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Taiwanese Journal of Obstetrics &... Mar 2022
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 35361376
DOI: 10.1016/j.tjog.2022.02.004 -
Acta Obstetricia Et Gynecologica... Jul 2023This study examined obstetric outcomes in patients diagnosed with uterine adenomyosis.
INTRODUCTION
This study examined obstetric outcomes in patients diagnosed with uterine adenomyosis.
MATERIAL AND METHODS
This historical cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was all hospital deliveries in women aged 15-54 years between January 2016 and December 2019. The exposure was a diagnosis of uterine adenomyosis. The main outcome measures were obstetric characteristics, including placenta previa, placenta accreta spectrum, and placental abruption. Secondary outcomes were delivery complications including severe maternal morbidity. Analytic steps to assess these outcomes included (i) a 1-to-N propensity score matching to mitigate and balance prepregnancy confounders to assess obstetric characteristics, followed by (ii) an adjusting model with preselected pregnancy and delivery factors to assess maternal morbidity. Sensitivity analyses were also performed with restricted cohorts to account for prior uterine scar, uterine myoma, and extra-uterine endometriosis.
RESULTS
After propensity score matching, 5430 patients with adenomyosis were compared to 21 720 patients without adenomyosis. Adenomyosis was associated with an increased odds of placenta accreta spectrum (adjusted-odds ratio [aOR] 3.07, 95% confidence interval [CI] 2.01-4.70), placenta abruption (aOR 3.21, 95% CI: 2.60-3.98), and placenta previa (aOR 5.08, 95% CI: 4.25-6.06). Delivery at <32 weeks of gestation (aOR 1.48, 95% CI: 1.24-1.77) and cesarean delivery (aOR 7.72, 95% CI: 7.04-8.47) were both increased in women with adenomyosis. Patients in the adenomyosis group were more likely to experience severe maternal morbidity at delivery compared to those in the nonadenomyosis group (aOR 1.86, 95% CI: 1.59-2.16). Results remained robust in the aforementioned several sensitivity analyses.
CONCLUSIONS
This national-level analysis suggests that a diagnosis of uterine adenomyosis is associated with an increased risk of placental pathology (placenta accreta spectrum, placenta abruption, and placental previa) and adverse maternal outcomes at delivery.
Topics: Pregnancy; Humans; Female; Placenta Previa; Placenta; Placenta Accreta; Cohort Studies; Risk Factors; Adenomyosis; Propensity Score; Abruptio Placentae; Retrospective Studies
PubMed: 37087741
DOI: 10.1111/aogs.14581 -
International Journal of Medical... 2013To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
PURPOSE
To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
METHODS
We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated.
RESULTS
Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups.
CONCLUSION
Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.
Topics: Adult; Cardiotocography; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Placenta; Placenta Previa; Pregnancy; Pregnancy Complications; Premature Birth; Risk Factors; Ultrasonography, Prenatal; Uterine Hemorrhage
PubMed: 24151440
DOI: 10.7150/ijms.6416 -
Journal of Medicine and Life 2021Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our...
Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017-April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at <37 weeks of gestation, and the maternal outcome was uterine preservation. Among the 12 patients, the mean age was 34±3.44 years. All women had risk factors for abnormally invasive placenta, such as placenta previa or previous cesarean delivery. Most women underwent planned cesarean delivery at the mean gestational age of 36.4±0.9 weeks. In our study, the uterus was preserved in only one case (8.33%), and hysterectomy with preservation of ovaries was performed in the rest of the cases. Mean maternal blood loss during surgery was 2175±1440 ml. Severe maternal outcomes were recorded only in one case (8.33%). We identified a low uterine preservation rate and a good perinatal outcome. Conservative management should be reserved for fertility desire and extensive disease due to surgical difficulty. Early identification of the risk factors and strategic management may improve maternal and fetal outcomes.
Topics: Adult; Cesarean Section; Female; Humans; Hysterectomy; Infant; Infant, Newborn; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies
PubMed: 34377203
DOI: 10.25122/jml-2021-0134 -
Frontiers in Endocrinology 2022To investigate the risk of preterm birth in women with a placenta previa or a low-lying placenta for different cut-offs of gestational age and to evaluate preventive... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate the risk of preterm birth in women with a placenta previa or a low-lying placenta for different cut-offs of gestational age and to evaluate preventive interventions.
SEARCH AND METHODS
MEDLINE, EMBASE, CENTRAL, Web of Science, WHO-ICTRP and clinicaltrials.gov were searched until December 2021. Randomized controlled trials, cohort studies and case-control studies assessing preterm birth in women with placenta previa or low-lying placenta with a placental edge within 2 cm of the internal os in the second or third trimester were eligible for inclusion. Pooled proportions and odds ratios for the risk of preterm birth before 37, 34, 32 and 28 weeks of gestation were calculated. Additionally, the results of the evaluation of preventive interventions for preterm birth in these women are described.
