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Kükrer S, Arlıer S, Dilek O, Gülümser Ç, Işıl Adıgüzel F. Diagnostic accuracy of magnetic resonance imaging to predict peripartum hysterectomy and neonatal mortality in total placenta previa: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 301:251-257. [PMID: 39173533 DOI: 10.1016/j.ejogrb.2024.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa. STUDY DESIGN This retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis. RESULTS Reduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm3; OR: 0.993, 95 % CI: 0.990-0.995 and OR: 1.007, 95 % CI: 1.005-1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 - 0.88 and OR: 1.7, 95 % CI: 1.4 - 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2-250, p = 0.001). CONCLUSIONS Placental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.
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Affiliation(s)
- Sadık Kükrer
- University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Mithat Özsan Bulvarı Kışla Mah, 4522 Sok. No:1, Adana, Turkey.
| | - Sefa Arlıer
- University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Mithat Özsan Bulvarı Kışla Mah, 4522 Sok. No:1, Adana, Turkey
| | - Okan Dilek
- University of Health Sciences Adana City Training and Research Hospital, Department of Radiology, Mithat Özsan Bulvarı Kışla Mah. 4522 Sok, No:1, Adana, Turkey
| | - Çağrı Gülümser
- Yuksek Ihtisas University, Department of Obstetrics and Gynecology, İşçi Blokları Mahallesi 1505. Cd. No: 18/A, 06530 Çankaya, Ankara, Turkey
| | - Fikriye Işıl Adıgüzel
- University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Mithat Özsan Bulvarı Kışla Mah, 4522 Sok. No:1, Adana, Turkey
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Hage L, Athiel Y, Barrois M, Cojocariu V, Peyromaure M, Goffinet F, Duquesne I. Identifying risk factors for urologic complications in placenta accreta spectrum surgical management. World J Urol 2024; 42:539. [PMID: 39325196 DOI: 10.1007/s00345-024-05239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/26/2024] [Indexed: 09/27/2024] Open
Abstract
PURPOSE To describe urologic complications associated with the surgical management of placenta accreta spectrum and determine their risk factors. METHODS A retrospective study was conducted on all patients diagnosed with abnormal invasive placentation who underwent surgery and delivered between 2002 and 2023 at a single expert maternity centre. Intra-operative and post-operative complications were described, with a special focus on urologic intra-operative injuries, including vesical or ureteral injuries. Univariate and multivariate analyses were performed to determine risk factors of intra-operative urologic injuries associated with placenta accreta spectrum surgical management. Additionally, using the Clavien-Dindo classification, the effects of intra-operative urologic injury and ureteral stent placement on post-operative outcome were evaluated. RESULTS A total of 216 patients were included, of which 47 (21.48%) had an intra-operative bladder and/or ureteral injury. Placenta percreta was associated with a higher rate of intra-operative urologic injury than placenta accreta (72.34% vs. 6.38%, p < 0.001). Multivariate analyses showed that patients who had placenta percreta and bladder invasion or emergency hysterectomy were associated with more intra-operative urologic injuries (OR = 8.07, 95% CI [2.44-26.75] and OR = 3.87, 95% CI [1.09-13.72], respectively). Patients with intra-operative urologic injuries had significantly more severe post-operative complications, which corresponds to a Clavien-Dindo score of 3 or more, at 90 days (21.28% vs. 5.92%, p = 0.004). CONCLUSION Surgical management of placenta accreta spectrum is associated with significant urologic morbidity, with a major impact on post-operative outcomes. Urologic complications seem to be correlated with the depth of invasion and the emergency of the hysterectomy.
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Affiliation(s)
- Lory Hage
- Department of Urology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Yoann Athiel
- Department of Obstetrics and Gynaecology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Mathilde Barrois
- Department of Obstetrics and Gynaecology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Vlad Cojocariu
- Department of Urology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Michaël Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - François Goffinet
- Department of Obstetrics and Gynaecology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France.
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Saldarriaga-Hoyos JJ, Sarria-Ortiz D, Galindo-Velasco V, Rivera-Torres LF, Nieto-Calvache AJ. Morbidity associated with emergency surgery versus scheduled surgery in patients with placenta accreta spectrum. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo74. [PMID: 39380586 PMCID: PMC11460419 DOI: 10.61622/rbgo/2024rbgo74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/03/2024] [Indexed: 10/10/2024] Open
Abstract
Objective This study aims to evaluate the clinical outcomes of surgical management for placenta accreta spectrum in a Latin American reference hospital specializing in this condition. The evaluation involves a comparison between surgeries performed on an emergent and scheduled basis. Methods A retrospective cohort study was conducted on patients with placenta accreta spectrum who underwent surgery between January 2011 and November 2021 at a hospital in Colombia, using data from the institutional PAS registry. The study included patients with intraoperative and/or histological confirmation of PAS, regardless of prenatal suspicion. Clinical outcomes were compared between patients who had emergent surgeries and those who had scheduled surgeries. Descriptive analysis involved summary measures and the Shapiro-Wilk test for quantitative variables, with comparisons made using Pearson's Chi-squared test and the Wilcoxon rank sum test, applying a significance level of 5%. Results A total of 113 patients were included, 84 (74.3%) of them underwent scheduled surgery, and 29 (25.6%) underwent emergency surgery. The emergency surgery group required more transfusions (72.4% vs 48.8%, p=0.047). Patients with intraoperative diagnosis of placenta accreta spectrum (21 women, 19.5%) had a greater volume of blood loss than patients taken into surgery with known presence of placenta accreta spectrum (3500 ml, IQR 1700 - 4000 vs 1700 ml, IQR 1195-2135. p <0.001). Conclusion Patients with placenta accreta spectrum undergoing emergency surgery require transfusions more frequently than those undergoing scheduled surgery.
