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The Journal of International Medical... Jan 2019To investigate the expression of β-catenin in chorionic villi, and to explore its roles in placenta accreta and placenta previa.
OBJECTIVES
To investigate the expression of β-catenin in chorionic villi, and to explore its roles in placenta accreta and placenta previa.
METHODS
We compared β-catenin expression in the control group, placenta accreta group (lesion area and normal zones), and placenta previa group (placental central and placental edge zones) by immunohistochemistry, Western blotting, and RT-PCR techniques.
RESULTS
Compared with the normal group, the placenta accreta group had a longer length of stay, greater bleeding volume, and lower newborn birth weight. Further, the expression of β-catenin was lower in both placenta previa and placenta accreta groups than in the control group, as measured by immunohistochemistry. Compared with the control group, expression of β-catenin was significantly lower in the placenta previa and placenta accreta groups by Western blotting and RT-PCR. Importantly, the level of placental β-catenin was significantly different when compared between the lesion and normal zones of placenta.
CONCLUSION
The expression of β-catenin in placenta accreta might play an important role in the regulation of placental cell invasion; low expression of β-catenin in placenta accreta might be responsible for excessive trophoblastic invasion.
Topics: Adult; Case-Control Studies; Chorionic Villi; Female; Gene Expression; Humans; Infant, Low Birth Weight; Infant, Newborn; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Trophoblasts; beta Catenin
PubMed: 30465458
DOI: 10.1177/0300060518799265 -
JAMA Network Open Aug 2022Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited...
IMPORTANCE
Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited regarding whether placenta previa is associated with a higher risk of worse maternal outcomes among patients with PAS disorders.
OBJECTIVE
To examine the association between placenta previa and the risk of severe maternal morbidities (SMMs) and higher resource use among patients with PAS disorders.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study extracted records of 3793 patients with PAS diagnosis and delivery indicators between October 1, 2015, and December 31, 2019, from the US National Inpatient Sample database.
EXPOSURES
Placenta previa.
MAIN OUTCOMES AND MEASURES
Data on 21 Centers for Disease Control and Prevention-defined SMMs and 25 study-defined surgical morbidities associated with PAS were extracted. Six surgical procedures (cystoscopy, intra-arterial balloon occlusion, cesarean delivery, hysterectomy, cystectomy, and oophorectomy), hospital length of stay, and inpatient costs were compared. Multivariable Poisson regression models built in the generalized estimating equation framework were used.
RESULTS
Among 3793 patients with PAS (median [IQR] age at admission, 33 [29-37] years), 621 women (16.4%) were Black, 765 (20.2%) were Hispanic, 1779 (46.9%) were White, 441 (11.6%) were of other races and/or ethnicities (47 [1.2%] were American Indian, 220 [5.8%] were Asian or Pacific Islander, and 174 [4.6%] were of multiple or other races and/or ethnicities), and 187 (4.9%) were of unknown race and ethnicity. A total of 1323 patients (34.9%) had placenta previa and 2470 patients (65.1%) did not; of those with placenta previa, 405 patients (30.6%) had invasive PAS. Patients with vs without placenta previa had a significantly higher rate and risk of any SMM (935 women [70.7%] vs 1087 women [44.0%]; P < .001; adjusted risk ratio [aRR], 1.19; 95% CI, 1.12-1.27) and any surgical morbidity (1170 women [88.4%] vs 1667 women [67.5%]; P < .001; aRR, 1.18; 95% CI, 1.13-1.23). With regard to specific outcomes, those with vs without placenta previa had a significantly higher rate of peripartum hemorrhage (878 patients [66.4%] vs 1217 patients [49.3%]; P < .001), blood product transfusion (413 patients [31.2%] vs 610 patients [24.7%]; P < .001), shock (83 patients [6.3%] vs 108 patients [4.4%]; P = .01), disseminated intravascular coagulation or other coagulopathy (77 patients [5.8%] vs 105 patients [4.3%]; P = .04), and urinary tract injury (44 patients [3.3%] vs 41 patients [1.7%]; P = .002). Patients with vs without placenta previa were more likely to undergo cesarean delivery (1292 patients [97.7%] vs 1787 patients [72.3%]; P < .001), hysterectomy (786 patients [59.4%] vs 689 patients [27.9%]; P < .001), cystoscopy (301 patients [22.8%] vs 203 patients [8.2%]; P < .001), cystectomy (157 patients [11.9%] vs 98 patients [4.0%]; P < .001), and intra-arterial balloon occlusion (121 patients [9.1%] vs 77 patients [3.1%]; P < .001) and to have significantly longer hospital length of stay (median [IQR], 5 [4-11] days vs 3 [3-5] days; P < .001) and total inpatient costs (median [IQR], $17 496 [$10 863-$30 619] vs $9728 [$6130-$16 790]; P < .001). Hypertensive disorder of pregnancy was associated with a decreased risk of placenta previa (aRR, 0.67; 95% CI, 0.46-0.96) among patients with PAS.
