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Song Z, Wang P, Zou L, Zhou Y, Wang X, Liu T, Zhang D. Enhancing postpartum hemorrhage prediction in pernicious placenta previa: a comparative study of magnetic resonance imaging and ultrasound nomogram. Front Physiol 2023; 14:1177795. [PMID: 37614762 PMCID: PMC10443221 DOI: 10.3389/fphys.2023.1177795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Objective: To explore the risk factors of postpartum hemorrhage (PPH) in patients with pernicious placenta previa (PPP) and to develop and validate a clinical and imaging-based predictive model. Methods: A retrospective analysis was conducted on patients diagnosed surgically and pathologically with PPP between January 2018 and June 2022. All patients underwent PPP magnetic resonance imaging (MRI) and ultrasound scoring in the second trimester and before delivery, and were categorized into two groups according to PPH occurrence. The total imaging score and sub-item prediction models of the MRI risk score/ultrasound score were used to construct Models A and B/Models C and D. Models E and F were the total scores of the MRI combined with the ultrasound risk and sub-item prediction model scores. Model G was based on the subscores of MRI and ultrasound with the introduction of clinical data. Univariate logistic regression analysis and the logical least absolute shrinkage and selection operator (LASSO) model were used to construct models. The receiver operating characteristic curve andision curve analysis (DCA) were drawn, and the model with the strongest predictive ability and the best clinical effect was selected to construct a nomogram. Internal sampling was used to verify the prediction model's consistency. Results: 158 patients were included and the predictive power and clinical benefit of Models B and D were better than those of Models A and C. The results of the area under the curve of Models B, D, E, F, and G showed that Model G was the best, which could reach 0.93. Compared with Model F, age, vaginal hemorrhage during pregnancy, and amniotic fluid volume were independent risk factors for PPH in patients with PPP (p < 0.05). We plotted the DCA of Models B, D, E, F, and G, which showed that Model G had better clinical benefits and that the slope of the calibration curve of Model G was approximately 45°. Conclusion: LASSO regression nomogram based on clinical risk factors and multiple conventional ultrasound plus MRI signs has a certain guiding significance for the personalized prediction of PPH in patients with PPP before delivery.
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Affiliation(s)
- Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Pengyuan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lue Zou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangzi Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoxue Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tong Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Zhao B, Yin L, Chu W, Wang F, Huo P, Gao J. Radio frequency ablation for the intrauterine treatment of giant placental chorioangioma associated with fetal compromise: A case report. Birth Defects Res 2023; 115:251-257. [PMID: 36259564 DOI: 10.1002/bdr2.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/21/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
Giant placental chorioangiomas associated with fetal hyperdynamic circulation complications are rare to see. Here, we summarized a case of giant placental chorioangioma associated with fetal anemia and heart failure treated by radiofrequency ablation (RFA) combined with cordocentesis and intrauterine transfusion. The sonographic appearance of the placental chorioangioma was atypical which was isoechoic with unclear boundary. RFA was performed successfully at 27 weeks of gestation, when the chorioangioma has increased to 17.0 × 10.6 × 12.3 cm3 . Unfortunately, intrauterine fetal demise was found on the first day after operation. After induction of labor, it was pathologically confirmed as placental chorioangioma.
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Affiliation(s)
- Bingyi Zhao
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lu Yin
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Chu
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fangna Wang
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ping Huo
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Jian Gao
- Department of Reproductive and Genetic Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
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Dall'Asta A, Forlani F, Shah H, Paramasivam G, Yazbek J, Bourne T, Calì G, Lees C. Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:e118-e124. [PMID: 33556967 DOI: 10.1055/a-1309-1665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To evaluate perioperative outcomes and the prognostic role of the tramline sign in a cohort of women with anterior placenta previa. MATERIALS AND METHODS Retrospective analysis of 3D ultrasound volumes from women with anterior placenta previa who underwent ultrasound examination beyond 32 weeks. 3D and 3D color volumes were obtained from a sagittal section of the uterus bisecting a partially full bladder and processed using Crystal Vue and Crystal Vue Flow rendering to look for the "tramline sign". "Partial obliteration" was defined as a loss of some or part of the uterine-serosal interface and "full obliteration" as when both interfaces were interrupted. Postnatal ascertainment of placenta accreta spectrum (PAS) was confirmed by findings recorded intraoperatively or on a pathology report. RESULTS 65 cases were included. The tramline sign was "partially" (17) or "fully" (19) obliterated in 36 cases (55.4 %), and present in 29 (44.6 %). Obliteration was associated with earlier gestational age at delivery (35 + 1 (26 + 3-38 + 3) vs. 36 + 4 (25 + 3-38 + 0) weeks, p = 0.005), greater estimated blood loss (800 (400-11 000) vs. 600 (300-2100) mls, p = 0.003), longer operative time (155 (60-240) vs. 54 (25-80) minutes, p < 0.001), higher rate of hysterectomy (97.2 % vs. 0.0 %, p < 0.001), longer postoperative admission (7 (3-19) vs. 3 (1-5) days, p < 0.001) and a 100 % rate of postnatal diagnosis of PAS. The finding of an "obliterated" tramline sign identified all women that required hysterectomy and all cases of PAS. CONCLUSION A "partially or fully obliterated" tramline sign is strongly associated with indicators of operative complexity, the postnatal confirmation of PAS, and the need for peripartum hysterectomy.