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Affiliation(s)
- Juan José Saldarriaga-Hoyos
- Fundación Valle del LiliDepartamento de Ginecología y ObstetriciaCaliColombiaFundación Valle del Lili, Departamento de Ginecología y Obstetricia, Cali, Colombia.
- Universidad IcesiFacultad de Ciencias de la SaludCaliColombiaUniversidad Icesi, Facultad de Ciencias de la Salud, Calle, Cali, Colombia.
| | - Daniela Sarria-Ortiz
- Fundación Valle del LiliCentro de Investigaciones ClínicasCaliColombiaFundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
| | - Valentina Galindo-Velasco
- Fundación Valle del LiliCentro de Investigaciones ClínicasCaliColombiaFundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
| | - Luisa Fernanda Rivera-Torres
- Fundación Valle del LiliCentro de Investigaciones ClínicasCaliColombiaFundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia.
| | - Albaro José Nieto-Calvache
- Fundación Valle del LiliDepartamento de Ginecología y ObstetriciaCaliColombiaFundación Valle del Lili, Departamento de Ginecología y Obstetricia, Cali, Colombia.
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Yalınkaya A, Oğlak SC. A Novel Approach for Conservative Management of Placenta Accreta Spectrum Disorder Cases: Experience of a Single Surgeon: PAS Disorders and Conservative Management. J Pregnancy 2024; 2024:9910316. [PMID: 38961859 PMCID: PMC11221975 DOI: 10.1155/2024/9910316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
Background: This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. Materials and Methods: This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Results: Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. Conclusions: We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.
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Affiliation(s)
- Ahmet Yalınkaya
- Department of Obstetrics and GynecologyDicle University Faculty of Medicine, Diyarbakır, Türkiye
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and GynecologyHealth Sciences UniversityGazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
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Losi L, Botticelli L, Mancini L, Negro R, Hanspeter E, Dematté E, Grandi G, Facchinetti F, Veneziano M, Malagoli C, Masini M, Fabbiani L, Rivasi F. Can immunohistochemistry improve the pathological diagnosis of placenta accreta spectrum (PAS) disorders? Arch Gynecol Obstet 2024; 309:2605-2612. [PMID: 37535133 DOI: 10.1007/s00404-023-07143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The term of placenta accreta spectrum (PAS) disorder includes all grades of abnormal placentation. It is crucial for pathologist provide standardized diagnostic assessment to evaluate the outcome of management strategies. Moreover, a correct and safe diagnosis is useful in the medico-legal field when it becomes difficult for the gynecologist to demonstrate the suitability and legitimacy of demolitive treatment. The purposes of our study were: (1) to assess histopathologic features according to the recent guidelines; (2) to determine if immunohistochemistry can be useful to identify extravillous trophoblast (EVT) and to measure the depth of infiltration into the myometrium to improve the diagnosis of PAS. METHODS The retrospective study was conducted on 30 cases of gravid hysterectomy with histopathologic diagnosis of PAS. To identify the depth of EVT, immunohistochemical stainings were performed using anti MNF116 (cytokeratins 5, 6, 8, 17, 19), actin-SM, HPL (Human Placental Lactogen), vimentin and GATA3 antibodies. RESULTS Our cases were graded based on the degree of invasion of the myometrium. Ten were grade 1 (33.3%), 12 grade 2 (40%) and 8 grade 3A (26.7%). EVT invasion was best seen and evident by double immunostainings with actin-SM and cytokeratins, actin-SM and HPL, actin-SM and GATA3. CONCLUSION The role of pathologist is decisive to determine the different grades of PAS. A better understanding of the depth of myometrial invasion can be achieved by the use of immunohistochemistry affording an important tool to obtain reproducible grading of PAS. This purpose is crucial in the setting of postoperative quality reviews and particularly in the forensic medicine field.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, Unit of Pathology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Luciano Mancini
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Rosa Negro
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Esther Hanspeter
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Eva Dematté
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Claudia Malagoli
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Meris Masini
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Luca Fabbiani
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Unit of Pathology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Francesco Rivasi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Kember AJ, Anderson JL, House SC, Reuter DG, Goergen CJ, Hobson SR. Impact of maternal posture on fetal physiology in human pregnancy: a narrative review. Front Physiol 2024; 15:1394707. [PMID: 38827993 PMCID: PMC11140392 DOI: 10.3389/fphys.2024.1394707] [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: 03/04/2024] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
In numerous medical conditions, including pregnancy, gravity and posture interact to impact physiology and pathophysiology. Recent investigations, for example, pertaining to maternal sleeping posture during the third trimester and possible impact on fetal growth and stillbirth risk highlight the importance and potential clinical implications of the subject. In this review, we provide an extensive discussion of the impact of maternal posture on fetal physiology from conception to the postpartum period in human pregnancy. We conducted a systematic literature search of the MEDLINE database and identified 242 studies from 1991 through 2021, inclusive, that met our inclusion criteria. Herein, we provide a synthesis of the resulting literature. In the first section of the review, we group the results by the impact of maternal posture at rest on the cervix, uterus, placenta, umbilical cord, amniotic fluid, and fetus. In the second section of the review, we address the impact on fetal-related outcomes of maternal posture during various maternal activities (e.g., sleep, work, exercise), medical procedures (e.g., fertility, imaging, surgery), and labor and birth. We present the published literature, highlight gaps and discrepancies, and suggest future research opportunities and clinical practice changes. In sum, we anticipate that this review will shed light on the impact of maternal posture on fetal physiology in a manner that lends utility to researchers and clinicians who are working to improve maternal, fetal, and child health.