RESULTS
In total, 34 studies were included, 24 reporting on preterm birth and 9 on preventive interventions. The pooled proportions were 46% (95% CI [39 - 53%]), 17% (95% CI [11 - 25%]), 10% (95% CI [7 - 13%]) and 2% (95% CI [1 - 3%]), regarding preterm birth <37, <34, <32 and <28 weeks in women with placenta previa. For low-lying placentas the risk of preterm birth was 30% (95% CI [19 - 43%]) and 1% (95% CI [0 - 6%]) before 37 and 34 weeks, respectively. Women with a placenta previa were more likely to have a preterm birth compared to women with a low-lying placenta or women without a placenta previa for all gestational ages. The studies about preventive interventions all showed potential prolongation of pregnancy with the use of intramuscular progesterone, intramuscular progesterone + cerclage or pessary.
CONCLUSIONS
Both women with a placenta previa and a low-lying placenta have an increased risk of preterm birth. This increased risk is consistent across all severities of preterm birth between 28-37 weeks of gestation. Women with placenta previa have a higher risk of preterm birth than women with a low-lying placenta have. Cervical cerclage, pessary and intramuscular progesterone all might have benefit for both women with placenta previa and low-lying placenta, but data in this population are lacking and inconsistent, so that solid conclusions about their effectiveness cannot be drawn.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42019123675.
Topics: Cervix Uteri; Female; Humans; Infant, Newborn; Placenta; Placenta Previa; Pregnancy; Premature Birth; Progesterone
PubMed: 36120450
DOI: 10.3389/fendo.2022.921220 -
American Journal of Obstetrics &... Apr 2023This study aimed to identify trends in pregnancy outcomes, especially delivery mode, among pregnant patients older than 45 years. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to identify trends in pregnancy outcomes, especially delivery mode, among pregnant patients older than 45 years.
DATA SOURCES
A literature search was performed using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between January 1, 2010, and June 30, 2022.
STUDY ELIGIBILITY CRITERIA
The primary outcomes were cesarean delivery and assisted delivery. The secondary outcomes were preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth. The inclusion criteria were studies examining the relationship between older age pregnancy and pregnancy outcomes, studies that compared pregnancy outcomes at maternal age ≥45 years and <45 years, and at least one of the primary and secondary pregnancy outcomes were included.
METHODS
Study screening was performed after duplicates were identified and removed. The quality of each study and publication bias were assessed. Forest plots and I statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. The inverse variance method was used to integrate the results if studies had an adjusted analysis.
RESULTS
Among 4209 studies initially retrieved, 24 were included in this review. All studies were retrospective, observational studies. Pregnant patients aged ≥45 years had a significantly higher cesarean delivery rate (odds ratio, 2.87; 95% confidence interval, 2.50-3.30; I=97%) than those aged <45 years. However, the emergency cesarean delivery rate was lower in older pregnant patients (odds ratio, 0.61; 95% confidence interval, 0.47-0.79; I=79%). Pregnancy in older individuals was associated with a lower assisted delivery rate than pregnancy in younger individuals (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; I=48%). Preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth were more likely to occur in pregnant patients aged ≥45 years than in those aged <45 years. Adjusted pooled analyses showed trends similar to those in the unadjusted pooled analyses.
CONCLUSION
Adverse pregnancy outcomes, typically cesarean delivery, were more likely to occur in older (≥45 years) pregnant patients than in younger pregnant patients. However, the assisted delivery rate was lower in older pregnant patients.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Aged; Pregnancy Outcome; Maternal Age; Diabetes, Gestational; Premature Birth; Abruptio Placentae; Pre-Eclampsia; Retrospective Studies; Placenta Previa; Postpartum Hemorrhage; Placenta
PubMed: 36739911
DOI: 10.1016/j.ajogmf.2023.100885 -
Acta Obstetricia Et Gynecologica... 2008To examine the association between placenta previa with maternal race and its variations by country of origin among Asian women.
OBJECTIVES
To examine the association between placenta previa with maternal race and its variations by country of origin among Asian women.
STUDY DESIGN
Retrospective cohort study.
METHODS
We analyzed data from a population-based retrospective cohort study of 16,751,627 pregnancies in the US. The data were derived from the national linked birth/infant mortality database for the period 1995-2000. Multiple logistic regressions were used to describe the relationship between placenta previa and race as well as country of origin among Asian women.