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Affiliation(s)
- Andrea Dall'Asta
- Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Francesco Forlani
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - Harsha Shah
- Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
| | - Gowrishankar Paramasivam
- Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom
| | - Joseph Yazbek
- Department of Gynaecologic Oncology, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Tom Bourne
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Giuseppe Calì
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy
| | - Christoph Lees
- Queen Charlottes and Chelsea Hospital, Imperial College Hleathcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, United Kingdom
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound. Diagnostics (Basel) 2022; 12:diagnostics12112810. [PMID: 36428871 PMCID: PMC9689386 DOI: 10.3390/diagnostics12112810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue.
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Jie HY, Zhou X, Zhao MP, Hu M, Mai QY, Zhou CQ. Pregnancy outcomes in patients with polycystic ovary syndrome who conceived after single thawed blastocyst transfer: a propensity score-matched study. BMC Pregnancy Childbirth 2022; 22:718. [PMID: 36127673 PMCID: PMC9487057 DOI: 10.1186/s12884-022-05011-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background It remains unclear whether polycystic ovary syndrome (PCOS) is an independent risk factor for pregnancy complications in women undergoing assisted reproductive technology (ART) treatment. For the integrative treatment of PCOS patients, it is still important to investigate the pregnancy outcomes of PCOS patients after adjusting for potential biases, such as body mass index, embryo quality and endometrial preparation method. Methods This retrospective cohort study ultimately included a total of 336 PCOS patients who conceived after single thawed blastocyst transfer in the PCOS group and 2,325 patients in the control group from January 2018 to December 2020. A propensity score matching (PSM) model was used, and 336 PCOS patients were matched with 336 patients in the control group. Results Before PSM, no differences in the miscarriage rate, pregnancy complication rate, preterm birth rate, or live birth rate were found between the PCOS group and the control group. After PSM, the late miscarriage rate of the PCOS group was significantly higher than that of the control group (3.3% vs. 0.6%, P = 0.040), although the early miscarriage rates were similar (14.0% vs. 13.7%). The rates of pregnancy complications, preterm birth and live birth in the PCOS group were comparable to those in the matched control group (P = 0.080, P = 0.105, P = 0.109, respectively). The neonatal weights of male infants and female infants were similar between the two groups (P = 0.219, P = 0.169). Subgroup analysis showed that PCOS patients with homeostasis model assessment of insulin resistance (HOMA-IR) levels ≥ 2.49 had a significantly increased risk of preterm birth compared with those with HOMA-IR levels < 1.26 and 1.26 ≤ HOMA-IR levels < 2.49 (26.0% vs. 6.0% vs. 9.8%, P = 0.005). PCOS patients with total testosterone levels ≥ 0.7 ng/ml had a higher early miscarriage rate but a lower late miscarriage rate than those with total testosterone levels < 0.7 ng/ml (29.4% vs. 12.3%, 0% vs. 3.6%, respectively, P = 0.032). Conclusions PCOS is an independent risk factor for late miscarriage in patients conceived after a single thawed blastocyst transfer, even after adjusting for biases. Among PCOS patients, insulin resistance and hyperandrogenism are associated with a higher risk of preterm birth and early miscarriage, respectively. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05011-4.
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Affiliation(s)
- Hui-Ying Jie
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiu Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Ming-Peng Zhao
- Department of Reproductive Medicine, Department of Obstetrics and Gynaecology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Min Hu
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Qing-Yun Mai
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Can-Quan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
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Zou L, Wang P, Song Z, Wang X, Chen X, Zhang M, Zhang D. Effectiveness of a fetal magnetic resonance imaging scoring system for predicting the prognosis of pernicious placenta previa: A retrospective study. Front Physiol 2022; 13:921273. [PMID: 36035494 PMCID: PMC9402898 DOI: 10.3389/fphys.2022.921273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The value of multiple magnetic resonance imaging (MRI) signs in predicting pernicious placenta previa (PPP) with placenta accreta spectrum disorders (PAS) is still controversial. This study aimed to investigate the value of a self-made fetal magnetic resonance imaging scoring system in predicting the different types of PAS in pernicious placenta previa and its associated risk of bleeding. Methods: This retrospective study included 193 patients diagnosed with PPP based on MRI findings before delivery. Based on pathological and intraoperative findings, we divided patients into four groups: non-PAS, placental adhesion, placental implantation, and placenta percreta. Receiver operator characteristic curves of the MRI total score and placental implantation type were drawn using pROC packages in the R Studio environment, and cutoff values of each type were calculated, as well as diagnostic evaluation indexes, such as sensitivity, specificity, and the Youden index. Hemorrhage during surgery was compared between the groups. Results: The boundary value between the non-PAS and placental adhesion was 5.5, that between placental adhesion and placental implantation was 11.5, and that between placental implantation and placenta percreta was 15.5 points. The respective specificities were 0.700, 0.869, and 0.958, and the respective sensitivities were 0.994, 0.802, and 0.577. The Youden indices were 0.694, 0.671, and 0.535, respectively. The median (minimum, maximum) quantities of hemorrhage during the operation in the non-PAS, placental adhesion, placental implantation, and placenta percreta groups were 225 (100, 3700), 600 (200, 6000), 1500 (300, 7000), and 3000 (400, 6300) ml, respectively. Hemorrhage was significantly different between the four groups (p < 0.001). Conclusion: These results suggest that the proposed MRI scoring system could be an effective diagnostic tool for assessing PPP types and predicting the associated bleeding risk.
