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Fertility and Sterility Nov 2022To define specific risk factors for placenta previa in pregnancies conceived with assisted reproductive technology (ART).
OBJECTIVE
To define specific risk factors for placenta previa in pregnancies conceived with assisted reproductive technology (ART).
DESIGN
Retrospective cohort.
SETTING
Fertility centers and inpatient obstetric units in Massachusetts.
PATIENT(S)
Patients conceiving with ART and delivering at 20 weeks gestation or later between 2011 and 2017 in Massachusetts.
INTERVENTION(S)
Patient demographic and medical factors and specific components of their cycles. Data were obtained by linking vital records of the State of Massachusetts to reproductive clinic data obtained from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, and then supplementing this information with laboratory and obstetric data from 2 large academic hospitals.
MAIN OUTCOME MEASURE
Associations were tested between multiple cycle- and patient-related factors and placenta previa or low-lying placenta at delivery. After testing for confounders, multivariate models were adjusted for maternal age, history of prior cesarean delivery and birth plurality, and are reported as adjusted relative risks (aRR).
RESULT(S)
We included 18,939 pregnancies, with 553 (2.9%) having placenta previa at delivery. Advanced maternal age (aRR, 1.25; 95% confidence interval [CI], 1.06-1.48), endometriosis, (aRR, 2.22; 95% CI, 1.71-2.86), and controlled ovarian hyperstimulation (aRR, 1.33; 95% CI, 1.12-1.59) were associated with placenta previa, whereas multiple births (aRR, 0.63; 95% CI, 0.48-0.81) and a history of polycystic ovary syndrome or ovulation disorders (aRR, 0.59; 95% CI, 0.46-0.75) had negative associations. The endometriosis association was strong in nulliparas and the controlled ovarian hyperstimulation association was strong in parous patients in a stratified analysis. No association was seen with prior history of cesarean delivery.
CONCLUSION(S)
Patients conceiving with ART do not have the typical previa risk factors of prior cesarean delivery and multiple gestations, whereas endometriosis and fresh embryo transfers contributed moderate risk. The embryo transfer process itself may affect previa development in this population.
Topics: Pregnancy; Female; Humans; Placenta Previa; Retrospective Studies; Endometriosis; Reproductive Techniques, Assisted; Risk Factors
PubMed: 36175207
DOI: 10.1016/j.fertnstert.2022.08.013 -
Ultrasound in Obstetrics & Gynecology :... Apr 2022Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal...
OBJECTIVES
Improvement in the antenatal diagnosis of placenta accreta spectrum (PAS) would allow preparation for delivery in a referral center, leading to decreased maternal morbidity and mortality. Our objectives were to assess the performance of classic ultrasound signs and to determine the value of novel ultrasound signs in the detection of PAS.
METHODS
This was a retrospective cohort study of women with second-trimester placenta previa who underwent third-trimester transvaginal ultrasound and all women with PAS in seven medical centers. A retrospective image review for signs of PAS was conducted by three maternal-fetal medicine physicians. Classic signs of PAS were defined as placental lacunae, bladder-wall interruption, myometrial thinning and subplacental hypervascularity. Novel signs were defined as small placental lacunae, irregular placenta-myometrium interface (PMI), vascular PMI, non-tapered placental edge and placental bulge towards the bladder. PAS was diagnosed based on difficulty in removing the placenta or pathological examination of the placenta. Multivariate regression analysis was performed and receiver-operating-characteristics (ROC) curves were generated to assess the performance of combined novel signs, combined classic signs and a model combining classic and novel signs.
RESULTS
A total of 385 cases with placenta previa were included, of which 55 had PAS (28 had placenta accreta, 11 had placenta increta and 16 had placenta percreta). The areas under the ROC curves for classic markers, novel markers and a model combining classic and novel markers for the detection of PAS were 0.81 (95% CI, 0.75-0.88), 0.84 (95% CI, 0.77-0.90) and 0.88 (95% CI, 0.82-0.94), respectively. A model combining classic and novel signs performed better than did the classic or novel markers individually (P = 0.03). An increasing number of signs was associated with a greater likelihood of PAS. With the presence of 0, 1, 2 and ≥ 3 classic ultrasound signs, PAS was present in 5%, 24%, 57% and 94% of cases, respectively.