RESULTS
About 3.3 per 1,000 pregnancies were complicated with placenta previa among white women, while the corresponding figures for black women and women of other races were 3.0 and 4.5 per 1,000 pregnancies, respectively. The excess risk remained substantial and significant after adjustment for confounders for women of other races compared to white women. The frequencies of placenta previa among Chinese, Japanese, Filipino, Asian Indian, Korean, Vietnamese and other Asian or Pacific Islander were 5.6, 5.1, 7.6, 4.5, 5.9, 4.4 and 4.4 per 1,000 pregnancies, respectively. The adjusted odds ratios ranged from 1.39 to 2.15 among Asian women by country of origin, with the lowest for Japanese and Vietnamese and the highest for Filipino women in our study.
CONCLUSION
Asian women have excess risk of placenta previa compared with white women. Major variation exists in placenta previa risk among Asian women, with the lowest risk in Japanese and Vietnamese women and the highest risk in Filipino women.
Topics: Adult; Asia; Cohort Studies; Female; Humans; Infant, Newborn; Male; Placenta Previa; Pregnancy; Retrospective Studies; United States
PubMed: 18568460
DOI: 10.1080/00016340802071037 -
Ultrasound in Obstetrics & Gynecology :... Aug 2001
Review
Topics: Female; Humans; Placenta; Placenta Previa; Pregnancy; Ultrasonography, Prenatal
PubMed: 11529985
DOI: 10.1046/j.1469-0705.2001.00511.x -
Saudi Medical Journal Sep 2023To determine the incidence, risk factors, and maternal outcomes of "major degree" placenta previa (PP)/placenta accreta spectrum (PAS) in Abha Maternity and Children's...
OBJECTIVES
To determine the incidence, risk factors, and maternal outcomes of "major degree" placenta previa (PP)/placenta accreta spectrum (PAS) in Abha Maternity and Children's Hospital, Abha, Saudi Arabia. Secondly, to compare our findings to those of previous studies on PP/PAS in Saudi Arabia.
METHODS
This is a retrospective study that included 299 patients diagnosed with major degree PP/PAS and admitted to Abha Maternity and Children's Hospital, Abha, Saudi Arabia, within 10 years (January 2012-December 2021). Also, we compared our results to the outcomes of PP/PAS patients in 6 previous Saudi studies.
RESULTS
The total number of deliveries was 54,341; PP minor and major degrees were diagnosed in 376 (0.69%) patients. Of them, 299 patients had PP major degree (79.5%). The pattern of main risk factors for major PP/PAS included: elder age, high parity, and previous cesarean deliveries. Nearly 30.5% had evidence of PAS on antenatal MRI (n=91). Approximately 68.5% (n=205) of patients were delivered <37 weeks. Of 299 patients, 29 (9.7%)patients had emergency cesarean hysterectomy. The maternal mortality rate was 0.3% (n=1). Generally, in many aspects, our results are comparable to similar Saudi studies on PP/PAS.
CONCLUSION
Major degree of PP/PAS is associated with high maternal morbidity but rare mortality. Over 30 years, our patients' obstetric characteristics did not change, including both elder age and high parity. A substantial increase in the rate of cesarean deliveries is a leading cause of major PP/PAS.
Topics: Pregnancy; Child; Humans; Female; Aged; Incidence; Placenta Previa; Retrospective Studies; Cesarean Section; Risk Factors
PubMed: 37717966
DOI: 10.15537/smj.2023.44.9.20230112 -
Computational and Mathematical Methods... 2022This study was to explore the value of the deep dictionary learning algorithm in constructing a B ultrasound scoring system and exploring its application in the clinical...
This study was to explore the value of the deep dictionary learning algorithm in constructing a B ultrasound scoring system and exploring its application in the clinical diagnosis and treatment of pernicious placenta previa (PPP). 60 patients with PPP were divided into a low-risk group (severe, implantable) and high-risk group (adhesive, penetrating) according to their clinical characteristics, B ultrasound imaging characteristics, and postpartum pathological examination results. Under PPP ultrasonic image information using the deep learning algorithm, the B ultrasound image diagnostic scoring system was established to predict the depth of various types of placenta accreta. The results showed that the cut-off values of severe, implantable, adhesive, and penetrating types were <2.3, 2.3-6.5, 6.5-9, and ≥9 points, respectively; there were significant differences in the termination of pregnancy and neonatal birth weight between the two groups ( < 0.05); the positive predictive value, negative predictive value, and false positive rate of ultrasound images based on the deep dictionary learning algorithm for PPP were 95.33%, 94.89%, and 3.56%, respectively. Thus, the ultrasound image diagnostic scoring system based on the deep learning algorithm has an important predictive role for PPP, which can provide a more targeted diagnosis and treatment plan for patients in clinical practice and improve the prediction and treatment efficiency.
Topics: Deep Learning; Female; Humans; Infant, Newborn; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography; Ultrasonography, Prenatal
PubMed: 35707039
DOI: 10.1155/2022/3452176