION
Our results suggested that maternal smoking is a risk factor for the PAS. There was no heterogeneity among studies that reported an association between smoking and the PAS. The Newcastle-Ottawa Scale (NOS) was used to measure study quality.
Topics: Chi-Square Distribution; Cohort Studies; Female; Humans; Observational Studies as Topic; Placenta Accreta; Pregnancy; Risk Factors; Smoking
PubMed: 35860796
DOI: 10.1155/2022/2399888 -
Korean Journal of Radiology Feb 2021Placenta accreta spectrum (PAS) is an abnormal placental adherence or invasion of the myometrium or extrauterine structures. As PAS is primarily staged and managed... (Review)
Review
Placenta accreta spectrum (PAS) is an abnormal placental adherence or invasion of the myometrium or extrauterine structures. As PAS is primarily staged and managed surgically, imaging can only guide and facilitate diagnosis. But, imaging can aid in preparations for surgical complexity in some cases of PAS. Ultrasound remains the imaging modality of choice; however, magnetic resonance imaging (MRI) is required for evaluation of areas difficult to visualize on ultrasound, and the assessment of the extent of placenta accreta. Numerous MRI features of PAS have been described, including dark intraplacental bands, placental bulge, and placental heterogeneity. Failure to diagnose PAS carries a risk of massive hemorrhage and surgical complications. This article describes a comprehensive, step-by-step approach to diagnostic imaging and its potential pitfalls.
Topics: Female; Humans; Magnetic Resonance Imaging; Placenta; Placenta Accreta; Pregnancy; Ultrasonography
PubMed: 33169550
DOI: 10.3348/kjr.2020.0580 -
International Journal of Hyperthermia :... 2021To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
OBJECTIVE
To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders.
MATERIALS AND METHODS
Thirty-four patients with placenta accreta, placenta increta, or placenta percreta were treated with USgHIFU from January 2016 to December 2019 and were retrospectively reviewed. The patients were classified into three categories according to the relationship between the trophoblastic villi and the myometrium, based on magnetic resonance imaging (MRI). Fifteen patients were classified as placenta accreta, 17 patients were classified as placenta increta, and 2 were classified as placenta percreta. All patients completed follow-up. Treatment efficacy and safety were evaluated.
RESULTS
No significant differences in baseline characteristics and results of HIFU ablation were observed between the patients with placenta accreta and those with placenta increta. The return of HCG levels to normal was longer in patients with placenta accreta compared with patients with placenta increta, while no significant difference was observed in the amount of intraoperative blood loss, the return of normal menstruation and the length of hospital stay.
CONCLUSIONS
HIFU treatment followed by hysteroscopic resection is safe and effective in the treatment of patients with placenta accreta and placenta increta.
Topics: Blood Loss, Surgical; Cesarean Section; Female; High-Intensity Focused Ultrasound Ablation; Humans; Placenta Accreta; Pregnancy; Retrospective Studies
PubMed: 33827369
DOI: 10.1080/02656736.2021.1909149 -
Placenta accreta: diagnosis, management and the molecular biology of the morbidly adherent placenta.The Journal of Maternal-fetal &... 2016Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and... (Review)
Review
Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and intra and post-partum complications. Ultrasound is critical for diagnosis and MRI is a complementary tool when the diagnosis is uncertain. Peripartum hysterectomy has been the standard of therapy but conservative management is increasingly being used. The etiology of accreta is due to a deficiency of maternal decidua resulting in placental invasion into the uterine myometrium. The molecular basis for the development of invasive placentation is yet to be elucidated but may involve abnormal paracrine/autocrine signaling between the deficient maternal decidua and the trophoblastic tissue. The interaction of hormones such as Relaxin which is abundant in maternal decidua and insulin-like 4, an insulin-like peptide found in placental trophoblastic tissue may play role in the formation of placenta accreta.
Topics: Female; Humans; Mass Screening; Placenta Accreta; Pregnancy
PubMed: 26135782
DOI: 10.3109/14767058.2015.1064103 -
American Journal of Obstetrics &... Mar 2023
Topics: Pregnancy; Female; Humans; Placenta Accreta; Conservative Treatment; Uterus; Hysterectomy
PubMed: 36717353
DOI: 10.1016/j.ajogmf.2023.100859