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Affiliation(s)
- Lue Zou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Pengyuan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoxue Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueting Chen
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Mingjie Zhang
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Dandan Zhang,
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto-Torres EE, Tirosh D, Jaiman S, Johnson A. Doppler evaluation of normal and abnormal placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:28-41. [PMID: 34806234 DOI: 10.1002/uog.24816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M F Bartal
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Jaiman
- Department of Obstetrics and Gynecology Wayne State University, Detroit, MI, USA
| | - A Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Wang Y, Zhou Y, Zeng L, Chen L, Zhao Y. Analysis of risk factors for massive intraoperative bleeding in patients with placenta accreta spectrum. BMC Pregnancy Childbirth 2022; 22:116. [PMID: 35148709 PMCID: PMC8832829 DOI: 10.1186/s12884-022-04391-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/11/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To analyze relevant factors for massive postpartum hemorrhage in women with placenta accreta spectrum in order to improve the ability to identify those at risk for intraoperative bleeding and improve outcome. METHODS This study is a retrospective study and based on data from Hospital electronic medical record. Placenta accreta patients who delivered by cesarean section at Peking University Third Hospital from September 2017 to December 2019 were selected and included. According to the amount of intraoperative bleeding, they were categoried into the massive bleeding group (bleeding volume ≥ 2000 mL, 68 cases) and non-massive bleeding group (bleeding volume < 2000 mL, 99 cases). Univariate analysis and multivariate logistic regression were used to analyze the correlations between related risk factors or ultrasound imaging characteristics and the severity of bleeding during operation. RESULTS (1) There were statistically significant differences in gravidity, parity, number of prior cesarean deliveries and placenta accreta ultrasound scores (P < 0.05) between the two groups of patients. (2) Among the ultrasonographic indicators, the disappearance of the post-placental clear space, the emergence of cross-border blood vessels in the region of subplacental vascularity, interruption or disappearance of the bladder line, and the presence of the cervical blood sinus had the most significant correlation with hemorrhage during PAS (P < 0.05). CONCLUSION The presence of cervical blood sinus, interruption or disappearance of bladder line, the disappearance of the post-placental clear space and abnormal subplacental vascularity are independent risk factors for massive hemorrhage during PAS. We should pay more attention to these indicators in prenatal ultrasound examination in order to reduce the intraoperative bleeding and improve maternal outcomes.
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Affiliation(s)
- Yuanyuan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yadan Zhou
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital, Zhengzhou, 450007, Henan, China
| | - Lin Zeng
- Research Centre of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
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Marcellin L, Goffinet F, Azria E, Thomin A, Garabedian C, Sibiude J, Verspyck E, Koskas M, Santulli P, Rousseau J, Ancel PY, Chapron C. Association Between Endometriosis Phenotype and Preterm Birth in France. JAMA Netw Open 2022; 5:e2147788. [PMID: 35133433 PMCID: PMC8826171 DOI: 10.1001/jamanetworkopen.2021.47788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Endometriosis is an inflammatory disease with a heterogeneous presentation that affects women of childbearing age. Given the limitations of previous retrospective studies, it is still unclear whether endometriosis has adverse implications for pregnancy outcomes. OBJECTIVE To evaluate the association between the presence of endometriosis and preterm birth and whether the risk varied according to the disease phenotype. DESIGN, SETTING, AND PARTICIPANTS This cohort study with exposed and unexposed groups was conducted in 7 maternity units in France from February 4, 2016, to June 28, 2018. Participants included women with singleton pregnancies who were followed up before 22 weeks' gestation along with their newborns delivered at or after 22 weeks' gestation. The final follow-up occurred in July 2019. Data were analyzed from October 7, 2020, to February 7, 2021. EXPOSURES Women in the endometriosis group had a documented history of endometriosis and were classified according to 3 endometriosis phenotypes: isolated superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA; potentially associated with SUP), and deep endometriosis (DE; potentially associated with SUP and OMA). Women in the control group did not have a history of clinical symptoms of endometriosis before their current pregnancy. MAIN OUTCOMES AND MEASURES The primary outcome was preterm birth between 22 weeks and 36 weeks 6 days of gestation. Association between endometriosis and the primary outcome was assessed through univariate and multivariate logistic regression analyses and was adjusted for the following risk factors associated with preterm birth: maternal age, body mass index (calculated as weight in kilograms divided by height in meters squared) before pregnancy, country of birth, parity, previous cesarean delivery, history of myomectomy and hysteroscopy, and preterm birth. The same analysis was performed according to the 3 endometriosis phenotypes (SUP, OMA, and DE). RESULTS Of the 1351 study participants (mean [SD] age, 32.9 [5.0] years) who had a singleton delivery after 22 weeks of gestation, 470 were assigned to the endometriosis group (48 had SUP [10.2%], 83 had OMA [17.7%], and 339 had DE [72.1%]) and 881 were assigned to the control group. No difference was observed in the rate of preterm deliveries before 37 weeks 0 days of gestation between the endometriosis and control groups (34 of 470 [7.2%] vs 53 of 881 [6.0%]; P = .38). After adjusting for confounding factors, endometriosis was not associated with preterm birth before 37 weeks' gestation (adjusted odds ratio, 1.07; 95% CI, 0.64-1.77). The results were comparable for the different disease phenotypes (SUP: 6.2% [3 of 48]; OMA: 7.2% [6 of 83]; and DE: 7.4% [25 of 339]; P = .84). CONCLUSIONS AND RELEVANCE This cohort study found no association between endometriosis and preterm birth, and the disease phenotype did not appear to alter the result. Monitoring the pregnancy beyond the normal protocols or changing management strategies for women with endometriosis may not be warranted to prevent preterm birth.