CONCLUSIONS
We have confirmed the value of classic ultrasound signs of PAS. The use of novel ultrasound signs in combination with classic signs improved the detection of PAS. These findings have clinical implications for the detection of PAS and may help guide the obstetric management of patients diagnosed with these placental disorders. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34725869
DOI: 10.1002/uog.24804 -
PloS One 2016The correlation between gestational hypertension-preeclampsia (GH-PE) and placenta previa (PP) is controversial. Specifically, it is unknown whether placenta previa has...
BACKGROUND
The correlation between gestational hypertension-preeclampsia (GH-PE) and placenta previa (PP) is controversial. Specifically, it is unknown whether placenta previa has any effect on the various types of preeclampsia (PE), and the role PP with concurrent placenta accreta (PA) play in the occurrence of GH-PE are not well understood.
OBJECTIVE
The aim of this study was to identify the effects of PP on GH, mild and severe preeclampsia (MPE and SPE), and early- and late-onset preeclampsia (EPE and LPE). Another aim of the study was to determine if concurrent PA impacts the relationship between PP and GH-PE.
METHODS
A retrospective single-center study of 1,058 patients having singleton pregnancies with PP was performed, and 2,116 pregnant women were randomly included as controls. These cases were collected from a tertiary hospital and met the inclusion criteria for the study. Clinical information, including PP and the gestational age at the onset of GH-PE were collected. Binary and multiple logistic regression analyses were conducted after the confounding variables were controlled to assess the effects of PP on different types of GH-PE.
RESULTS
There were 155 patients with GH-PE in the two groups. The incidences of GH-PE in the PP group and the control group were 2.5% (26/1058) and 6.1% (129/2116), respectively (P = 0.000). Binary and multiple regression analyses were conducted after controlling for confounding variables. Compared to the control group, in the PP group, the risk of GH-PE was reduced significantly by 78% (AOR: 0.216; 95% CI: 0.135-0.345); the risks of GH and PE were reduced by 55% (AOR: 0.451; 95% CI: 0.233-0.873) and 86% (AOR: 0.141; 95% CI: 0.073-0.271), respectively; the risks of MPE and SPE were reduced by 73% (AOR: 0.269; 95% CI: 0.087-0828) and 88% (AOR: 0.123; 95% CI: 0.055-0.279), respectively; and the risks of EPE and LPE were reduced by 95% (AOR: 0.047; 95% CI: 0.012-0.190) and 67% (AOR: 0.330; 95% CI: 0.153-0.715), respectively. The incidence of concurrent PA in women with PP was 5.86%; PP with PA did not significantly further reduce the incidence of GH-PE compared with PP without PA (1.64% vs. 2.51%, P>0.05). Binary logistic regression analyses were conducted after controlling for confounding variables, compared with the non-PP + GH-PE group, and the AOR of FGR in the non-PP + non-GH-PE group was 0.206 (0.124-0.342). Compared with the PP + GH-PE group, the AOR of FGR in the PP + non-GH-PE group was 0.430 (0.123-1.500).
CONCLUSION
PP is not only associated with a significant reduction in the incidence of GH-PE, but also is associated with a reduction in incidence of various types of PE. Concurrent PA and PP do not show association with a reduction in incidence of GH-PE.
Topics: Adult; Female; Humans; Hypertension, Pregnancy-Induced; Incidence; Placenta Accreta; Placenta Previa; Pre-Eclampsia; Pregnancy; Retrospective Studies; Risk Factors; Young Adult
PubMed: 26731265
DOI: 10.1371/journal.pone.0146126 -
Taiwanese Journal of Obstetrics &... Apr 2016To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta.
OBJECTIVE
To assess the efficacy and safety of longitudinal parallel compression suture to control heavy postpartum hemorrhage (PPH) in patients with placenta previa/accreta.