CONCLUSIONS AND RELEVANCE
In this study, placenta previa was associated with an increased risk of maternal and surgical morbidities and higher resource use among women with PAS. These findings suggest that interventions to alleviate maternal and surgical morbidities are especially needed for patients with placenta previa-complicated PAS disorders.
Topics: Cesarean Section; Female; Humans; Hysterectomy; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; United States
PubMed: 35994286
DOI: 10.1001/jamanetworkopen.2022.28002 -
Anales Del Sistema Sanitario de Navarra 2009A haemorrhage is one of the most frequent, and potentially most serious, causes for emergency consultation during gestation. In this review we offer an overall approach... (Review)
Review
A haemorrhage is one of the most frequent, and potentially most serious, causes for emergency consultation during gestation. In this review we offer an overall approach to managing a pregnant woman who attends Accidents and Emergencies due to vaginal bleeding and then, in a more specific way, we consider how to manage some of the most frequent entities of the obstetric haemorrhage. With respect to haemorrhages in the second trimester, we give greater attention to how to manage a miscarriage, since other entities that are also frequent receive a specific evaluation in other chapters. In the second trimester three entities account for the greatest percentage of haemorrhages, such as placenta praevia, the premature detachment of the normally inserted placenta and uterine rupture. In each case we have evaluated the etiopathology, diagnostic attitude and management in the most systematic way possible.
Topics: Female; Hemorrhage; Humans; Placenta Diseases; Placenta Previa; Pregnancy; Pregnancy Complications, Hematologic; Uterine Rupture
PubMed: 19436342
DOI: 10.23938/ASSN.0190 -
BMC Pregnancy and Childbirth Jun 2023To evaluate the effect of placental location on the severity of placenta accreta spectrum (PAS).
BACKGROUND
To evaluate the effect of placental location on the severity of placenta accreta spectrum (PAS).
METHODS
We analyzed 390 patients with placenta previa combined with placenta accreta spectrum who underwent cesarean section between January 1, 2014 and December 30, 2020 in the electronic case database of the Second Hospital of Hebei Medical University. According to the position of the placenta, 390 placentas were divided into the posterior group (n = 89), the anterior group (n = 60) and the non-central group (n = 241).
RESULTS
The history of cesarean delivery rates in the anterior group (91.67%) and the non-central group (85.71%) were statistically different from the posterior group (63.74%)(P < 0.001). Univariate logistic regression results showed that employment, urban living, gestational age, complete placenta previa, fetal presentation shoulder, gravidity, cesarean section and vaginal delivery were all predictors for the severity of placenta accreta (P < 0.05). The anterior group (P = 0.001, OR = 4.13, 95%CI: 1.84-9.24) and the non-central group (P = 0.001, OR = 2.90, 95%CI: 1.55-5.45) had a higher incidence of invasive accreta placentation than the posterior group, and were independent risk factors for invasive accreta placentation.
CONCLUSION
Compared with posterior placenta, anterior and non-central placenta are independent risk factors for invasive PAS in patients with placenta previa, during which we should be more cautious in treatment.
Topics: Pregnancy; Humans; Female; Placenta Accreta; Cesarean Section; Placenta Previa; Placenta; Retrospective Studies
PubMed: 37264325
DOI: 10.1186/s12884-023-05736-w -
Revista Da Associacao Medica Brasileira... 2023This study aimed to investigate the expression levels of sirtuin 2 and sirtuin 7 in the placenta accreta spectrum to reveal their role in its pathogenesis.
OBJECTIVE
This study aimed to investigate the expression levels of sirtuin 2 and sirtuin 7 in the placenta accreta spectrum to reveal their role in its pathogenesis.