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Affiliation(s)
- Louis Marcellin
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Francois Goffinet
- Université de Paris, Paris, France
- Port-Royal Maternity, AP-HP, Centre-University of Paris, Federation Hospitalo-Universitaire for Prematurity, Paris, France
| | - Elie Azria
- Maternité Notre-Dame-de-Bon-Secours, Groupe Hospitalier Paris-Saint-Joseph, Paris, France
| | - Anne Thomin
- Sorbonne Université, Paris, France
- Trousseau Hospital, AP-HP, Paris, France
| | - Charles Garabedian
- University Lille, Unité Lilloise de Recherche 2694, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Department of Obstetrics, Lille, France
| | - Jeanne Sibiude
- Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, AP-HP Hôpital Louis Mourier, Colombes, France
| | - Eric Verspyck
- Service de Gynécologie et Obstétrique, CHU de Rouen, Rouen, France
| | - Martin Koskas
- Université de Paris, Paris, France
- Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France
| | - Pietro Santulli
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Jessica Rousseau
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Clinical Research Unit, Center for Clinical Investigation P1419, AP-HP, Paris, France
- Centre de Recherche Épidémiologiques et Bio Statistiques de Sorbonne Paris Cité, Obstetrical Perinatal and Pediatric Epidemiology Research Team, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Charles Chapron
- Université de Paris, Paris, France
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
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Rouzi AA, Sulaimani M. Damage-Control Surgery for Maternal Near-Miss Cases of Placenta Previa and Placenta Accreta Spectrum. Int J Womens Health 2021; 13:1161-1165. [PMID: 34858065 PMCID: PMC8631974 DOI: 10.2147/ijwh.s334743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose There is paucity of reports on damage control surgery use in near-miss cases associated with placenta previa, and placenta accreta spectrum. The objective is to report the outcome of damage control surgery for the obstetrical hemorrhage in near-miss cases of placenta previa and placenta accreta spectrum. Materials and Methods The records of all women who had damage control surgery defined as abdominopelvic packing, followed by a period of medical stabilization in the intensive care unit for near-miss placenta previa and placenta accreta spectrum at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between November 1, 2007, and March 1, 2020, were identified and reviewed. Results During the study period, seven women met the inclusion criteria. There were three women with placenta previa, three women with placenta previa accreta, and one woman with placenta accreta. Five women had cesarean section followed by laparotomy, hysterectomy, and damage control surgery, one woman had a cesarean hysterectomy and damage control surgery, and one woman had hysterectomy and damage control surgery. Estimated “near-miss” intraoperative bleeding ranged from 2 to 7 liters for the seven women (median 5 L; IQR 3.5, 6), which was managed by massive blood transfusion. Complications included disseminated intravascular coagulation (3 women), intestinal obstruction (1 woman), acute renal failure (1 woman), and vesicovaginal fistula (1 woman). Hospital stay ranged from 8 to 44 days (median 37; IQR 21, 39). Conclusion Damage control surgery can be life-saving. It should be in the armamentarium of the health care providers managing women with placenta previa, and placenta accreta spectrum.
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Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Sulaimani
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
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Liu N, Hu Q, Liao H, Wang X, Yu H. Vasa previa: Perinatal outcomes in singleton and multiple pregnancies. Biosci Trends 2021; 15:118-125. [PMID: 33746156 DOI: 10.5582/bst.2021.01052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vasa previa (VP) is a rare and life-threatening condition for the fetus. It is associated with increased perinatal mortality rates. The current study sought to retrospectively analyze the perinatal outcomes of VP in singleton and multiple pregnancies between January 1, 2013 and December 31, 2019 at a tertiary hospital in west China. One hundred and fifty-seven cases of VP were identified, including 131 singletons, 23 twins and 3 triplets. VP in 20 cases was diagnosed at delivery. There were 183 live births. Neonatal mortality was significantly higher in cases with no prenatal diagnosis (9.7% vs. 1.3%, p = 0.035). There was a significantly higher rate of NICU admission, premature infant and neonatal pneumonia in cases with prenatal diagnosis (p < 0.05). Among twin pregnancies with VP as a prenatal diagnosis, there were significantly earlier gestational age at admission (31.1 vs. 34.1 weeks, p = 0.000) and delivery age (33.4 vs. 35.3 weeks, p = 0.000) than those among singleton pregnancies. The neonatal mortality in twins with prenatal diagnosis was significantly higher than that in singletons (0% vs. 6.9%, p = 0.037). Early hospitalization of VP in the third trimester may be reasonable. The data suggest that the timing of elective delivery at 34-36 weeks in singletons and 32-34 weeks in twins may be suitable. It should be emphasized to make corresponding optimal delivery time according to individual differences for the women, especially in twin pregnancy.
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Affiliation(s)
- Na Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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12
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Shipp TD, Poder L, Feldstein VA, Oliver ER, Promes SB, Strachowski LM, Sussman BL, Wang EY, Weber TM, Winter T, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding. J Am Coll Radiol 2020; 17:S497-S504. [PMID: 33153560 DOI: 10.1016/j.jacr.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Vaginal bleeding can occur throughout pregnancy with varied etiologies. Although history and physical examination can identify many etiologies, imaging, in particular ultrasound (US), is the backbone of current medical practice. US pregnant uterus transabdominal, US pregnant uterus transvaginal, and US duplex Doppler velocimetry are usually appropriate for the evaluation of women with painless vaginal bleeding, those with painful vaginal bleeding, and also for those with second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. US cervix transperineal may be appropriate for those with painless or painful vaginal bleeding but is usually not appropriate for second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. Because the outcome of pregnancies is unequivocally related to the specific etiology of the vaginal bleeding, knowledge of imaging results directly informs patient management to optimize the outcome for mother and fetus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists.
