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Medical Science Monitor : International... Mar 2023BACKGROUND Placenta previa is defined as a placenta that grows from the anterior or posterior wall of the uterus and covers the cervix. The incidence of placenta previa...
BACKGROUND Placenta previa is defined as a placenta that grows from the anterior or posterior wall of the uterus and covers the cervix. The incidence of placenta previa has been increasing in recent years. It is thought that bleeding is more common during surgery in cases with anterior placenta that is closing the cervix. This study investigated the importance of placental location in pregnant women with placenta previa who had a previous cesarean section. MATERIAL AND METHODS This study covered the period from July 2017 to June 2020. The 116 patients included in the study were divided into 2 groups according to placental location: anterior (group 1) and posterior (group 2). All patients had previously delivered via cesarean section. Operation time, presence of invasion, estimated blood loss during surgery, and transfused erythrocyte volume were evaluated. Medical records were used to access the relevant data. RESULTS The patients in group 1 and group 2 had an average of 2.71 and 2.01 previous cesarean sections, respectively (P=0.002). The placental invasion (percreta) rate was significantly higher in group 1 than in group 2 (65.4 vs 5.3%, P<0.001), as was the estimated blood loss during surgery (790 vs 527 mL, P=0.014). The total erythrocyte suspension was considerably higher in group 1 than in group 2 patients (0.8 vs 0.2, P=0.014), both during and after surgery. CONCLUSIONS In patients with placenta previa, the location of the placenta should always be examined with ultrasonography to allow better preoperative planning.
Topics: Pregnancy; Female; Humans; Placenta; Placenta Previa; Cesarean Section; Uterus; Placenta Accreta; Retrospective Studies
PubMed: 36987375
DOI: 10.12659/MSM.939326 -
Medical Science Monitor : International... Sep 2022BACKGROUND The incidence of placenta previa is gradually increasing. The major risk factor is a history of cesarean section (CS). Such patients may experience severe...
BACKGROUND The incidence of placenta previa is gradually increasing. The major risk factor is a history of cesarean section (CS). Such patients may experience severe bleeding during pregnancy and surgery. Patients with placenta previa were classified based on risk factors in this study. This retrospective study from a single center in Turkey aimed to evaluate the factors associated with placenta previa in 151 women. MATERIAL AND METHODS Patients with placenta previa were grouped by the presence/absence of prior CS. Group 1 (123 patients) had undergone at least 1 CS, and Group 2 (28 patients) had not undergone CS. The diagnosis of placenta previa was made by ultrasound. Placenta previa was defined as cases where the placenta crossed the internal os. Duration of surgery, bleeding during surgery, and the amounts of erythrocyte suspensions required were compared between groups. RESULTS Of Group 1 patients, 67.5% had anterior placenta previa compared to 46.4% in Group 2. The mean duration of surgery was: 52.0±19.2 and 28.5±4.6 min (P<0.001); the number of sutures was 8.4±2.4 and 5.9±0.9 (P<0.001); the bleeding volumes were 720.3±536.2 and 344±137.0 mL (P<0.001); and the amount of erythrocyte suspension administered intraoperatively was 0.2±0.7 and 0.0±0.0 unit (P=0.032). CONCLUSIONS Mean duration of surgery, number of sutures, bleeding volume, and intraoperatively applied ES volumes were significantly different between groups. Identification of placenta previa patients who have undergone prior CS is vitally important in terms of preoperative preparation.
Topics: Cesarean Section; Female; Humans; Placenta; Placenta Previa; Pregnancy; Retrospective Studies; Risk Factors; Turkey
PubMed: 36155611
DOI: 10.12659/MSM.938023 -
European Review For Medical and... Mar 2022The aim of this study was to assess the association between maternal weight gain and placenta morphology in the complete placenta previa pregnancies.
OBJECTIVE
The aim of this study was to assess the association between maternal weight gain and placenta morphology in the complete placenta previa pregnancies.