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Affiliation(s)
- Allan J. Kember
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Shiphrah Biomedical Inc., Toronto, ON, Canada
| | - Jennifer L. Anderson
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Sarah C. House
- Temerty Faculty of Medicine, Medical Education, University of Toronto, Toronto, ON, Canada
| | - David G. Reuter
- Cardiac Innovations, Seattle Children’s Hospital, Seattle, WA, United States
| | - Craig J. Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sebastian R. Hobson
- Temerty Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada
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Wang Y, Zhang S. Reflections on peripartum hysterectomy: A 10-year retrospective observational study in Northeast China. Int J Gynaecol Obstet 2024; 165:764-771. [PMID: 37964420 DOI: 10.1002/ijgo.15241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/30/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. METHODS This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. RESULTS Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. CONCLUSION Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high-risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH.
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Affiliation(s)
- Yang Wang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuo Zhang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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Vuong ADB, Pham TH, Pham XTT, Truong DP, Nguyen XT, Trinh NB, Nguyen DV, Nguyen YON, Nguyen TNTN, Ho QN, Nguyen PN. Modified one-step conservative uterine surgery (MOSCUS) versus cesarean hysterectomy in the management of placenta accreta spectrum: A single-center retrospective analysis based on 619 Vietnamese pregnant women. Int J Gynaecol Obstet 2024; 165:723-736. [PMID: 38009657 DOI: 10.1002/ijgo.15220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To compare maternal outcome measures in surgical management of placenta accreta spectrum (PAS)-the modified one-step conservative uterine surgery (MOSCUS), a new approach at Tu Du Hospital in Vietnam, versus cesarean hysterectomy, and to identify factors that appear to contribute to the successful outcome of the MOSCUS. METHODS This retrospective study was conducted at Tu Du Hospital in southern Vietnam between January 2019 and December 2020. The study enrolled all pregnant women at more than 28 weeks of pregnancy with a diagnosis of PAS who underwent either a cesarean hysterectomy or a uterus-preserving approach using the MOSCUS method. RESULTS The prevalence of PAS at our single tertiary referral hospital was 0.4% (619 PAS cases/132 518 births) in 2 years. Among 296 patients, the surgical time duration, estimated blood loss, and red blood cell transfusion in the MOSCUS group (n = 217) were all significantly less than in the cesarean hysterectomy group (n = 79) (152.72 ± 42.23 vs 185.13 ± 58.22 min, 1000 vs 1500 mL, and 500 vs 710 mL, respectively). Intraoperatively, the rate of visceral injuries in the hysterectomy group was higher than that in the MOSCUS group (P < 0.001). However, the rate of postoperative infection was higher in the MOSCUS group than in the cesarean hysterectomy group (P = 0.012). Of a total of 217 cases managed using the MOSCUS management, 24 required a secondary hysterectomy; the success rate was 88.9% (95% confidence interval [CI] 84.3%-93.1%). Some of the primary factors associated with the success of MOSCUS included maternal age less than 35 years, planned surgery, severity of PAS, and estimated blood loss during surgery (odds ratio [OR] 5.16, 95% CI 1.96-13.59; OR 3.05, 95% CI 1.08-8.62; OR 3.62, 95% CI 1.19-10.98; and OR 49.66, 95% CI 11.16-221.02, respectively; P < 0.05). CONCLUSION MOSCUS is an acceptable alternative to cesarean hysterectomy in many patients diagnosed with PAS. This new surgical management of PAS resulted in the preservation of the uterus, and a favorable outcome in nearly 9 out of 10 pregnant women. We believe that MOSCUS can be safely offered for the management of PAS in referral hospital settings.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Thanh Hai Pham
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Thi Pham
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Diem Phuong Truong
- Department of Obstetrics Bloc M, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Xuan Trang Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Ngoc Bich Trinh
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Dinh Vinh Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | | | | | - Quang Nhat Ho
- Department of Postoperative Care Bloc A, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
- Tu Du Clinical Research Unit (TD-CRU), Tu Du Hospital, Ho Chi Minh City, Vietnam
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Denizli R, Tanacan A, Bastemur AG, Sakcak B, Farisogullari N, Kara Ö, Kutman HGK, Neselioglu S, Erel Ö, Sahin D. Evaluation of maternal serum thiol and ischemia-modified albumin levels in cases of placenta previa: A case-control study in a tertiary center. J Obstet Gynaecol Res 2024; 50:611-617. [PMID: 38325805 DOI: 10.1111/jog.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
AIM We aim to compare the maternal serum thiol and ischemia-modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP). METHODS Fifty-five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated. RESULTS The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05). CONCLUSIONS Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases.
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Affiliation(s)
- Ramazan Denizli
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Gülçin Bastemur
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Nihat Farisogullari
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Özgür Kara
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | | | - Salim Neselioglu
- Department of Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Özcan Erel
- Department of Biochemistry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - Dilek Sahin
- Division of Perinatology, Department of Obstetrics and Gynecology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Taman M, Mosa DM, Hashem HA, Samir K, Ibrahim EM, Abdelbar A, Mousa A, Elesawi M. Accuracy of Ultrasound in the Prediction of the FIGO Classification of Placenta Accreta Spectrum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102262. [PMID: 37924943 DOI: 10.1016/j.jogc.2023.102262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES To evaluate the accuracy of greyscale ultrasound (US) and colour Doppler detecting placenta accreta spectrum (PAS) based on the newly recommended International Federation of Obstetrics and Gynaecology (FIGO) grading system. METHODS This prospective study was conducted on women diagnosed with placenta previa or low-lying placenta involving the anterior uterine wall and associated with PAS as identified by the US. Transabdominal and transvaginal greyscale US was performed on admission between 34 and 36 weeks of gestation and compared to clinical grading and histopathological examination after cesarean hysterectomy. RESULTS In total, 36 pregnant females who underwent a cesarean hysterectomy due to placenta previa complicated by PAS were included in this study. All patients had a history of previous cesarean deliveries, ranging from 1 to 5 deliveries. The US has an overall sensitivity of 33%, 55%, and 84.62%, and specificity of 100%, 75%, and 60% in detecting the 3 degrees of PAS, respectively. US cannot differentiate between the different subtypes of PAS grade 3 (a, b, and c). CONCLUSION The overall US evaluation was highly significant in predicting the FIGO diagnosis of PAS; however, all ultrasonographic signs were equally relevant in diagnosing grade 1 and/or 2 PAS and were inaccurate in differing the subtypes of PAS grade 3.