METHODS
A total of 30 placenta accreta spectrum, 20 placenta previa, and 30 controls were experienced. The sirtuin 2 and sirtuin 7 expression levels in the placentas of these groups were determined by Western blot. sirtuin 2 and sirtuin 7 serum levels in the maternal and fetal cord blood were examined by enzyme-linked immunosorbent assay.
RESULTS
It was found that sirtuin 7 in placenta accreta spectrum was significantly lower in the placenta compared to the control and placenta previa groups (p<0.05). However, a significant difference was not observed between the sirtuin 2 and sirtuin 7 levels in the maternal and fetal cord serum samples of those three groups (p>0.05).
CONCLUSION
Sirtuin 7 may play an important role in the formation of placenta accreta spectrum. The effect of decreased expression of sirtuin 7 might be tissue-dependent in the placenta accreta spectrum and needs to be investigated further.
Topics: Pregnancy; Female; Humans; Placenta Accreta; Placenta Previa; Sirtuin 2; Placenta; Blotting, Western; Retrospective Studies
PubMed: 37585995
DOI: 10.1590/1806-9282.20230360 -
Ginekologia Polska 2022This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency...
OBJECTIVES
This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency cesarean delivery (ECD) in placenta previa (PP) patients without placenta accreata spectrum (PAS) in a tertiary referral hospital.
MATERIAL AND METHODS
This retrospective cohort study included 237 singleton pregnant women who were diagnosed with PP without PAS at the time of delivery. PP patients who were delivered at the scheduled time were included in the PCD group. Patients with PP delivered in an emergency setting before the scheduled date were assigned to the ECD group. We recorded demographic and clinical characteristics, maternal and neonatal outcomes.
RESULTS
Of the 237 patients who met the inclusion criteria, 157 patients (66.8%) underwent PCD, and 80 patients required ECD (33.2%). Patients' hospitalization and pre-discharge hemoglobin levels were significantly lower in the ECD group (11.25 ± 1.97 g/dL and 9.74 ± 2.09 g/dL, respectively) than in the PCD group (10.77 ± 2.67 g/dL and 9.27 ± 2.70, p = 0.002 and p = 0.004, respectively). While six patients (7.5%) were required intensive care unit (ICU) admission in the ECD group, no patient was required to follow up in ICU in the PCD group (p < 0.001). The hospital length of stay (LOS) was tended to be significantly longer in the ECD group (2.8 ± 0.7 days) than in the PCD group (2.4 ± 0.6 days, p < 0.001). Neonatal outcomes of birth weight, Apgar scores, NICU admission, and neonatal death were significantly better in the PCD group than in the ECD group.
CONCLUSIONS
The PCD group has better maternal outcomes, including preoperative and discharge hemoglobin levels, ICU admission and hospital LOS, and better neonatal outcomes than the ECD group. Clinicians should pay regard to that scheduling the delivery to advanced pregnancy weeks has a failure possibility, and patients could not reach the scheduled day due to the emergency states.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Placenta Previa; Retrospective Studies; Cesarean Section; Placenta; Hemoglobins
PubMed: 35072247
DOI: 10.5603/GP.a2021.0160 -
Cadernos de Saude Publica Feb 2018This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental... (Meta-Analysis)
Meta-Analysis Review
This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.
Topics: Abruptio Placentae; Adult; Female; Humans; Maternal Age; Odds Ratio; Parity; Placenta Previa; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 29489954
DOI: 10.1590/0102-311X00206116 -
American Journal of Obstetrics &... Dec 2023The number of cases of placenta accreta spectrum disorder has been increasing with the increase in in vitro fertilization and cesarean deliveries. In addition, placenta...
Tourniquet, Uterine Inversion, and Placental dissection (TURIP) procedure as a novel hemostatic technique to preserve fertility for placenta accreta spectrum disorders without placenta previa.
The number of cases of placenta accreta spectrum disorder has been increasing with the increase in in vitro fertilization and cesarean deliveries. In addition, placenta accreta spectrum without placenta previa is difficult to diagnose before delivery and sometimes requires a hysterectomy because of heavy bleeding. We have devised a uterus-preserving technique (referred to as the tourniquet, uterine inversion, and placental dissection procedure) for such cases. First, the bleeding is stopped by the tourniquet method, the uterus is relaxed with nitroglycerin, and the uterus is inverted to expose the adhesion site. After that, the placenta is detached by sharp dissection under direct visualization, and the detached areas are sutured, and then the tourniquet and internal rotation are released. This technique does not require advanced skills. Thus, a surgeon could avoid performing a hysterectomy and have a greater chance of uterus preservation when encountering massive hemorrhage caused by unpredictable placenta accreta spectrum without placenta previa in either cesarean deliveries or vaginal deliveries.