PATIENTS AND METHODS
This was a prospective clinical cohort study. Pregnancy weight gain was defined as the difference between delivery and at first trimester. Morphological parameters, including placenta length, breadth, thickness, length-breadth, surface area, weight, and fetoplacental weight ratio, were direct measured delivery.
RESULTS
Eighty-five women were included in this study. Maternal weight gain was 11.12 ± 3.95 kg. Placenta length, breadth, thickness, length-breadth, surface area, weight and fetoplacental weight ratio were 19.42 ± 1.97 cm, 18.29 ± 1.80 cm, 2.18 ± 0.38 cm, 1.13 ± 0.80 cm, 281.60 ± 57.23 cm2, 569.05 ± 118.77 g, and 4.88 ± 0.88, respectively. Correlation analysis showed that there was a positive correlation between maternal weight gain and placenta length (r = 0.261, p = 0.016), placenta breadth (r = 0.239, p = 0.028), and placenta surface area (r = 0.254, p = 0.019). In the linear regression model, maternal weight gain was significantly associated with placenta length [β (95% CI): 0.130 (0.025-0.236)], breadth [β (95% CI): 0.109 (0.012-0.205)], and surface area [β (95%CI): 3.677 (0.615-6.739)]. The results were still stable after adjusting for pre-pregnancy weight.
CONCLUSIONS
Maternal weight gain in pregnancy was associated with placental length, placental breadth, and placental surface area in a complete placenta previa pregnancies. Considering the single center data, further studies are needed to recognize the significance of the association analyzed in our study.
Topics: Cohort Studies; Female; Humans; Placenta; Placenta Previa; Pregnancy; Prospective Studies; Weight Gain
PubMed: 35363348
DOI: 10.26355/eurrev_202203_28346 -
Nigerian Journal of Clinical Practice Apr 2023Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known high-risk condition associated with placental previa.
BACKGROUND
Placental adhesion spectrum (PAS) is a disease in which the trophoblast invades the myometrium, and is a well-known high-risk condition associated with placental previa.
AIM
The morbidity of nulliparous women with placenta previa without PAS disorders is unknown.
PATIENTS AND METHODS
The data from nulliparous women who underwent cesarean delivery were collected retrospectively. The women were dichotomized into malpresentation (MP) and placenta previa groups. The placenta previa group was categorized into previa (PS) and low-lying (LL) groups. When the placenta covers the internal cervical os, it is called placenta previa, when the placenta is near the cervical os, it is called the low-lying placenta. Their maternal hemorrhagic morbidity and neonatal outcomes were analyzed and adjusted using multivariate analysis based on univariate analysis.
RESULTS
A total of 1269 women were enrolled: 781 women in the MP group and 488 women in the PP-LL group. Regarding packed red blood cell transfusion, PP and LL had adjusted odds ratio (aOR) of 14.7 (95% confidence interval (CI): 6.6 - 32.5), and 11.3 (95% CI: 4.9 - 26) during admission, and 51.2 (95% CI: 22.1 - 122.7) and 10.3 (95% CI: 3.9 - 26.6) during operation, respectively. For intensive care unit admission, PS and LL had aOR of 15.9 (95% CI: 6.5 - 39.1) and 3.5 (95% CI: 1.1 - 10.9), respectively. No women had cesarean hysterectomy, major surgical complications, or maternal death.
CONCLUSION
Despite placenta previa without PAS disorders, maternal hemorrhagic morbidity was significantly increased. Thus, our results highlight the need for resources for those women with evidence of placenta previa including a low-lying placenta, even if those women do not meet PAS disorder criteria. In addition, placenta previa without PAS disorder was not associated with critical maternal complications.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Placenta; Placenta Previa; Retrospective Studies; Placenta Accreta; Morbidity
PubMed: 37203107
DOI: 10.4103/njcp.njcp_456_22 -
Ultrasound in Obstetrics & Gynecology :... Nov 2019To evaluate fetal growth in pregnancies complicated by placenta previa with or without placenta accreta spectrum (PAS) disorder, compared with in pregnancies with a...