MATERIALS AND METHODS
Fifteen women received a longitudinal parallel compression suture to stop life-threatening PPH due to placenta previa with or without accreta during cesarean section. The suture apposed the anterior and posterior walls of the lower uterine segment together using an absorbable thread A 70-mm round needle with a Number-1 absorbable thread was used. The point of needle entry was 1 cm above the upper margin of the cervix and 1 cm from the right lateral border of the lower segment of the anterior wall. The suture was threaded through the uterine cavity to the serosa of the posterior wall. Then, it was directed upward and threaded from the posterior to the anterior wall at ∼1-2 cm above the upper boundary of the lower uterine segment and 3-cm medial to the right margin of the uterus. Both ends of the suture were tied on the anterior aspect of uterus. The left side was sutured in the same way.
RESULTS
The success rate of the procedure was 86.7% (13/15). Two of 15 cases were concurrently administered gauze packing and achieved satisfactory hemostasis. All patients resumed a normal menstrual flow, and no postoperative anatomical or physiological abnormalities related to the suture were observed. Three women achieved further pregnancies after the procedure.
CONCLUSION
Longitudinal parallel compression suture is a safe, easy, effective, practical, and conservative surgical technique to stop intractable PPH from the lower uterine segment, particularly in women who have a cesarean scar and placenta previa/accreta.
Topics: Adult; Cesarean Section; Female; Hemostasis, Surgical; Humans; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Pressure; Suture Techniques; Sutures; Young Adult
PubMed: 27125401
DOI: 10.1016/j.tjog.2016.02.008 -
Journal of Health Economics Mar 2020We revisit the causal effect of birthweight. Because variation in birthweight in developed countries primarily stems from variation in gestational age rather than...
We revisit the causal effect of birthweight. Because variation in birthweight in developed countries primarily stems from variation in gestational age rather than intrauterine growth restriction, we depart from the widely-used twin fixed-effects estimator and employ an instrumental variable - the diagnosis of placenta previa, which provides exogenous variation in gestation length. We find protective effects of additional birthweight against infant mortality and health capital loss, such as cerebral palsy, but in contrast to sibling and twin studies, no strong evidence for non-health long-run outcomes, such as test scores. We also find that short-run birthweight effects have diminished significantly over the decades.
Topics: Birth Weight; Female; Fetal Growth Retardation; Gestational Age; Humans; Infant; Infant Health; Infant Mortality; Infant, Newborn; Placenta Previa; Pregnancy
PubMed: 31951828
DOI: 10.1016/j.jhealeco.2019.102269 -
Taiwanese Journal of Obstetrics &... May 2022To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
OBJECTIVE
To clarify whether "low-risk total PP" patients bleed more than partial/marginal PP patients.
MATERIALS AND METHODS
The retrospective cohort study was performed involving patients with PP between April 2006 and December 2018. The placental position was determined by ultrasound. From medical charts, the backgrounds as well as obstetric and neonatal outcomes of PP patients were retrieved.
RESULTS
This study included 349 patients with PP, which was classified into three types according to the distance between the placenta and internal ostium: total (n = 174), partial (n = 52), and marginal (n = 123) PP. In total PP patients, three factors (prior CS, anterior placenta, and placental lacunae on ultrasound) significantly increased blood loss at CS, the need for hysterectomy, homologous transfusion (≥10 U), and ICU admission. No significant difference was observed in bleeding-related poor outcomes (rate of blood loss ≥2000 mL, amount of homologous transfusion, need for hysterectomy, and ICU admission) between total PP patients without all three factors: "low-risk total PP patients" and partial/marginal PP patients (19.8 vs. 17.1%; p = 0.604, 3.7 vs. 1.1%; p = 0.330, 1.2 vs. 1.1%; p = 1.000, and 1.2 vs. 1.1%; p = 1.000, respectively).
CONCLUSION
Prior CS, anterior placenta, and placental lacunae on ultrasound were risk factors for a bleeding-related poor outcome in total PP patients. Total PP patients without these three factors showed the same bleeding-related poor outcome as partial/marginal PP patients.
Topics: Female; Hemorrhage; Humans; Infant, Newborn; Placenta; Placenta Accreta; Placenta Previa; Pregnancy; Pregnancy Outcome; Retrospective Studies
PubMed: 35595436
DOI: 10.1016/j.tjog.2022.03.007 -
European Review For Medical and... Jun 2015The aim of this research is to evaluate the association between placenta previa and hypertensive disorders of pregnancy (HDP). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this research is to evaluate the association between placenta previa and hypertensive disorders of pregnancy (HDP).
