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Lin LH, Lin Q, Wang XM, Zhang RH, Zheng LH, Zhang H. The possible impact of the universal two-child policy on pregnancy outcomes. Arch Gynecol Obstet 2024; 310:739-748. [PMID: 38032412 DOI: 10.1007/s00404-023-07283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The implementation of the universal two-child policy contributes to adverse pregnancy outcomes, but how the policy change leads to adverse pregnancy outcomes is not well elaborated. In this study, we aimed to compare maternal characteristics and complications, accessed the change in the proportion of maternal characteristics and maternal complications, and evaluated the mediation of maternal characteristics on maternal complications. METHODS Demographic and clinical data of three-level sample facilities were extracted from China's National Maternity Near Miss Obstetrics Surveillance System from Jan 1, 2012 to May 31, 2021. The associations between the universal two-child policy and maternal risk factors, the universal two-child policy and maternal complications, and maternal risk factors and maternal complications were evaluated using multivariate logistic regression analyses, with odds ratios (ORs) and 95% confidence intervals (CIs). Mediation analysis was used to estimate the potential mediation effects on the associations between the policy and maternal complications. Population-attributable fractions (PAF) were conducted to quantify the maternal complications burden attributable to the implementation of the universal two-child policy. RESULTS In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facilities. After adjusting for covariables, there were significant associations between the universal two-child policy and maternal risk factors (P < 0.001), the universal two-child policy and an increased risk of maternal complications (P < 0.001), and maternal risk factors and maternal complications(P < 0.001). The effects of the universal two-child policy on maternal near miss and medical disease were significantly mediated by maternal risk factors with mediation proportions of 19.77% and 4.07% at the municipal-level sample facility, and mediation proportions for 2.72% at the county-level sample facility on medical disease. The universal two-child policy contributed 19.34%, 5.82%, 8.29%, and 46.19% in the incidence of the maternal near miss, antepartum or intrapartum complication, post-partum complication, and medical disease at municipal-level sample facility, respectively. The corresponding PAF% at county-level sample facility was 40.49% for maternal near miss, 32.39% for the antepartum or intrapartum complication, 61.44% for post-partum complication, and 77.72% for medical disease. For provincial-level sample facility, the incidence of maternal near miss, antepartum or intrapartum complications, and medical diseases decreased (P < 0.05) and no statistically significant difference occurred in the incidence of post-partum complications. CONCLUSIONS In the context of the universal two-child policy, the incidence of maternal near miss, antepartum or intrapartum complication, and post-partum complication increased at municipal- and county-level sample facility. Maternal risk factors may play a mediating role in the effect of policy change and maternal complications. Provincial hospitals have been able to improve the quality of perinatal health care and reduce adverse pregnancy outcomes by adjusting their obstetric service strategies in the context of the new birth policy.
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Affiliation(s)
- Li-Hua Lin
- Department of Healthcare, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China
| | - Qiuping Lin
- Department of Traditional Chinese Medicine, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Xiao-Mei Wang
- Department of Obstetrics, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China
| | - Rong-Hua Zhang
- Department of Obstetrics, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China
| | - Liang-Hui Zheng
- Department of Obstetrics, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China
| | - Huibin Zhang
- Department of Pathology, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Maternity and Child Health Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, People's Republic of China.
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Anupama Marnal BA, Poornima M, Sapna HP. Unusual case of placenta accreta - A Case Report. APOLLO MEDICINE 2022. [DOI: 10.4103/am.am_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Intestinal immunoregulation: lessons from human mendelian diseases. Mucosal Immunol 2021; 14:1017-1037. [PMID: 33859369 DOI: 10.1038/s41385-021-00398-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023]
Abstract
The mechanisms that maintain intestinal homeostasis despite constant exposure of the gut surface to multiple environmental antigens and to billions of microbes have been scrutinized over the past 20 years with the goals to gain basic knowledge, but also to elucidate the pathogenesis of inflammatory bowel diseases (IBD) and to identify therapeutic targets for these severe diseases. Considerable insight has been obtained from studies based on gene inactivation in mice as well as from genome wide screens for genetic variants predisposing to human IBD. These studies are, however, not sufficient to delineate which pathways play key nonredundant role in the human intestinal barrier and to hierarchize their respective contribution. Here, we intend to illustrate how such insight can be derived from the study of human Mendelian diseases, in which severe intestinal pathology results from single gene defects that impair epithelial and or hematopoietic immune cell functions. We suggest that these diseases offer the unique opportunity to study in depth the pathogenic mechanisms leading to perturbation of intestinal homeostasis in humans. Furthermore, molecular dissection of monogenic intestinal diseases highlights key pathways that might be druggable and therapeutically targeted in common forms of IBD.