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan B Promes
- Penn State Health, Hershey, Pennsylvania; American College of Emergency Physicians
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2020; 72:13-24. [PMID: 32747328 DOI: 10.1016/j.bpobgyn.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) disorders allows planned management by a multidisciplinary team in a tertiary center, and thus can reduce hemorrhagic morbidity, compared with intrapartum diagnosis. Previous Cesarean section and placenta previa are the two most common risk factors. Prenatal ultrasound is a promising diagnostic tool for PAS in the second or third trimester. Recent evidence shows sonographic markers of PAS can be present in the first trimester. Prenatal ultrasound may help predict the depth and topography of placental invasion which are the major determinants of maternal morbidity. The presence of increased vascularity in the inferior part of the lower uterine segment and the parametrial region is associated with a more severe disorder according to a newly proposed staging system. In this chapter, we will discuss how to improve the prediction of PAS, the depth, and topography of placental invasion.
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Affiliation(s)
- Florrie N Y Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; Gleneagles Hong Kong, Hong Kong SAR, China.
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Evaluation of perioperative complications using a newly described staging system for placenta accreta spectrum. Eur J Obstet Gynecol Reprod Biol 2020; 250:54-60. [PMID: 32387893 DOI: 10.1016/j.ejogrb.2020.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The antenatal diagnosis of placenta accreta spectrum (PAS) is in large part subjective and based on expert interpretation. The aim of this study was to externally evaluate a recently developed staging system based on specific and defined prenatal ultrasound (US) features in a cohort of women at risk of PAS undergoing specialist prenatal US, in particular relating to surgical morbidity at delivery. MATERIALS AND METHODS Database study of cases with confirmed placenta previa. In all, the placenta was evaluated in a systematic fashion. PAS was subclassified in PAS0-PAS3 according to the loss of clear zone, placental lacunae, bladder wall interruption, uterovesical hypervascularity and increased vascularity in the parametrial region. RESULTS 43 cases were included, of whom 33 had major placenta previa. 31 cases were categorized as PAS0; 3, 4 and 5 cases as PAS1, PAS2 and PAS3, respectively. All women underwent caesarean section and hysterectomy was required in 10. The comparison of the perinatal outcomes among the PAS categories yielded greater operative time (50 (35-129) minutes for PAS0 vs 70 (48-120) for PAS1 vs 95 (60-150) for PAS2 vs 100 (87-180) for PAS3, p < 0.001) and estimated blood loss (800 (500-2500) mls for PAS0 vs 3500 (800-7500) for PAS1 vs 2850 (500-7500) for PAS2 vs 6000 (2500-11000) for PAS3, p < 0.001) for the highest PAS categories, which were also associated with a higher rate of hysterectomy (p < 0.001), blood transfusion (p = 0.002) and admission to ITU or HDU (p < 0.001) and longer postoperative admission of 3 (1-9) days for PAS0 vs 3 (2-12) for PAS1 vs 4.5 (3-6) for PAS2 vs 5 (3-22) for PAS3, p = 0.02. CONCLUSION Perioperative complications are closely associated with PAS stage. This information is useful for counselling women and may be important in allocating staff and infrastructure resources at the time of delivery.
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15
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di Pasquo E, Ghi T, Calì G, D'Antonio F, Fratelli N, Forlani F, Prefumo F, Kaihura CT, Volpe N, Dall'Asta A, Frusca T. Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:460-466. [PMID: 31503353 DOI: 10.1002/uog.21866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/16/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a new ultrasound sign, intracervical lakes (ICL), in predicting the presence of placenta accreta spectrum (PAS) disorder and delivery outcome in patients with placenta previa or low-lying placenta. METHODS This was a retrospective multicenter study of women with placenta previa or low-lying placenta at ≥ 26 weeks' gestation, who were referred to three Italian tertiary units from January 2015 to September 2018. The presence of ICL, defined as tortuous anechoic spaces within the cervix which appeared to be hypervascular on color Doppler, was evaluated on ultrasound images obtained at the time of referral. The primary aim was to explore the diagnostic accuracy of ICL in detecting the presence and depth of PAS disorder. The secondary aim was to explore the accuracy of this sign in predicting total estimated blood loss, antepartum bleeding, major postpartum hemorrhage at the time of Cesarean section and need for Cesarean hysterectomy. The diagnostic accuracy of ICL in combination with typical sonographic signs of PAS disorder, was assessed by computing summary estimates of sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and diagnostic odds ratios (DOR). RESULTS A total of 332 women with placenta previa or low-lying placenta were included in the analysis, with a median maternal age of 33.0 (interquartile range, 29.0-37.0) years. ICL were noted in 15.1% of patients. On logistic regression analysis, the presence of ICL was associated independently with major postpartum hemorrhage (odds ratio (OR), 3.3 (95% CI, 1.6-6.5); P < 0.001), Cesarean hysterectomy (OR, 7.0 (95% CI, 2.1-23.9); P < 0.001) and placenta percreta (OR, 2.8 (95% CI, 1.3-5.8); P ≤ 0.01), but not with the presence of any PAS disorder (OR, 1.6 (95% CI, 0.7-3.5); P = 0.2). Compared with the group of patients without ultrasound signs of PAS disorder, the presence of at least one typical sonographic sign of PAS disorder in combination with ICL had a DOR of 217.2 (95% CI, 27.7-1703.4; P < 0.001) for placenta percreta and of 687.4 (95% CI, 121.4-3893.0; P < 0.001) for Cesarean hysterectomy. CONCLUSION ICL may represent a marker of deep villus invasion in women with suspected PAS disorder on antenatal sonography and anticipate the occurrence of severe maternal morbidity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E di Pasquo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Calì
