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Medical Science Monitor : International... Oct 2021BACKGROUND Placenta accreta spectrum (PAS) includes placenta increta, placenta percreta, and placenta accreta. PAS is due to abnormal decidualization and can lead to...
Comparison of Magnetic Resonance Imaging of the Lower Uterine Segment in Pregnant Women with Central Placenta Previa with and without Placenta Accreta Spectrum from a Single Center.
BACKGROUND Placenta accreta spectrum (PAS) includes placenta increta, placenta percreta, and placenta accreta. PAS is due to abnormal decidualization and can lead to severe maternal hemorrhage and occurs in up to 3% of women with central placental previa (CPP). This study from a single center aimed to compare the magnetic resonance imaging (MRI) changes in the lower uterine segment in pregnant women with CPP, with and without PAS. MATERIAL AND METHODS This retrospective study includes 90 pregnant women with PAS and 66 pregnant women without PAS. All participants were confirmed to have CPP by MRI. Eight MRI parameters were assessed and compared with perinatal outcomes for mothers and newborns. RESULTS The pregnancies in the non-PAS group had less operative time (P=0.001), less intrapartum hemorrhage (P<0.001), and less blood transfusion than the PAS group (P<0.001). The 8 MRI variables with different odds ratios were placenta thickness (4.20), cervical lengths (3.27), placental dark T2 bands area (5.10), cervical marginal sinus (3.04), bladder bulge (3.55), myometrial thinning (6.41), lower uterine segment bulge (4.61), and placental signals in the cervix (9.14). The sensitivity and specificity of MRI in the diagnosis of PAS were 82.22% and 91.09%, respectively, by the combined 8 MRI features, and the area under the curve (AUC) was 0.816. CONCLUSIONS The findings from this study showed that MRI of the lower uterine segment had high sensitivity and specificity for the diagnosis of PAS in pregnant women with CPP.
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Placenta Accreta; Placenta Previa; Pregnancy; Prenatal Diagnosis; Retrospective Studies; Sensitivity and Specificity
PubMed: 34675167
DOI: 10.12659/MSM.932759 -
Ultrasound in Obstetrics & Gynecology :... Aug 2009
Topics: Delivery, Obstetric; Diagnostic Errors; Female; Hospitalization; Humans; Placenta Previa; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal
PubMed: 19644942
DOI: 10.1002/uog.7312 -
Environmental Health and Preventive... Jun 2019Placenta previa and placenta accreta associate with high morbidity and mortality for both mothers and fetus. Metal exposure may have relationships with placenta previa...
BACKGROUND
Placenta previa and placenta accreta associate with high morbidity and mortality for both mothers and fetus. Metal exposure may have relationships with placenta previa and placenta accreta. This study analyzed the associations between maternal metal (cadmium [Cd], lead [Pb], mercury [Hg], selenium [Se], and manganese [Mn]) concentrations and placenta previa and placenta accreta.
METHODS
We recruited 17,414 women with singleton pregnancies. Data from a self-administered questionnaire regarding the first trimester and medical records after delivery were analyzed. Maternal blood samples were collected to measure metal concentrations. The subjects were classified into four quartiles (Q1, Q2, Q3, and Q4) according to metal concentrations.
RESULTS
The odds ratio for placenta previa was significantly higher among subjects with Q4 Cd than those with Q1 Cd. The odds ratio for placenta previa was significantly higher for subjects with Q2 Pb than those with Q1 Pb.
CONCLUSION
Participants with placenta previa had higher Cd concentrations. However, this study was cross-sectional and lacked important information related to Cd concentration, such as detailed smoking habits and sources of Cd intake. In addition, the subjects in this study comprised ordinary pregnant Japanese women, and it was impossible to observe the relationship between a wide range of Cd exposure and placenta previa. Therefore, epidemiological and experimental studies are warranted to verify the relationship between Cd exposure and pregnancy abnormalities.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Japan; Metals, Heavy; Placenta Accreta; Placenta Previa; Pregnancy; Selenium
PubMed: 31174461
DOI: 10.1186/s12199-019-0795-7 -
PloS One 2016Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative...
BACKGROUND
Placenta previa, one of the most severe obstetric complications, carries an increased risk of intraoperative massive hemorrhage. Several risk factors for intraoperative hemorrhage have been identified to date. However, the correlation between birth weight and intraoperative hemorrhage has not been investigated. Here we estimate the correlation between birth weight and the occurrence of intraoperative massive hemorrhage in placenta previa.