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Wang YL, Weng SS, Huang WC. First-trimester abortion complicated with placenta accreta: A systematic review. Taiwan J Obstet Gynecol 2019; 58:10-14. [DOI: 10.1016/j.tjog.2018.11.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 11/28/2022] Open
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Wang YL, Su TH, Huang WC, Weng SS. Laparoscopic management of placenta increta after late first-trimester dilation and evacuation manifesting as an unusual uterine mass. J Minim Invasive Gynecol 2011; 18:250-3. [PMID: 21354073 DOI: 10.1016/j.jmig.2010.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/31/2010] [Accepted: 11/02/2010] [Indexed: 12/23/2022]
Abstract
Placenta increta is a rare and potentially life-threatening complication of pregnancy. The initial symptoms are generally vaginal bleeding during difficult placental removal in the third trimester. However, placenta increta may complicate first- and early second-trimester pregnancy loss. The diagnosis may be difficult during early pregnancy because the lesion is difficult to identify. Herein is reported the case of a woman with a diagnosis of placenta increta that caused prolonged bleeding after a late first-trimester abortion and manifested as an unusual lower segment uterine mass. Management included laparoscopy, and the placental tissue was completely removed successfully and uneventfully.
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Affiliation(s)
- Yeou-Lih Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
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Vyshka G, Çapari N, Shaqiri E. Placenta increta causing hemoperitoneum in the 26th week of pregnancy: a case report. J Med Case Rep 2010; 4:412. [PMID: 21176187 PMCID: PMC3017074 DOI: 10.1186/1752-1947-4-412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 12/22/2010] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Placenta increta is a serious complication of pregnancy. We describe a case leading to uterine rupture associated with massive intra-abdominal hemorrhage. CASE PRESENTATION A 34-year-old Caucasian Albanian woman, gravida 2, para 1, was admitted to the emergency department of our hospital for acute abdominal pain associated with profound secondary anemia. An anatomopathological diagnosis of placenta increta destruens was made. An urgent hysterectomy was performed after resuscitation procedures, applied due to the severe anemia and the abdominal drama accompanying the case. Intra-operatively, a uterus-saving procedure was found to be impossible, and hysterectomy remained the only surgical option. The uterine structures were sent for further microscopic evaluation. On histological examination, deep trophoblastic infiltration of the uterine wall was observed, justifying the surgeon's decision. Our patient received blood transfusions and antibiotics. Her sutures were removed on the eighth postoperative day and she was discharged the following day in a stable condition. CONCLUSION This case, describing a patient with uterine rupture and massive hemorrhage, illustrates a serious and potentially fatal complication of placenta previa. In such cases, surgery is essential, and hysterectomy may be the only viable option.
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Affiliation(s)
- Gentian Vyshka
- Biomedical & Experimental Department, Faculty of Medicine, Rr. Dibrës 371, Tirana, Albania
| | | | - Elmas Shaqiri
- Department of Forensic Pathology, Institute of Legal Medicine, Rr. Dibrës 372, Tirana, Albania
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Son G, Kwon J, Cho H, Kim S, Yoon B, Nam E, Kim J, Kim Y, Kim J, Cho N, Kim S. A case of placenta increta presenting as delayed postabortal intraperitoneal bleeding in the first trimester. J Korean Med Sci 2007; 22:932-5. [PMID: 17982250 PMCID: PMC2693868 DOI: 10.3346/jkms.2007.22.5.932] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Placenta increta is an uncommon and life-threatening complication of pregnancy characterized by complete or partial absence of the decidua basalis. Placenta increta usually presents with vaginal bleeding during difficult placental removal in the third-trimester. Although placenta increta may complicate first and early second-trimester pregnancy loss, the diagnosis can be very difficult during early pregnancy and thus the lesion is difficult to identify. We encountered with a woman who was diagnosed with placenta increta after receiving emergency hysterectomy due to intraperitoneal bleeding 2 months after an uncomplicated dilatation and curettage in the first trimester. Therefore, we report this case with a brief review of the literature.