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Affiliation(s)
- Mohamed Taman
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Doaa Mosad Mosa
- Department of Rheumatology and Rehabilitation, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.
| | - Hatem Abo Hashem
- Professor of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khalid Samir
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Eman M Ibrahim
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Abdelbar
- Department of Obstetrics and Gynecology, Cairo University Hospital, Cairo, Egypt
| | - Abdalla Mousa
- Department of Obstetrics and Gynecology, Cairo University Hospital, Cairo, Egypt
| | - Maher Elesawi
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
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11
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Lee SU, Jo JH, Lee H, Na Y, Park IY. A Multicenter, Retrospective Comparison Study of Pregnancy Outcomes According to Placental Location in Placenta Previa. J Clin Med 2024; 13:675. [PMID: 38337369 PMCID: PMC10856070 DOI: 10.3390/jcm13030675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: We investigated the association between placental location and pregnancy outcomes in placenta previa. Methods: This multi-center retrospective study enrolled 781 women who delivered between May 1999 and February 2020. We divided the dataset into anterior (n = 209) and posterior (n = 572) groups and compared the baseline characteristics and obstetric and neonatal outcomes. The adverse obstetric outcomes associated with placenta location were evaluated using a multivariate logistic analysis. Results: Gestational age at delivery in the anterior group (253.0 ± 21.6) was significantly lower than that in the posterior group (257.6 ± 19.1) (p = 0.008). The anterior group showed significantly higher parity, rates of previous cesarean section, non-vertex fetal positions, admissions for bleeding, emergency cesarean sections, transfusions, estimated blood loss, and combined placenta accrete spectrum (p < 0.05). In the multivariate analysis, the anterior group had higher rates of transfusion (OR 2.23; 95% CI 1.50-3.30), placenta accreta spectrum (OR 2.16; 95% CI 1.21-3.97), and non-vertex fetal positions (OR 2.47; 95% CI 1.09-5.88). Conclusions: These findings suggest that more caution is required in the treatment of patients with anterior placenta previa. Therefore, if placenta previa is diagnosed prenatally, it is important to determine the location of the body and prepare for massive bleeding in the anterior group.
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Affiliation(s)
- Seon Ui Lee
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Ji Hye Jo
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Haein Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yoojin Na
- Department of Obstetrics and Gynecology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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12
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Doğru Ş, Akkuş F, Atci AA, Metin ÜS, Uyar M, Acar A. Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries. Obstet Gynecol Sci 2024; 67:58-66. [PMID: 38044617 DOI: 10.5468/ogs.23154] [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: 06/10/2023] [Accepted: 10/24/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP). METHODS Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared. RESULTS A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037). CONCLUSION Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.
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Affiliation(s)
- Şükran Doğru
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Fatih Akkuş
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Aslı Altinordu Atci
- Division of Perinatology, Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ülfet Sena Metin
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Mehmet Uyar
- Department of public health, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
| | - Ali Acar
- Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey
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13
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Fitzgerald GD, Newton JM, Atasi L, Buniak CM, Burgos-Luna JM, Burnett BA, Carver AR, Cheng C, Conyers S, Davitt C, Deshmukh U, Donovan BM, Easter SR, Einerson BD, Fox KA, Habib AS, Harrison R, Hecht JL, Licon E, Nino JM, Munoz JL, Nieto-Calvache AJ, Polic A, Ramsey PS, Salmanian B, Shamshirsaz AA, Shamshirsaz AA, Shrivastava VK, Woolworth MB, Yurashevich M, Zuckerwise L, Shainker SA. Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care. Am J Obstet Gynecol MFM 2024; 6:101229. [PMID: 37984691 DOI: 10.1016/j.ajogmf.2023.101229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
The incidence of placenta accreta spectrum, the deeply adherent placenta with associated increased risk of maternal morbidity and mortality, has seen a significant rise in recent years. Therefore, there has been a rise in clinical and research focus on this complex diagnosis. There is international consensus that a multidisciplinary coordinated approach optimizes outcomes. The composition of the team will vary from center to center; however, central themes of complex surgical experts, specialists in prenatal diagnosis, critical care specialists, neonatology specialists, obstetrics anesthesiology specialists, blood bank specialists, and dedicated mental health experts are universal throughout. Regionalization of care is a growing trend for complex medical needs, but the location of care alone is just a starting point. The goal of this article is to provide an evidence-based framework for the crucial infrastructure needed to address the unique antepartum, delivery, and postpartum needs of the patient with placenta accreta spectrum. Rather than a clinical checklist, we describe the personnel, clinical unit characteristics, and breadth of contributing clinical roles that make up a team. Screening protocols, diagnostic imaging, surgical and potential need for critical care, and trauma-informed interaction are the basis for comprehensive care. The vision from the author group is that this publication provides a semblance of infrastructure standardization as a means to ensure proper preparation and readiness.