MATERIALS AND METHODS
We included all 256 singleton pregnancies delivered via cesarean section at our hospital because of placenta previa between 2003 and 2015. We calculated not only measured birth weights but also standard deviation values according to the Japanese standard growth curve to adjust for differences in gestational age. We assessed the correlation between birth weight and the occurrence of intraoperative massive hemorrhage (>1500 mL blood loss). Receiver operating characteristic curves were constructed to determine the cutoff value of intraoperative massive hemorrhage.
RESULTS
Of 256 pregnant women with placenta previa, 96 (38%) developed intraoperative massive hemorrhage. Receiver-operating characteristic curves revealed that the area under the curve of the combination variables between the standard deviation of birth weight and intraoperative massive hemorrhage was 0.71. The cutoff value with a sensitivity of 81.3% and specificity of 55.6% was -0.33 standard deviation. The multivariate analysis revealed that a standard deviation of >-0.33 (odds ratio, 5.88; 95% confidence interval, 3.04-12.00), need for hemostatic procedures (odds ratio, 3.31; 95% confidence interval, 1.79-6.25), and placental adhesion (odds ratio, 12.68; 95% confidence interval, 2.85-92.13) were independent risk of intraoperative massive hemorrhage.
CONCLUSION
In patients with placenta previa, a birth weight >-0.33 standard deviation was a significant risk indicator of massive hemorrhage during cesarean section. Based on this result, further studies are required to investigate whether fetal weight estimated by ultrasonography can predict hemorrhage during cesarean section in patients with placental previa.
Topics: Adult; Birth Weight; Cesarean Section; Female; Hemorrhage; Humans; Intraoperative Complications; Placenta Previa; Pregnancy; ROC Curve
PubMed: 27902772
DOI: 10.1371/journal.pone.0167332 -
American Journal of Perinatology May 2024Our objective was to determine whether resolution of a low-lying placenta or placenta previa is associated with postpartum hemorrhage (PPH).
OBJECTIVE
Our objective was to determine whether resolution of a low-lying placenta or placenta previa is associated with postpartum hemorrhage (PPH).
STUDY DESIGN
This is a retrospective, matched-control cohort study of women who underwent transvaginal sonography during fetal anatomic survey between 18 and 24 weeks of gestation at the University of Pennsylvania from January 2017 to May 2019. Exposure was defined as low-lying placenta (≤1 cm from the internal cervical os) or placenta previa (covering the os) at anatomic survey that was found to be resolved by transvaginal ultrasound in the third trimester. For each exposure, we identified a control patient whose placenta was > 1 cm from internal os at anatomic survey performed on the same day. The primary outcome was PPH at delivery, defined as estimated blood loss ≥ 1,000 mL.
RESULTS
A total of 450 women were included (225/group). The exposed group of resolved placental previa included 85.0% with resolved low-lying placenta and 15.0% with resolved previa. The rate of PPH was significantly higher in the exposed group versus controls (9.8% vs. 4.4%, = 0.03). Women with resolved previa were 2.5 times more likely to experience PPH than controls (adjusted odds ratio = 2.58, 95% confidence interval: 1.17-5.69), even when controlling for parity, prior cesarean, and delivery mode. Women with resolved previa were also more likely to present to triage with bleeding (16.4% vs. 8.0%, = 0.006), receive antenatal corticosteroids, (9.3% vs. 3.1%, = 0.006), and receive intravenous iron postpartum (7.6% vs. 3.1%, = 0.04).
CONCLUSION
Our data demonstrate that women with a resolved low-lying placenta or placenta previa remain at significantly increased risk of bleeding-related complications in pregnancy and during delivery when compared with those who never had a previa. Clinicians should consider this association when counseling patients and performing hemorrhage risk stratification.
KEY POINTS
· Women with resolved previa or low-lying placenta were 2.5 times more likely to experience PPH.. · Women with resolved previa or low-lying placenta were more likely to be induced for bleeding.. · Resolved previa or low-lying placenta is still associated with adverse hemorrhage-related outcomes..