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - F D'Antonio
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Science, UiT, The Arctic University of Norway, Tromsø, Norway
| | - N Fratelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - F Forlani
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - C T Kaihura
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - N Volpe
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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16
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Retrospective Evaluation of Patients with Placenta Previa. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.591664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Zhu L, Xie L. Value of ultrasound scoring system for assessing risk of pernicious placenta previa with accreta spectrum disorders and poor pregnancy outcomes. J Med Ultrason (2001) 2019; 46:481-487. [PMID: 31392444 DOI: 10.1007/s10396-019-00965-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/01/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate a system for assessing the risk of pernicious placenta previa (PPP) with placenta accreta spectrum (PAS) disorders and poor pregnancy outcomes. METHODS This prospective study focused on PPP women at ≥ 28 weeks' pregnancy. Transabdominal or transvaginal ultrasonography was used to assess PAS and poor pregnancy outcomes with a system involving uteroplacental demarcation, number and size of lacunae, bladder line, and placental basal and lacunae flow. Every item was assigned 0-2 points, and the sum yielded the final score. Diagnosis of PAS was based on surgery or pathology. One or more of postpartum hemorrhage (PPH) ≥ 1000 ml, hysterectomy, and organ invasion were regarded as a poor pregnancy outcome. Receiver operating characteristic (ROC) curves were generated. RESULTS Fifty-one PPP women were included, with 70.6% having PAS and 75.0% of PAS women having a poor pregnancy outcome. The incidence of PAS diagnosis was 36.4% for those with a score < 5 points, with 0% having a poor outcome; 76.5% for those with a score ≥ 5 to < 8 points, with 61.5% having a poor outcome; and 100% for those with a score ≥ 8 points, with 100% having a poor pregnancy outcome. CONCLUSION The system for predicting PPP with PAS and poor pregnancy outcomes was of high accuracy.
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Affiliation(s)
- Lingling Zhu
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China
| | - Limei Xie
- Ultrasound Department, Sheng Jing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, 110004, Liaoning, China. .,Ultrasound Department, Roicare Hospital and Clinics, No. 136 Dongbeida Road, Shenyang, 110044, Liaoning, China.
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18
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Ryo E, Namai S, Nakagawa I, Kanda R, Yatsuki K, Ayabe T. Descended marginal sinus of the placenta. Clin Case Rep 2019; 7:826-828. [PMID: 30997094 PMCID: PMC6452445 DOI: 10.1002/ccr3.2092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 12/03/2022] Open
Abstract
This is the first reported case of descent of the placental marginal sinus through the cervix to the external os. We think marginal sinus rupture does exist. The definition of placental edge should be the parenchyma in diagnosis of low-lying placentation. Clinically, however, the low-lying marginal sinus should be treated similar to low-lying placentation.
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Affiliation(s)
- Eiji Ryo
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
| | - Shigenari Namai
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
| | - Ippei Nakagawa
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
| | - Ranka Kanda
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
| | - Keita Yatsuki
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
| | - Takuya Ayabe
- Department of Obstetrics and Gynecology, School of MedicineTeikyo UniversityTokyoJapan
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Alouini S, Megier P, Fauconnier A, Huchon C, Fievet A, Ramos A, Megier C, Valéry A. Diagnosis and management of placenta previa and low placental implantation. J Matern Fetal Neonatal Med 2019; 33:3221-3226. [PMID: 30688129 DOI: 10.1080/14767058.2019.1570118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To evaluate the migration of low-placental implantation (LPI) during the third trimester of pregnancy and its effect on delivery and post-partum hemorrhage.Methods: We conducted a retrospective study at a level 3 maternity center including all cases of placenta previa (PP) and LPI between 1998 and 2014. The distance (d) between cervical internal os (CIO) and placental edge (PE) were measured by vaginal ultrasonography in the third trimester of pregnancy at 32 and 3 weeks after. We analyzed CIO-PE distance, volume of post-partum hemorrhage, delivery decision, and mode of delivery using Kruskall-Wallis test.Results: In total, 319 patients presented with PP or LPI. All complete PP (121) and 90.6% (58 of 64) of the placentas less than 1 cm from the CIO did not migrate. Among the 138 placentas with an initial CIO-PE d greater than 1 cm, only 17 (12.3%) did not migrate above 2 cm. The patients for whom the decision to perform a cesarean section (C-section) was retained and realized had a CIO-PE d significantly lower than those who delivered vaginally (p < .001). The patients who delivered by C-section had a lower CIO-PE d when an emergency C-section was performed, specifically for hemorrhage (p < .001). The mean volume of hemorrhage was significantly higher for patients with a CIO-PE d less than 2 cm.Conclusion: Complete PP and the majority of the placentas less than 1 cm from the CIO did not migrate. Above 1 cm, the majority of the placentas migrated three to four weeks later. For the placentas less than 1 cm from the CIO, a significant risk of hemorrhage at delivery was observed. Thus, prophylactic cesarean section is required for CIO-PE distances <1 cm. For distances between 1 and 2 cm, the volume of blood loss tends to be more important than for distances >3 cm without statistical significance. A vaginal delivery could be tried after information of patients.