OBJECTIVES
To evaluate fetal growth in pregnancies complicated by placenta previa with or without placenta accreta spectrum (PAS) disorder, compared with in pregnancies with a low-lying placenta.
METHODS
This was a multicenter retrospective cohort study of singleton pregnancies complicated by placenta previa with or without PAS disorder, for which maternal characteristics, ultrasound-estimated fetal weight and birth weight were available. Four maternal-fetal medicine units participated in data collection of diagnosis, treatment and outcome. The control group comprised singleton pregnancies with a low-lying placenta (0.5-2 cm from the internal os). The diagnosis of PAS and depth of invasion were confirmed at delivery using both a predefined clinical grading score and histopathological examination. For comparison of pregnancy characteristics and fetal growth parameters, the study groups were matched for smoking status, ethnic origin, fetal sex and gestational age at delivery.
RESULTS
The study included 82 women with placenta previa with PAS disorder, subdivided into adherent (n = 35) and invasive (n = 47) PAS subgroups, and 146 women with placenta previa without PAS disorder. There were 64 controls with a low-lying placenta. There was no significant difference in the incidence of small-for-gestational age (SGA) (birth weight ≤ 10 percentile) and large-for-gestational age (LGA) (birth weight ≥ 90 percentile) between the study groups. Median gestational age at diagnosis was significantly lower in pregnancies with placenta previa without PAS disorder than in the low-lying placenta group (P = 0.002). No significant difference was found between pregnancies complicated by placenta previa with PAS disorder and those without for any of the variables. Median estimated fetal weight percentile was significantly lower in the adherent compared with the invasive previa-PAS subgroup (P = 0.047). Actual birth weight percentile at delivery did not differ significantly between the subgroups (P = 0.804).
CONCLUSIONS
No difference was seen in fetal growth in pregnancies complicated by placenta previa with PAS disorder compared with those without and compared with those with a low-lying placenta. There was also no increased incidence of either SGA or LGA neonates in pregnancies with placenta previa and PAS disorder compared with those with placenta previa with spontaneous separation of the placenta at birth. Adverse neonatal outcome in pregnancies complicated by placenta previa and PAS disorder is linked to premature delivery and not to impaired fetal growth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Birth Weight; Case-Control Studies; Female; Fetal Development; Humans; Infant, Newborn; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 30779235
DOI: 10.1002/uog.20244 -
BMC Pregnancy and Childbirth Jun 2021Placenta previa, a serious obstetric issue, should be managed by experienced teams. The safe and appropriate mode of delivery for placenta previa is by cesarean... (Comparative Study)
Comparative Study
BACKGROUND
Placenta previa, a serious obstetric issue, should be managed by experienced teams. The safe and appropriate mode of delivery for placenta previa is by cesarean delivery. However, no studies were found comparing either maternal or neonatal outcomes for different skin incision in women with placenta previa. The aim of this study was to compare maternal and neonatal outcomes by skin incision types (transverse compared with vertical) in a large cohort of women with placenta previa who were undergoing cesarean delivery.
METHODS
This was a retrospective cohort study carried out between January 2014 and June 2019. All pregnant women with placenta previa had confirmed by ultrasonologist before delivery and obstetrician at delivery. The primary outcome was the estimated blood loss during the surgery and within the first 24 hours postoperatively. Mean (standard deviation), median (interquartile range) or frequency (percentage) was reported to variables. Appropriate parametric and nonparametric tests were used to analyses.