Topics: Female; Pregnancy; Humans; Placenta Accreta; Placenta Previa; Uterine Inversion; Placenta; Tourniquets; Hemostatic Techniques; Fertility
PubMed: 37832647
DOI: 10.1016/j.ajogmf.2023.101185 -
Annals of Palliative Medicine Jun 2021Placenta previa is one dangerous disease which threatens the health of pregnant women and their fetuses. The purpose of this study was to evaluate the clinical value of...
BACKGROUND
Placenta previa is one dangerous disease which threatens the health of pregnant women and their fetuses. The purpose of this study was to evaluate the clinical value of ultrasound combined with magnetic resonance imaging (MRI) in screening for placenta previa complicated by placenta accreta.
METHODS
Seventy patients with abnormal fetal position admitted to our hospital from January 2019 to January 2020 were selected for the study. Patients were diagnosed by ultrasound alone, MRI alone, and ultrasound combined with MRI. Diagnostic accuracy, sensitivity, specificity and false positive and negative diagnosis rates were evaluated against the postoperative pathological examinations of the patients.
RESULTS
The diagnostic accuracy, sensitivity and false negative rate for ultrasound combined with MRI were 86.27%, 97.78% and 72.00%, respectively. These results were significantly superior to those of MRI or ultrasound alone (P<0.05). The specificity and false positive rate for ultrasound combined with MRI were 13.73% and 5.26%, respectively, which were not significantly different from those for MRI or ultrasound alone (P>0.05).
CONCLUSIONS
Compared with ultrasound or MRI alone, ultrasound combined with MRI has higher accuracy and sensitivity in the diagnosis of placenta previa with placenta accreta, along with lower false positive diagnosis rates. These findings are clinically important for improving the diagnostic efficiency.
Topics: Female; Humans; Magnetic Resonance Imaging; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Ultrasonography
PubMed: 34237975
DOI: 10.21037/apm-21-1285 -
American Journal of Obstetrics and... May 2015The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before...
OBJECTIVE
The purpose of this study was to examine the association between previous cesarean delivery and subsequent placenta previa while distinguishing cesarean delivery before the onset of labor from intrapartum cesarean delivery.
STUDY DESIGN
We conducted a retrospective cohort study of electronic medical records from 20 Utah hospitals (2002-2010) with restriction to the first 2 singleton deliveries of nulliparous women at study entry (n=26,987). First pregnancy delivery mode was classified as (1) vaginal (reference), (2) cesarean delivery before labor onset (prelabor), or (3) cesarean delivery after labor onset (intrapartum). Risk of second delivery previa was estimated by previous delivery mode with the use of logistic regression and was adjusted for maternal age, insurance, smoking, comorbidities, previous pregnancy loss, and history of previa.
RESULTS
Most first deliveries were vaginal (82%; n=22,142), followed by intrapartum cesarean delivery (14.6%; n=3931), or prelabor cesarean delivery (3.4%; n=914). Incidence of second delivery previa was 0.29% (n=78) and differed by previous delivery mode: vaginal, 0.24%; prelabor cesarean delivery, 0.98%; intrapartum cesarean delivery, 0.38% (P<.001). Relative to vaginal delivery, previous prelabor cesarean delivery was associated with an increased risk of second delivery previa (adjusted odds ratio, 2.62; 95% confidence interval, 1.24-5.56). There was no significant association between previous intrapartum cesarean delivery and previa (adjusted odds ratio, 1.22; 95% confidence interval, 0.68-2.19).
CONCLUSION
Previous prelabor cesarean delivery was associated with a >2-fold significantly increased risk of previa in the second delivery, although the approximately 20% increased risk of previa that was associated with previous intrapartum cesarean delivery was not significant. Although rare, the increased risk of placenta previa after previous prelabor cesarean delivery may be important when considering nonmedically indicated prelabor cesarean delivery.
Topics: Adolescent; Adult; Cesarean Section; Cohort Studies; Delivery, Obstetric; Female; Humans; Logistic Models; Maternal Age; Middle Aged; Odds Ratio; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors; Utah; Young Adult
PubMed: 25576818
DOI: 10.1016/j.ajog.2015.01.004