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Affiliation(s)
- Garrett D Fitzgerald
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Fitzgerald).
| | - J M Newton
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Newton)
| | - Lamia Atasi
- Department of Obstetrics and Gynecology, Mercy Hospital, St. Louis, MO (Dr Atasi)
| | - Christina M Buniak
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA (Dr Buniak)
| | | | - Brian A Burnett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Dr Burnett)
| | - Alissa R Carver
- Department of Obstetrics and Gynecology, Wilmington Maternal-Fetal Medicine, Wilmington, NC (Dr Carver)
| | - CeCe Cheng
- Department of Obstetrics and Gynecology, Health Science Center at San Antonio, University of Texas, San Antonio, TX (Dr Cheng)
| | - Steffany Conyers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Caroline Davitt
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Davitt and Am Shamshiraz)
| | - Uma Deshmukh
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Bridget M Donovan
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Donovan and Shainker)
| | - Sara Rae Easter
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Easter)
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT (Dr Einerson)
| | - Karin A Fox
- Baylor College of Medicine, Houston, TX (Dr Fox)
| | - Ashraf S Habib
- Duke University School of Medicine, Durham, NC (Dr Habib)
| | - Rachel Harrison
- Department of Obstetrics and Gynecology, Advocate Aurora Health, Chicago, IL (Dr Harrison)
| | - Jonathan L Hecht
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker)
| | - Ernesto Licon
- Miller Women's & Children's Hospital/Long Beach Memorial Medical Center, Orange, CA (Dr Licon)
| | - Julio Mateus Nino
- Department of Obstetrics and Gynecology, Atrium Health Wake Forest School of Medicine, Winston-Salem, NC (Dr Nino)
| | - Jessian L Munoz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX (Dr Munoz)
| | | | | | - Patrick S Ramsey
- University of Texas Health/University Health San Antonio, San Antonio, TX (Dr Ramsey)
| | - Bahram Salmanian
- Department of Obstetrics and Gynecology, University of Colorado Health Anschutz Medical Campus, Boulder, CO (Dr Salmanian)
| | | | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Davitt and Am Shamshiraz)
| | - Vineet K Shrivastava
- Miller Women's and Children's Hospital/Long Beach Memorial Medical Center, Orange, CA (Dr Shrivastava)
| | | | - Mary Yurashevich
- Department of Anesthesiology, Duke Health, Durham, NC (Dr Yurashevich)
| | - Lisa Zuckerwise
- and Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Zuckerwise)
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Drs Conyers, Deshmukh, Donovan, Hecht, and Shainker); Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA (Drs Donovan and Shainker)
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14
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Bonsen LR, Harskamp V, Feddouli S, Bloemenkamp KWM, Duvekot JJ, Pors A, van Roosmalen J, Zwart JJ, van Lith JMM, Hendriks J, Urlings TAJ, van den Akker T, van der Bom JG, Henriquez DDCA. Prophylactic radiologic interventions to reduce postpartum hemorrhage in women with risk factors for placenta accreta spectrum disorder: a nationwide cohort study. J Matern Fetal Neonatal Med 2023; 36:2251076. [PMID: 37673791 DOI: 10.1080/14767058.2023.2251076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To quantify the association between prophylactic radiologic interventions and perioperative blood loss in women with risk factors for placenta accreta spectrum disorder (PAS). METHODS We conducted a retrospective nationwide cohort study of women with risk factors for placenta accreta spectrum disorder who underwent planned cesarean section in 69 Dutch hospitals between 2008 and 2013. All women had two risk factors for PAS: placenta previa/anterior low-lying placenta and a history of cesarean section(s). Women with and without ultrasonographic signs of PAS were studied as two separate groups. We compared the total blood loss of women with prophylactic radiologic interventions, defined as preoperative placement of balloon catheters or sheaths in the internal iliac or uterine arteries, with that of a control group consisting of women without prophylactic radiologic interventions using multivariable regression. We evaluated maternal morbidity by the number of red blood cell (RBC) units transfused within 24 h following childbirth (categories: 0, 1-3, >4), duration of hospital admission, and need for intensive care unit (ICU) admission. RESULTS A total of 350 women with placenta previa/anterior low-lying placenta and history of cesarean section(s) were included: 289 with normal ultrasonography, of whom 21 received prophylactic radiologic intervention, and 61 had abnormal ultrasonography, of whom 22 received prophylactic intervention. Among women with normal ultrasonography without prophylactic intervention (n = 268), the median blood loss was 725 mL (interquartile range (IQR) 500-1500) vs. 1000 mL (IQR 550-1750) in women with intervention (n = 21); the adjusted difference in blood loss was 9 mL (95% confidence interval (CI) -315-513), p = .97). Among women with abnormal ultrasonography, those without prophylactic intervention (n = 39) had a median blood loss of 2500 mL (IQR 1200-5000) vs. 1750 mL (IQR 775-4000) in women with intervention (n = 22); the adjusted difference in blood loss was -1141 mL (95% CI -1694- -219, p = .02). Results of outcomes on maternal morbidity were comparable among women with and without prophylactic intervention. CONCLUSION These findings suggest that prophylactic radiologic interventions prior to planned cesarean section may help to limit perioperative blood loss in women with clear signs of placenta accreta spectrum disorder on ultrasonography, but there was no evidence of a difference within the subgroup without such ultrasonographic signs. The use of these interventions should be discussed in a multidisciplinary shared decision-making process, including discussions of potential benefits and possible complications. TRIAL REGISTRATION Netherlands Trial Registry, https://onderzoekmetmensen.nl/en/trial/28238, identifier NL4210 (NTR4363).