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Affiliation(s)
- Gahyun Son
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jieun Kwon
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyejin Cho
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Sangwun Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Bosung Yoon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Eunji Nam
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Jaehoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Youngtae Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewook Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
| | - Namhoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
- Women's Cancer Clinic, Yonsei University College of Medicine, Seoul, Korea
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Comstock CH. Antenatal diagnosis of placenta accreta: a review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:89-96. [PMID: 15971281 DOI: 10.1002/uog.1926] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The incidence of placenta accreta should rise steadily over the next century as the frequency of Cesarean sections and advanced maternal age, both independent risk factors, increases. Patients who are at risk should be identified before an ultrasound examination and the characteristic findings searched for. In the first trimester, these include a low-lying sac that appears to be attached to the anterior wall of the uterus. As early as 16 weeks irregular vascular sinuses appear, which have turbulent flow within. The bladder wall may appear interrupted or have small bulges of the placenta into the bladder space. Absence of the normal echolucent space between the placenta and myometrium is not a reliable sign by itself, since this space may be absent in normal patients with an anterior placenta. Color Doppler will show that some of the placental sinuses traverse the uterine wall. Magnetic resonance imaging has not yet been shown to aid in the diagnosis, but in the future, with improvement of resolution and shortened sequences, it should be particularly useful in identifying the patients that have placenta percreta.
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Affiliation(s)
- C H Comstock
- Division of Fetal Imaging, Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
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Lichtenberg ES, Frederiksen MC. Cesarean scar dehiscence as a cause of hemorrhage after second-trimester abortion by dilation and evacuation. Contraception 2004; 70:61-4. [PMID: 15208054 DOI: 10.1016/j.contraception.2004.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2003] [Revised: 02/17/2004] [Accepted: 02/17/2004] [Indexed: 12/01/2022]
Abstract
Women who have had a cesarean section have a risk of uterine rupture when undergoing a second-trimester pregnancy termination. Beyond the first trimester, uterine rupture has been associated with the use of labor-induction agents and, less often, a placenta accreta. Scar dehiscence, a less disruptive form of scar separation, has not been reported with dilation and evacuation abortion. We present two cases of uterine scar dehiscence causing serious bleeding after otherwise uncomplicated dilatation and evacuation procedures. Neither case was associated with uterine contractions, an iatrogenic perforation or placenta accreta. Uterine scar dehiscence, a surreptitious process, can be the cause of hemorrhage after uncomplicated dilatation and evacuation.
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Affiliation(s)
- E Steve Lichtenberg
- Department of Obstetrics and Gynecology, Northwestern University Feinberg Medical School, Chicago, IL, USA.
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PLACENTA INCRETA PRESENTING AS DELAYED POSTABORTAL HEMORRHAGE. Obstet Gynecol 1999. [DOI: 10.1097/00006250-199905001-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Innes G, Rosen P. An unusual cause of abdominal pain and shock in pregnancy: case report and review of the literature. J Emerg Med 1985; 2:361-6. [PMID: 3910716 DOI: 10.1016/0736-4679(85)90291-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A near fatal case of spontaneous uterine rupture resulting from placenta percreta is presented. Placenta accreta refers to all conditions in which placental villi attach to, invade, or penetrate the myometrium. Placenta percreta is the most extreme form of morbid placental attachment and is said to exist when the uterine wall is completely breached by invading placental villi. Although uncommon, placenta percreta is an important entity of which the emergency physician should be aware because of its propensity to cause uterine rupture and catastrophic bleeding. This article reviews the pathophysiology, presentation, diagnosis, and emergency department management of placenta accreta, increta, and percreta.
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