MATERIALS AND METHODS
A computerized literature search was carried out on PubMed to collect relevant articles on the association between placenta previa and HDP before November 2013. Pooled relative risk (RR) and 95% confidence intervals (CIs) were used to assess the strength of the associations.
RESULTS
A total of 7 cohort studies were identified according to the inclusion criteria. Overall, a significantly inverse correlation between placenta previa and HDP was found when all study results were pooled into the meta-analysis (RR = 0.55, 95% CI: 0.32-0.97). For subgroup analyses, the same results were found in pregnancy-induced hypertension (PIH) group (RR = 0.36, 95% CI: 0.23-0.57) but not in other HDPs group (RR = 0.94, 95% CI: 0.44-2.00).
CONCLUSIONS
This meta-analysis suggested a reduced risk for PIH in women with placenta previa.
Topics: Adult; Cohort Studies; Female; Humans; Hypertension; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Risk Factors
PubMed: 26166635
DOI: No ID Found -
Chinese Medical Journal Jun 2018
Topics: Cesarean Section; Female; Humans; Placenta Accreta; Placenta Previa; Pregnancy
PubMed: 29893372
DOI: 10.4103/0366-6999.233961 -
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 -
Frontiers in Endocrinology 2022Emerging evidence has shown that fertilization (IVF) is associated with higher risks of certain placental abnormalities or complications, such as placental abruption,...
INTRODUCTION
Emerging evidence has shown that fertilization (IVF) is associated with higher risks of certain placental abnormalities or complications, such as placental abruption, preeclampsia, and preterm birth. However, there is a lack of large population-based analysis focusing on placental abnormalities or complications following IVF treatment. This study aimed to estimate the absolute risk of placental abnormalities or complications during IVF-conceived pregnancy.
METHODS
We conducted a retrospective cohort study of 16 535 852 singleton pregnancies with delivery outcomes in China between 2013 and 2018, based on the Hospital Quality Monitoring System databases. Main outcomes included placental abnormalities (placenta previa, placental abruption, placenta accrete, and abnormal morphology of placenta) and placenta-related complications (gestational hypertension, preeclampsia, eclampsia, preterm birth, fetal distress, and fetal growth restriction (FGR)). Poisson regression modeling with restricted cubic splines of exact maternal age was used to estimate the absolute risk in both the IVF and non-IVF groups.
RESULTS
The IVF group (n = 183 059) was more likely than the non-IVF group (n = 16 352 793) to present placenta previa (aRR: 1.87 [1.83-1.91]), placental abruption (aRR: 1.16 [1.11-1.21]), placenta accrete (aRR: 2.00 [1.96-2.04]), abnormal morphology of placenta (aRR: 2.12 [2.07 to 2.16]), gestational hypertension (aRR: 1.55 [1.51-1.59]), preeclampsia (aRR: 1.54 [1.51-1.57]), preterm birth (aRR: 1.48 [1.46-1.51]), fetal distress (aRR: 1.39 [1.37-1.42]), and FGR (aRR: 1.36 [1.30-1.42]), but no significant difference in eclampsia (aRR: 0.91 [0.80-1.04]) was found. The absolute risk of each outcome with increasing maternal age in both the IVF and non-IVF group presented two patterns: an upward curve showing in placenta previa, placenta accreta, abnormal morphology of placenta, and gestational hypertension; and a J-shape curve showing in placental abruption, preeclampsia, eclampsia, preterm birth, fetal distress, and FGR.
CONCLUSION
IVF is an independent risk factor for placental abnormalities and placental-related complications, and the risk is associated with maternal age. Further research is needed to evaluate the long-term placenta-related chronic diseases of IVF patients and their offspring.
Topics: Abruptio Placentae; Eclampsia; Female; Fertilization; Fetal Distress; Fetal Growth Retardation; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Placenta; Placenta Previa; Pre-Eclampsia; Pregnancy; Premature Birth; Retrospective Studies
PubMed: 35846290
DOI: 10.3389/fendo.2022.924070