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Affiliation(s)
- Lisanne R Bonsen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Valerie Harskamp
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Sana Feddouli
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Kitty W M Bloemenkamp
- Department of Obstetrics, Wilhelmina's Children Hospital Birth Center, Division Woman and Baby, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aad Pors
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Joost J Zwart
- Department of Obstetrics and Gynecology, Deventer Hospital, Deventer, the Netherlands
| | - Jan M M van Lith
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joris Hendriks
- Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Thijs A J Urlings
- Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Athena Institute, VU University, Amsterdam, the Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Jon J. van Rood Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Dacia D C A Henriquez
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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15
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Pinton A, Deneux-Tharaux C, Seco A, Sentilhes L, Kayem G. Incidence and risk factors for severe postpartum haemorrhage in women with anterior low-lying or praevia placenta and prior caesarean: Prospective population-based study. BJOG 2023; 130:1653-1661. [PMID: 37226308 DOI: 10.1111/1471-0528.17554] [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: 12/26/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the incidence and risk factors for severe postpartum haemorrhage (PPH) in women with an anterior low-lying or praevia placenta, prior caesarean and no prenatal suspicion of placenta accreta spectrum (PAS). DESIGN Population-based study in 176 maternity units in France. POPULATION All women with anterior low-lying (0-19 mm from the cervical internal os) or praevia placenta, diagnosed prospectively before birth, prior caesarean and no prenatal suspicion of PAS. METHODS Multivariable logistic regression to identify risk factors for severe PPH in the main population and after exclusion of women with PAS diagnosed only at birth. MAIN OUTCOME MEASURES Severe PPH defined by a composite criterion either estimated blood loss of ≥1500 ml, transfusion of ≥4 or more units of packed red blood cells, embolisation or surgical treatment. RESULTS Of the 520 114 women constituting the source population, 230 (0.44/1000 women; 95% confidence interval [CI] 0.38-0.50) met the inclusion criteria. Severe PPH rate was 24.8% (95% CI 19.2-30.4) overall, 27.5% (95% CI 21.8-33.3) in women with placenta praevia and 15.4% (95% CI 10.7-20.0) in women with low-lying placenta. PAS was diagnosed at birth in 22 women (9.9%; 95% CI 5.8-13.4), although previously unsuspected. After their exclusion, severe PPH incidence was 17.3% (95% CI 12.4-22.2). In multivariate analysis, the only factor associated with a higher severe PPH risk was placenta previa (aOR, 3.65; 95%CI, 1.20-15.8). CONCLUSION Severe PPH is frequent among women with anterior low-lying or praevia placenta and prior caesarean, even after exclusion of women with PAS. The risk of severe PPH for those with praevia is nearly twice that with low-lying placenta.
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Affiliation(s)
- Anne Pinton
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Department of Obstetrics and Gynaecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Catherine Deneux-Tharaux
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Aurélien Seco
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Clinical Research Unit Necker Cochin, APHP, Paris, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - Gilles Kayem
- Université Paris Cité, CRESS U1153, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
- Department of Obstetrics and Gynaecology, Trousseau Hospital, APHP, Sorbonne University, Paris, France
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16
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Farisoğullari N, Tanaçan A, Sakcak B, Denizli R, Özkavak OO, Turgut E, Kara Ö, Yazihan N, Şahin D. The Association of Serum Midkine Level with Invasion in Placenta Previa: A Case-Control Study from a Tertiary Reference Center. J Interferon Cytokine Res 2023; 43:557-564. [PMID: 38126935 DOI: 10.1089/jir.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
We aimed to examine the relationship between serum midkine levels and placental invasion in pregnant women with placenta previa. The study group consisted of 43 pregnant women diagnosed with placenta previa, whereas the control group consisted of 60 healthy pregnant women. Serum midkine levels were compared between pregnant women with placenta previa and the control group in this study's first part. Thereafter, the utility of midkine in the prediction of the abnormally invasive placenta (AIP) was investigated and optimal cutoff values were calculated. Significantly higher serum midkine level was observed in placenta previa cases than in the controls (1.16 ng/mL vs. 0.18 ng/mL, P < 0.001). Serum midkine level was also significantly higher in the AIP group among the placenta previa cases (P = 0.004). In the receiver operating characteristic analysis, the cutoff value of the midkine level in predicting AIP was 1.19 ng/mL. This study revealed that the serum midkine level is higher in pregnant women with AIP. Maternal serum midkine level may be used as a complementary biomarker to the radiological and clinical findings for the prediction of the AIP in placenta previa cases.
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Affiliation(s)
- Nihat Farisoğullari
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Atakan Tanaçan
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Bedri Sakcak
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Ramazan Denizli
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Osman Onur Özkavak
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Ezgi Turgut
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Özgür Kara
- Division of Perinatology, Department of Obstetrics and Gynecology, Turkish Ministry of Health Ankara City Hospital, Cankaya, Turkey
| | - Nuray Yazihan
- Department of Pathophysiology, Internal Medicine, Ankara University Medical School, Cankaya, Turkey
| | - Dilek Şahin
- Division of Perinatology, Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health Ankara City Hospital, Ankara, Turkey
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17
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Teixeira B, Pinto PV, Realista R, Silva M, Costa A, Machado AP, Moucho M. Placenta Accreta Spectrum Disorders - The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:e747-e753. [PMID: 38141594 DOI: 10.1055/s-0043-1772482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). METHODS Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes. RESULTS During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. CONCLUSION After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.
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Affiliation(s)
- Beatriz Teixeira
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Viana Pinto
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Anatomy, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rodrigo Realista
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuela Silva
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Paula Machado
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marina Moucho
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
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18
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Maurea S, Verde F, Romeo V, Stanzione A, Mainenti PP, Raia G, Barbuto L, Iacobellis F, Santangelo F, Sarno L, Migliorini S, Petretta M, D'Armiento M, De Dominicis G, Santangelo C, Guida M, Romano L, Brunetti A. Prediction of placenta accreta spectrum in patients with placenta previa using a clinical, US and MRI combined model: A retrospective study with external validation. Eur J Radiol 2023; 168:111116. [PMID: 37801998 DOI: 10.1016/j.ejrad.2023.111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE To build and validate a predictive model of placental accreta spectrum (PAS) in patients with placenta previa (PP) combining clinical risk factors (CRF) with US and MRI signs. METHOD Our retrospective study included patients with PP from two institutions. All patients underwent US and MRI examinations for suspicion of PAS. CRF consisting of maternal age, cesarean section number, smoking and hypertension were retrieved. US and MRI signs suggestive of PAS were evaluated. Logistic regression analysis was performed to identify CRF and/or US and MRI signs associated with PAS considering histology as the reference standard. A nomogram was created using significant CRF and imaging signs at multivariate analysis, and its diagnostic accuracy was measured using the area under the binomial ROC curve (AUC), and the cut-off point was determined by Youden's J statistic. RESULTS A total of 171 patients were enrolled from two institutions. Independent predictors of PAS included in the nomogram were: 1) smoking and number of previous CS among CRF; 2) loss of the retroplacental clear space at US; 3) intraplacental dark bands, focal interruption of the myometrial border and placental bulging at MRI. A PAS-prediction nomogram was built including these parameters and an optimal cut-off of 14.5 points was identified, showing the highest sensitivity (91%) and specificity (88%) with an AUC value of 0.95 (AUC of 0.80 in the external validation cohort). CONCLUSION A nomogram-based model combining CRF with US and MRI signs might help to predict PAS in PP patients, with MRI contributing more than US as imaging evaluation.