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Affiliation(s)
- Souhail Alouini
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Pascal Megier
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, University of Versailles Saint-Quentin in Yvelines, Versailles, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, University of Versailles Saint-Quentin in Yvelines, Versailles, France
| | - Adele Fievet
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Anna Ramos
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Charles Megier
- Department of Gynaecology and Obstetrics, Centre Hospitalier Régional d'Orléans, Orleans, France
| | - Antoine Valéry
- Department of Medical Informatics and Statistics, Centre Hospitalier Régional d'Orléans, Orleans, France
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Sadek SM, Ahmad RA, Atia H, Abdullah AG. Towards more accurate measurement of edge to os distance in low-lying placenta using three dimensional transvaginal ultrasound: an innovative technique. BMC Pregnancy Childbirth 2018; 18:472. [PMID: 30509241 PMCID: PMC6278013 DOI: 10.1186/s12884-018-2107-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measurement of edge to os distance (EOD) is essential to differentiate low-lying from normal placenta, and to plan for delivery. Till now, measurement by 2D TVS is the gold standard, however, its accuracy is questioned. In this study, we introduced an innovative technique for measurement of EOD using 3D TVS. Our aim was to compare EOD measurements of the standard 2D technique, to those of our innovative 3D technique, and to correlate the difference, if any, with placental site and internal os width. METHODS This study was conducted in the ultrasound unit of obstetrics and gynecology department, Zagazig University Hospitals, during the period from June 2014 to August 2017. Seventy six cases in whom the lower placental edge didn't reach the internal os (IO), and the EOD was less than 35 mm, were included in the study. Placental location was identified by 2D transabdominal sonography then 2D TVS was used to measure the EOD in all cases. Our new technique was then applied to measure EOD by 3D TVS following stepwise manipulations of the orthogonal planes in multiplanar view. Width of IO was measured also in all cases. RESULTS The mean EOD measured by 3D TVS was significantly shorter than that measured using the 2D TVS. Anterolateral/posterolateral and lateral placentas were associated with high discrepancy in measurements between both methods, being the highest with lateral group. There was significant positive correlation between the IO width and the degree of difference between the EOD measured by both methods. CONCLUSIONS Two dimensional TVS may not be accurate in EOD measurements in many cases of low-lying placentas, and 3D TVS may increase the accuracy of measurements in these cases. This new method is simple, precise and easily applied.
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Affiliation(s)
- Somayya M. Sadek
- Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reda A. Ahmad
- Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hytham Atia
- Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Adel G. Abdullah
- Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Chong Y, Zhang A, Wang Y, Chen Y, Zhao Y. An ultrasonic scoring system to predict the prognosis of placenta accreta: A prospective cohort study. Medicine (Baltimore) 2018; 97:e12111. [PMID: 30170439 PMCID: PMC6392640 DOI: 10.1097/md.0000000000012111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To discuss the value of "self-made ultrasonic scoring system" in predicting the different types of placenta accreta, and for predicting its associated risk of bleeding and hysterectomy.A prospective study was performed in 137 patients who were suspiciously diagnosed with placenta accreta before delivery. All the patients were examined by the scoring system, and were classified into 3 groups according to their scores: score of ≤5 as N1, ≥6 and ≤9 as N2, and ≥10 as N3 groups. The accuracy and the Kappa values were calculated. Hemorrhage during the operation and the uterine resection rate were also compared.There were 73 patients in N1, 36 in N2, and 28 in N3 groups. The prediction accuracy rates were 87.6% (64/73) and 92.0% (25/28), respectively in groups 1 and 3. The Kappa value was 0.75\0.77 for the prediction accuracy rate. The median quantities of hemorrhage during the operation were 400[100, 2000] mL, 1200[300, 9000] mL, and 4000[800, 13,000] mL, respectively. The uterine resection rates were 0.0%(0/73), 11.1%(4/36), and 39.3%(11/28), respectively. Comparison of hemorrhage and uterine resection rate among the 3 groups was significant (P < .001). Among them, statistically significant differences in hemorrhage and uterine resection rate were observed in every 2 groups (P < .05).These results suggested that self-made ultrasonic scoring system remained an effective diagnostic tool for assessing the types of placenta accreta, and predicted the associated bleeding risk, indicating the possibility of hysterectomy.
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Cui S, Zhi Y, Cheng G, Zhang K, Zhang L, Shen L. Retrospective analysis of placenta previa with abnormal placentation with and without prophylactic use of abdominal aorta balloon occlusion. Int J Gynaecol Obstet 2017; 137:265-270. [PMID: 28236650 DOI: 10.1002/ijgo.12132] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/12/2017] [Accepted: 02/22/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of prophylactic abdominal aorta balloon occlusion in cases of placenta previa with abnormal placentation. METHODS In a retrospective study, data were analyzed for patients who had placenta previa with placenta accreta and underwent elective cesarean delivery (>34 weeks) with or without temporary aortic balloon occlusion at a center in Zhengzhou, China, between October 2015 and September 2016. The primary clinical outcomes were operative time, estimated blood loss, intraoperative blood transfusion volume, hemoglobin, hysterectomy, and hospitalization. RESULTS Among 69 eligible women, 38 had temporary balloon occlusion, and 31 had no balloon occlusion. Operative time, blood transfusion volume, change in hemoglobin, hysterectomy, and length of hospitalization did not differ. Although mean blood loss did not differ, fewer patients in the balloon group than the non-balloon group had an estimated blood loss of more than 1000 mL (24 [63%] vs 28 [90%]; P=0.009). In terms of different placental types, the estimated blood loss among women with placenta accreta and placenta increta was lower in the balloon group than in the non-balloon group (P<0.001 and P=0.01, respectively). CONCLUSION Prophylactic balloon occlusion of the abdominal aorta reduced bleeding after cesarean delivery for women with abnormal placentation.