RESULTS
The study included 1098 complete records, 332 (30.24%) cases in the vertical skin incision group and 766 (69.76%) cases in the transverse skin incision group. Those with vertical incision showed a higher percentage of preterm delivery, anterior placenta, abnormally invasive placenta, and history of previous cesarean delivery, and a lower percentage of first pregnancy, in vitro fertilization, and emergency cesarean delivery. After controlling for confounding factors, higher incidence of post-partum hemorrhage (OR 5.47, 95% CI 3.84-7.79), maternal intensive care unit (OR 4.30, 95% CI 2.86-6.45), transfusion (OR 5.97, 95% CI 4.15-8.58), and 5-min APGAR< 7 (OR 9.03, 95% CI 1.83-44.49), a more estimated blood loss (β 601.85, 95%CI 458.78-744.91), and a longer length of hospital stay after delivery (β 0.54, 95%CI 0.23-0.86) were found in the vertical skin incision group.
CONCLUSIONS
Our data demonstrated that transverse skin incision group showed the better perinatal outcomes in women with placenta previa. Future collaborative studies are needed to be done by centers for placenta previa to have a better understanding of the characteristics and the outcomes of the disease in the choosing skin incision.
Topics: Adult; Blood Transfusion; Cesarean Section; Female; Humans; Incidence; Infant, Newborn; Length of Stay; Male; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Surgical Wound
PubMed: 34167519
DOI: 10.1186/s12884-021-03923-1 -
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 -
International Journal of Clinical... 2022The present study was performed in order to investigate the conbined effect of balloon occlusion and uterine artery embolization on coagulation function in patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
The present study was performed in order to investigate the conbined effect of balloon occlusion and uterine artery embolization on coagulation function in patients with high-risk placenta previa during cesarean section.
METHODS
There involved a total of 38 patients with high-risk placenta previa undergoing cesarean section in our hospital from August 2019 to January 2021. The patients enrolled were randomly divided into study group (19 cases, receiving balloon occlusion combined with uterine artery embolization) and control group (19 cases, receiving conventional cesarean section). The operation time, intraoperative blood loss, plasma injection volume and hospital stay of the two groups were recorded. Moreover, the postoperative coagulation function indexes, including thrombin time (TT), fibrinogen (FBI), activated partial thromboplastin time (APTT) and prothrombin time (PT), were monitored and compared. Neonatal Apgar score and postoperative complications of the two groups were regarded as parameters for comparison.
RESULTS
The intraoperative blood loss, plasma injection volume and hospital stay of the study group were significantly lower compared with the control group ( < 0.05), whereas the operation time of the two groups was comparable ( > 0.05). Compared with the control group, the levels of TT, APTT and PT were lower while the level of FBI was higher in the study group ( < 0.05). The Apgar 1-min and 5-min scores of newborns were compared between the two groups ( > 0.05). However, the incidence of postoperative complications in the study group showed evidently lower outcomes compared with the control group ( < 0.05).
CONCLUSION
The combined approach of balloon occlusion and uterine artery embolization offered potential for improving the coagulation function of patients with high-risk placenta previa during cesarean section. In addition, the approach reduced the amount of blood loss and plasma injection, shortened the length of hospital stay, which was believed available for wide clinical application.
Topics: Balloon Occlusion; Blood Loss, Surgical; Cesarean Section; Female; Humans; Infant, Newborn; Placenta Previa; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Artery Embolization
PubMed: 35685595
DOI: 10.1155/2022/7750598 -
Taiwanese Journal of Obstetrics &... Apr 2017To introduce the primary experience of using aortic balloon catheters during cesarean section for placenta previa and/or placenta accreta.
OBJECTIVE
To introduce the primary experience of using aortic balloon catheters during cesarean section for placenta previa and/or placenta accreta.
MATERIALS AND METHODS
From January 2013 to May 2015, 43 patients who were preoperatively diagnosed with major placenta previa and/or placenta accreta and who underwent prophylactic aortic catheterization before caesarean section (CS) were included in the study. We analyzed the clinical data of the study population. Surgery- and catheterization-related complications were also reported.