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Affiliation(s)
- Simone Maurea
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Francesco Verde
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy; Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Valeria Romeo
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Arnaldo Stanzione
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy.
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging of the National Council of Research (CNR), Naples, Italy
| | - Giorgio Raia
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Luigi Barbuto
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Fabrizia Santangelo
- Department of Obstetrics and Gynecology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Laura Sarno
- University of Naples "Federico II", Department of Neuroscience, Reproductive and Dentistry Sciences, Naples, Italy
| | - Sonia Migliorini
- University of Naples "Federico II", Department of Neuroscience, Reproductive and Dentistry Sciences, Naples, Italy
| | | | - Maria D'Armiento
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
| | - Gianfranco De Dominicis
- Department of Anatomical Pathology, "Antonio Cardarelli" Hospital, Antonio Cardarelli, Naples, Italy
| | - Claudio Santangelo
- Department of Obstetrics and Gynecology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Maurizio Guida
- University of Naples "Federico II", Department of Neuroscience, Reproductive and Dentistry Sciences, Naples, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Arturo Brunetti
- University of Naples "Federico II", Department of Advanced Biomedical Sciences, Naples, Italy
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19
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Watcharasin P, Pranpanus S, Suwannanon R, Rajaborirug S. Effective training program for antenatal diagnosis of placenta accreta spectrum disorder. Int J Gynaecol Obstet 2023; 163:211-217. [PMID: 37078663 DOI: 10.1002/ijgo.14806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To develop and evaluate a training program for diagnosing placenta accreta spectrum (PAS) disorder in obstetrics/gynecology and radiology residents. METHODS This single-center prospective study was based on 177 ultrasound images of pathologically confirmed PAS extracted from 534 cases of placenta previa suspicious for PAS. First- to third-year residents were evaluated before training to assess experience and ability to diagnose PAS. They attended a principal lecture followed by weekly self-study exercises over 5 weeks. Post-course tests evaluated the efficacy of the training program for improving diagnosis of PAS after the program. RESULTS Twenty-three (38.3%) obstetrics/gynecology and 37 (61.7%) radiology residents were trained. Before the training program, 98.3% reported minimal experience and 100% low confidence to correctly diagnose PAS. During the program, the overall accuracy of all participants in diagnosing PAS increased from 71.3% before to 95.2% after training (P < 0.001). Regression analyses showed that ability to diagnose PAS increased 2.52-fold (P < 0.001) following the program. The retention of knowledge at 1, 3, and 6 months posttest was 84.7%, 87.5%, and 87.7%, respectively. CONCLUSION An antenatal diagnosis of PAS training program can be effective as a residency training program, considering the globally rising cesarean delivery rates.
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Affiliation(s)
- Pattharapa Watcharasin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Savitree Pranpanus
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Ruedeekorn Suwannanon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Songyos Rajaborirug
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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20
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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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21
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Badachhape AA, Bhandari P, Devkota L, Srivastava M, Tanifum EA, George V, Fox KA, Yallampalli C, Annapragada AV, Ghaghada KB. Nanoparticle Contrast-enhanced MRI for Visualization of Retroplacental Clear Space Disruption in a Mouse Model of Placental Accreta Spectrum (PAS). Acad Radiol 2023; 30:1384-1391. [PMID: 36167627 PMCID: PMC10036264 DOI: 10.1016/j.acra.2022.08.025] [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: 07/14/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Prior preclinical studies established the utility of liposomal nanoparticle blood-pool contrast agents in visualizing the retroplacental clear space (RPCS), a marker of normal placentation, while sparing fetuses from exposure because the agent does not cross the placental barrier. In this work, we characterized RPCS disruption in a mouse model of placenta accreta spectrum (PAS) using these agents. MATERIALS AND METHODS Contrast-enhanced MRI (CE-MRI) and computed tomography (CE-CT) using liposomal nanoparticles bearing gadolinium (liposomal-Gd) and iodine were performed in pregnant Gab3-/- and wild type (WT) mice at day 16 of gestation. CE-MRI was performed on a 1T scanner using a 2D T1-weighted sequence (100×100×600 µm3 voxels) and CE-CT was performed at a higher resolution (70×70×70 µm3 voxels). Animals were euthanized post-imaging and feto-placental units (FPUs) were harvested for histological examination. RPCS conspicuity was scored through blinded assessment of images. RESULTS Pregnant Gab3-/- mice showed elevated rates of complicated pregnancy. Contrast-enhanced imaging demonstrated frank infiltration of the RPCS of Gab3-/- FPUs. RPCS in Gab3-/- FPUs was smaller in volume, demonstrated a heterogeneous signal profile, and received lower conspicuity scores than WT FPUs. Histology confirmed in vivo findings and demonstrated staining consistent with a thinner RPCS in Gab3-/- FPUs. DISCUSSION Imaging of the Gab3-/- mouse model at late gestation with liposomal contrast agents enabled in vivo characterization of morphological differences in the RPCS that could cause the observed pregnancy complications. An MRI-based method for visualizing the RPCS would be valuable for early detection of invasive placentation.