Topics: Humans; Female; Placenta Previa; Pregnancy; Postpartum Hemorrhage; Adult; Retrospective Studies; Case-Control Studies; Ultrasonography, Prenatal; Pregnancy Trimester, Third; Risk Factors
PubMed: 36351445
DOI: 10.1055/a-1974-9399 -
PloS One 2023Pouch of Douglas obliteration, which prevents exteriorization of the uterus, increases surgical morbidity in patients with placenta previa. We aimed to identify magnetic...
AIM
Pouch of Douglas obliteration, which prevents exteriorization of the uterus, increases surgical morbidity in patients with placenta previa. We aimed to identify magnetic resonance imaging features that can predict pouch of Douglas obliteration preoperatively.
METHODS
We retrospectively assessed 39 women with posterior placenta previa who underwent magnetic resonance imaging for the preoperative assessment of placenta accreta spectrum. We defined the angle formed by the anatomical conjugate line (based on pelvimetry) and the cervical canal as the cervical inclination angle, which was measured on sagittal T2-weighted magnetic resonance imaging. Subsequently, we analyzed the correlation between the cervical inclination angle and pouch of Douglas obliteration.
RESULTS
The median maternal age was 34 years (range, 22-44 years) and 26 (66.7%) women delivered at term. The median cervical inclination angle was 98° (range, 71-128). Pouch of Douglas obliteration was confirmed in six patients (15.4%). The cut-off value of the cervical inclination angle for the prediction of pouch of Douglas obliteration was 102° with a sensitivity of 66.7%, specificity of 78.8%, positive predictive value of 36.4%, and negative predictive value of 92.9% (area under the curve, 0.83).
CONCLUSIONS
Measuring the cervical inclination angle may help in ruling out an obliteration of the pouch of Douglas. It may also be useful in the operative management of women with posterior placenta previa. However, caution should be exercised when generalizing the results of this study because of the small sample size, which makes the results prone to bias.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Male; Placenta Previa; Retrospective Studies; Uterus; Organizations; Abdominal Wall
PubMed: 37590296
DOI: 10.1371/journal.pone.0290244 -
Frontiers in Endocrinology 2022It remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This...
BACKGROUND
It remained controversial whether women with multiple gestation are at higher risk of placenta accreta spectrum (PAS) disorders and large-scale studies are needed. This study aimed to assess whether PAS incidence is higher among women with multiple gestation than among singleton, as well as to compare the characteristics and outcomes of PAS in multiple and singleton gestation.
METHODS
Women who underwent cesarean section with live births at Peking University First Hospital from January 2015 to December 2020 were included. Demographic and clinical information was collected through chart review. Logistic regression models were used to analyze the associations between multiple gestation and PAS. The clinical characteristics and perioperative outcomes of PAS in multiple and singleton gestation were further compared.
RESULTS
Among the 14583 women included, 2.4% (352/14583) were diagnosed with PAS. PAS was slightly more prevalent among multiple gestations than among singletons (2.5% vs 2.4%, =0.857). After adjusting for known risk factors and pregnancy complications, multiple gestation was associated with a higher risk of PAS (a=1.63, 95% 1.01-2.62). Among PAS patients, women who had multiple births had a significantly lower rate of previous cesarean deliveries (27.6% vs. 56.3%, =0.003), placenta previa (17.2% vs. 56.3%, <0.001) and invasive PAS (24.1% vs. 53.9, =0.002) than singletons. There were no significant differences in perioperative outcomes between these two groups.
CONCLUSION
Multiple gestation could be independently associated with an elevated risk of PAS. The clinical characteristics of PAS in the multiple and singleton gestation groups differed significantly in cesarean delivery history and placenta previa. The results of this study may inform guidelines on the screening, early detection and timely intervention of PAS patients among women with multiple births.
Topics: Cesarean Section; China; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies
PubMed: 35663330
DOI: 10.3389/fendo.2022.862785 -
Chinese Medical Journal Mar 2020Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Cell salvage has recently been recommended for obstetric use in cases with a high risk of massive hemorrhage during cesarean section (CS). However, limited data are available to support the use of one suction device to collect lost blood. This study aimed to investigate the volume of red blood cells (RBCs) salvaged and the components of amniotic fluid (AF) in blood salvaged by one suction device or two devices during CS in patients with placenta previa and/or accrete.