RESULTS
Major placenta previa or placenta accreta was surgically confirmed in 42 patients, 28 of whom had both conditions. The mean patient age was 32.3 ± 5.5 years, whereas the median gestational age at delivery was 260 (range, 153-280) days. Twenty-nine (67.4%) patients had previously undergone CS, and 13 (30%) patients had undergone emergency surgery for antenatal hemorrhage. The median estimated blood loss during surgery was 500 (range, 100-3,000) mL, and the median duration of occlusion was 20 (range, 5-32) minutes. Hysterectomy was performed in five (11.6%) patients and uterine artery embolization in two (4.6%) patients. Two patients with placenta percreta experienced surgery-related complications, and two patients required hospital readmission. No major catheterization-related complications were observed. Forty-two live births were recorded, and the Apgar score of the infants at 5 minutes was > 7.
CONCLUSION
Intraoperative aortic balloon occlusion is a relatively safe method for treating placenta previa and/or placenta accreta during scheduled and emergency CS and might be helpful to prevent hysterectomy and embolization in women wishing to preserve fertility.
Topics: Adult; Aorta; Balloon Occlusion; Blood Loss, Surgical; Blood Transfusion; Cesarean Section; Female; Humans; Hysterectomy; Intraoperative Complications; Operative Time; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Retrospective Studies; Treatment Outcome
PubMed: 28420498
DOI: 10.1016/j.tjog.2016.11.004 -
BMC Pregnancy and Childbirth Aug 2021Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem.... (Comparative Study)
Comparative Study
Clinical analysis of second-trimester pregnancy termination after previous caesarean delivery in 51 patients with placenta previa and placenta accreta spectrum: a retrospective study.
BACKGROUNDS
Pregnancy termination during the second trimester in patients with placenta previa and placenta accreta spectrum (PAS) is a complex and challenging clinical problem. Based on our literature review, there has been a relative increase in the number of such cases being treated by hysterotomy and/or local uterine lesion resection and repair. In the present study, a retrospective analysis was conducted to compare the clinical outcomes when different management strategies were used to terminate pregnancy in the patients with placenta previa and PAS.
METHODS
A total of 51 patients who underwent pregnancy termination in the second trimester in Beijing Obstetrics and Gynecology Hospital between June 2013 and December 2018 were retrospectively analyzed in this study. All patients having previous caesarean delivery (CD) were diagnosed with placenta previa status and PAS.
RESULTS
① Among the 51 patients, 16 cases received mifepristone and misoprostol medical termination, 15 cases received mifepristone and Rivanol medical termination, but 1 of them was transferred to hysterotomy due to failed labor induction, another 20 cases were performed planned hysterotomy. There was no placenta percreta cases and uterine artery embolization (UAE) was all performed before surgery.② There were 31 cases who underwent medical termination and 30 cases were vaginal delivery. Dilation and evacuation (D&E) were used in 20 cases of medical abortion failure and in all 30 cases of difficult manual removal of placental tissue. ③ A statistically significant difference was found among the three different strategies in terms of gestational weeks, the type of placenta previa status, main operative success rate and β-HCG regression time (P < 0.05). ④ There were 4(7.8%) cases who were taken up for hysterectomy because of life-threatening bleeding or severe bacteremia during or after delivery and hysterotomy. The uterus was preserved with the implanted placenta partly or completely left in situ in 47(92.2%) cases. Combined medical and/or surgical management were used for the residual placenta and the time of menstrual recovery was 52(range: 33 to 86) days after pregnancy termination.
CONCLUSIONS
Terminating a pregnancy by vaginal delivery through medical induction of labor may be feasible if clinicians have an overall understanding of gestational age, the type of placenta previa status, the type of placenta accreta, and patients concerns about preserving fertility. A collaborative team effort in tertiary medical centers with a very experience MDT and combined application of multiple methods is required to optimize patient outcomes.
Topics: Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Cesarean Section; China; Female; Humans; Hysterotomy; Labor, Induced; Mifepristone; Misoprostol; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Vaginal Birth after Cesarean; Young Adult
PubMed: 34407784
DOI: 10.1186/s12884-021-04017-8