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Affiliation(s)
- Shihong Cui
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunxiao Zhi
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Guomei Cheng
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Kai Zhang
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Lindong Zhang
- The Third Hospital of Zhengzhou University, Zhengzhou, China
| | - Linna Shen
- The Third Hospital of Zhengzhou University, Zhengzhou, China
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24
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van der Krogt L, Hezelgrave NL, Seed PT, Shennan AH. Prediction of spontaneous preterm birth using fetal fibronectin in women with a low-lying placenta. J Matern Fetal Neonatal Med 2016; 30:313-316. [DOI: 10.3109/14767058.2016.1171837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Natasha L. Hezelgrave
- Division of Women's Health, King's College London, Women's Health Academic Centre, King’s Health Partners, St Thomas' Hospital, London, England, UK
| | - Paul T. Seed
- Division of Women's Health, King's College London, Women's Health Academic Centre, King’s Health Partners, St Thomas' Hospital, London, England, UK
| | - Andrew H. Shennan
- Division of Women's Health, King's College London, Women's Health Academic Centre, King’s Health Partners, St Thomas' Hospital, London, England, UK
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25
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26
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Polat M, Kahramanoglu I, Senol T, Ozkaya E, Karateke A. Shorter the cervix, more difficult the placenta percreta operations. J Matern Fetal Neonatal Med 2015; 29:2327-31. [DOI: 10.3109/14767058.2015.1085017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Teixidor Viñas M, Belli AM, Arulkumaran S, Chandraharan E. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:350-355. [PMID: 25402727 DOI: 10.1002/uog.14728] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 10/29/2014] [Accepted: 11/02/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To evaluate patient outcomes and need for further interventions in women with a morbidly adherent placenta (MAP), before and after introduction of the Triple-P procedure involving placental non-separation, myometrial excision and reconstruction of the uterine wall. METHODS Between December 2007 and February 2014, 30 patients with MAP were treated at our center. In 2007, we instituted a policy of bilateral prophylactic occlusion balloon catheter placement in both internal iliac arteries followed by Cesarean section with non-placental separation and preservation of the uterus. In 2010, the surgical technique was modified and the Triple-P procedure introduced. As a result, 19 women in our study received the Triple-P protocol (study group) and 11 did not (control group). The quantity of blood replacement products, estimated blood loss, and necessity for uterine arterial embolization and/or hysterectomy were recorded retrospectively and compared between the two groups. RESULTS Placenta percreta was confirmed in six (54.5%) patients in the control group and 13 (68.4%) in the study group. Estimated mean blood loss during the procedure was lower in the study group than in the control group (1.70 L vs 2.17 L, respectively), but the difference was not statistically significant (P = 0.445). The risks of postpartum hemorrhage (PPH) and hysterectomy were statistically significantly lower in the study group (PPH, 54.5% vs 15.8%; P = 0.035; hysterectomy, 27.3% vs 0.0%; P = 0.045). As a consequence, there was a significant decrease in duration of inpatient stay in the study group (P = 0.044). CONCLUSION Introduction of the Triple-P procedure conveyed a significantly reduced rate of hysterectomy, PPH and duration of hospital stay in patients with MAP. .
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Affiliation(s)
| | - A M Belli
- Department of Radiology, St George's Hospital, London, UK
| | - S Arulkumaran
- Department of Obstetrics and Gynaecology, St George's Hospital, London, UK
| | - E Chandraharan
- Department of Obstetrics and Gynaecology, St George's Hospital, London, UK
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Abdel Moniem AM, Ibrahim A, Akl SA, Aboul-Enen L, Abdelazim IA. Accuracy of three-dimensional multislice view Doppler in diagnosis of morbid adherent placenta. J Turk Ger Gynecol Assoc 2015; 16:126-36. [PMID: 26401104 DOI: 10.5152/jtgga.2015.15038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/09/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To detect the accuracy of the three-dimensional multislice view (3D MSV) Doppler in the diagnosis of morbid adherent placenta (MAP). MATERIAL AND METHODS Fifty pregnant women at ≥28 weeks gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale ultrasound scan was performed for the subjects to confirm the gestational age, placental location, and findings suggestive of MAP, followed by the 3D power Doppler and then the 3D MSV Doppler to confirm the diagnosis of MAP. Intraoperative findings and histopathology results of removed uteri in cases managed by emergency hysterectomy were compared with preoperative sonographic findings to detect the accuracy of the 3D MSV Doppler in the diagnosis of MAP. RESULTS The 3D MSV Doppler increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 3D power Doppler. The sensitivity and negative predictive value (NPV) (79.6% and 82.2%, respectively) of crowded vessels over the peripheral sub-placental zone to detect difficult placental separation and considerable intraoperative blood loss in cases of MAP using the 3D power Doppler was increased to 82.6% and 84%, respectively, using the 3D MSV Doppler. In addition, the sensitivity, specificity, and positive predictive value (PPV) (90.9%, 68.8%, and 47%, respectively) of the disruption of the uterine serosa-bladder interface for the detection of emergency hysterectomy in cases of MAP using the 3D power Doppler was increased to 100%, 71.8%, and 50%, respectively, using the 3D MSV Doppler. CONCLUSION The 3D MSV Doppler is a useful adjunctive tool to the 3D power Doppler or color Doppler to refine the diagnosis of MAP.
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Affiliation(s)
- Alaa M Abdel Moniem
- Department of Ultrasound and Fetal Care Unit, Ain Shams University, Cairo, Egypt
| | - Ahmed Ibrahim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Sherif A Akl
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Loay Aboul-Enen
- Department of Ultrasound and Fetal Care Unit, Ain Shams University, Cairo, Egypt
| | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt and Ahmadi Kuwait Oil (KOC) Company Hospital, Ahmadi, Kuwait
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