METHODS
Thirty patients with placenta previa and/or accrete undergoing elective CS in the Women's Hospital of Zhejiang University School of Medicine were recruited for the present study from November 1, 2017 to December 1, 2018. The patients were randomly assigned to one of the two groups according to an Excel-generated random number sheet: Group 1 (n = 15), in which only one suction device was used to aspirate all blood and AF, and Group 2 (n = 15), in which a second suction device was mainly used to aspirate AF before the delivery of the placenta. Three samples of blood per patient (pre-wash, post-wash, and post-filtration) were collected to measure AF components. The salvaged RBC volumes were recorded. Continuous data of pre-wash, post-wash, and post-filtration samples were analyzed by using one-way analysis of variance with Tukey's test for multiple comparisons, or Kruskal-Wallis test with Dunn test for multiple comparisons. Comparisons of continuous data between Group 1 and Group 2 were conducted using Student's t test or Mann-Whitney U test.
RESULTS
The salvaged RBC volume was significantly higher in Group 1 than that in Group 2 (401.6 ± 77.2 mL vs. 330.1 ± 53.3 mL, t = 4.175, P < 0.001). In both groups, squamous cells, lamellar bodies, and fat were significantly reduced by washing (all P<0.001) and squamous cells were further reduced by filtering (P < 0.001). Squamous cells were found in six post-filtration samples (three from each group). Lamellar bodies and fat were completely removed by filtering. Insulin-like growth factor binding protein 1, alpha-fetoprotein, albumin, lactate dehydrogenase, and potassium were significantly reduced post-wash (all P < 0.05), with no further significant reduction after filtration in either group (all P > 0.05). The mean percentage of fetal RBCs post-filtration was (1.8 ± 0.8)% with a range of 1.0% to 3.5% and (1.9 ± 0.9)% with a range of 0.7% to 4.0% in Groups 1 and 2, respectively, showing no significant difference between the two groups (U = 188.5, P = 0.651).
CONCLUSION
Cell salvage performed by one suction device could result in higher volume of salvaged RBCs and can be used safely for CS in patients with placenta previa and/or accrete when massive hemorrhage occurs.
TRIAL REGISTRATION NUMBER
ChiCTR-INR-17012926, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.
Topics: Adult; Amniotic Fluid; Cesarean Section; Erythrocytes; Female; Humans; Placenta Previa; Pregnancy; Suction
PubMed: 32097203
DOI: 10.1097/CM9.0000000000000699 -
BMC Pregnancy and Childbirth May 2023To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).
DATA SOURCES
Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.
STUDY ELIGIBILITY CRITERIA
All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.
STUDY APPRAISAL AND SYNTHESIS METHODS
Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.
RESULTS
The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.
CONCLUSIONS
The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.
TRIAL REGISTRATION
Number CRD42021267501.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Placenta; Placenta Previa; Cesarean Section; Retrospective Studies; Prospective Studies; Cross-Sectional Studies; Ultrasonography, Prenatal
PubMed: 37189095
DOI: 10.1186/s12884-023-05675-6 -
Medicine Jan 2021This study aimed to examine whether marginal sinus placenta previa, defined as when the marginal sinus just reaches the internal cervical os and placental parenchyma...
This study aimed to examine whether marginal sinus placenta previa, defined as when the marginal sinus just reaches the internal cervical os and placental parenchyma might be >2 cm from the internal cervical os, can be diagnosed using ultrasonography (US). We identified the placenta previa cases that underwent both US and magnetic resonance imaging (MRI) between April 2010 and December 2018 at our institution. The diagnostic discrepancies for marginal sinus placenta previa between US and MRI were examined retrospectively. Of the 183 cases of placenta previa, 28 (15.3%) cases were diagnosed as marginal sinus placenta previa using MRI. Among them, 18 cases (64.3%) could also be diagnosed using US. The sensitivity and specificity of the diagnosis of marginal sinus placenta previa using US were 64.3% and 92.9%, respectively. A change in US diagnosis occurred in 10 (35.7%) cases, all of which were diagnosed with low-lying placenta previa or marginal placenta previa and did not develop any serious miserable obstetrical outcomes. In conclusion, the diagnostic accuracy of US for detecting marginal sinus placenta previa was not significant. MRI examination may be required to accurately categorize the types of placenta previa.
Topics: Adult; Female; Gestational Age; Humans; Magnetic Resonance Imaging; Placenta Previa; Pregnancy; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 33429830
DOI: 10.1097/MD.0000000000024253