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Affiliation(s)
- Andrew A Badachhape
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Prajwal Bhandari
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Laxman Devkota
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Mayank Srivastava
- Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Eric A Tanifum
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Verghese George
- Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Chandrasekhar Yallampalli
- Department of Obstetrics and Gynecology, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Ananth V Annapragada
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030
| | - Ketan B Ghaghada
- Department of Radiology, Baylor College of Medicine, Houston, Texas,; Department of Radiology, Texas Children's Hospital, Houston, Texas 77030.
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22
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Khandelwal M, Shipp TD, Zelop CM, Abuhamad AZ, Afshar Y, Einerson BD, Fox KA, Huisman TAGM, Lyell DJ, Perni U, Platt LD, Shainker SA. Imaging the Uterus in Placenta Accreta Spectrum Disorder. Am J Perinatol 2023; 40:1013-1025. [PMID: 37336220 DOI: 10.1055/s-0043-1761914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present. KEY POINTS: · Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.. · Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.. · Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler)..
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Affiliation(s)
- Meena Khandelwal
- Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Thomas D Shipp
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, Valley Medical Group, Paramus, New Jersey and Clinical Professor of Obstetrics and Gynecology, Ne NYU Grossman School of Medicine, New York
| | - Alfred Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, California
| | - Brett D Einerson
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Thierry A G M Huisman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houstan, Texas
| | - Deirdre J Lyell
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
| | - Uma Perni
- Subspecialty Care for Women's Health, Cleveland Clinic, Beachwood, Ohio
| | - Lawrence D Platt
- Center for Fetal Medicine & Women's Ultrasound and the David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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23
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Ioscovich A, Weiss A, Shatalin D. The anesthetic approach to a patient with placenta accreta spectrum. Curr Opin Anaesthesiol 2023; 36:263-268. [PMID: 36745077 DOI: 10.1097/aco.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Placenta accreta poses significant risk of morbidity and mortality to a laboring patient. Here we review available treatment options, highlight trends in bleeding prevention and diagnosis that have been shown to improve patient outcome, and provide best practice suggestions. We also discuss the decision-making process for choice of anesthesia, as it is not based on a gold-standard paradigm. RECENT FINDINGS The use of resuscitative endovascular balloon occlusion of the aorta has been gaining popularity around the world. It has been shown to cause an equivocal reduction in perioperative bleeding in placenta accreta spectrum (PAS), reduce the rate of hysterectomies, and is a safe and relatively easy technique. There are other invasive radiology techniques that have also proven to be beneficial in bleeding prevention: balloon occlusion of hypogastric arteries intraoperatively, internal iliac artery embolization, and intraoperative ligation of the hypogastric or uterine arteries. SUMMARY Optimal management of PAS begins with early and definitive diagnosis. A multidisciplinary approach along with preparation of special equipment and the use of a check-list maximize the chance for success. Anesthesia could be done with all types of regional or under general, considering case-by-case factors but most importantly choosing according to the institution's best facility and skill.
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Affiliation(s)
- Alexander Ioscovich
- Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, affiliated with The Hebrew University, Jerusalem, Israel
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24
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Ye Y, Li J, Liu S, Zhao Y, Wang Y, Chu Y, Peng W, Lu C, Liu C, Zhou J. Efficacy of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control in patients with abnormally invasive placenta: a historical cohort study. BMC Pregnancy Childbirth 2023; 23:333. [PMID: 37165316 PMCID: PMC10170700 DOI: 10.1186/s12884-023-05649-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Patients with abnormally invasive placenta (AIP) are at high risk of massive postpartum hemorrhage. Resuscitative endovascular balloon occlusion of the aorta (REBOA), as an adjunct therapeutic strategy for hemostasis, offers the obstetrician an alternative for treating patients with AIP. This study aimed to evaluate the role of REBOA in hemorrhage control in patients with AIP. METHODS This was a historical cohort study with prospectively collected data between January 2014 to July 2021 at a single tertiary center. According to delivery management, 364 singleton pregnant AIP patients desiring uterus preservation were separated into two groups. The study group (balloon group, n = 278) underwent REBOA during cesarean section, whereas the reference group (n = 86) did not undergo REBOA. Surgical details and maternal outcomes were collected. The primary outcome was estimated blood loss and the rate of uterine preservation. RESULTS A total of 278 (76.4%) participants experienced REBOA during cesarean section. The patients in the balloon group had a smaller blood loss during cesarean Sect. (1370.5 [752.0] ml vs. 3536.8 [1383.2] ml; P < .001) and had their uterus salvaged more often (264 [95.0%] vs. 23 [26.7%]; P < .001). These patients were also less likely to be admitted to the intensive care unit after delivery (168 [60.4%] vs. 67 [77.9%]; P = .003) and had a shorter operating time (96.3 [37.6] min vs. 160.6 [45.5] min; P < .001). The rate of neonatal intensive care unit admission (176 [63.3%] vs. 52 [60.4%]; P = .70) and total maternal medical costs ($4925.4 [1740.7] vs. $5083.2 [1705.1]; P = .13) did not differ between the two groups. CONCLUSIONS As a robust hemorrhage-control technique, REBOA can reduce intraoperative hemorrhage in patients with AIP. The next step is identifying associated risk factors and defining REBOA inclusion criteria to identify the subgroups of AIP patients who may benefit more.
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Affiliation(s)
- Yuanhua Ye
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Jing Li
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Shiguo Liu
- Prenatal Diagnosis Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yang Zhao
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yanhua Wang
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yijing Chu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Wei Peng
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Caixia Lu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Chong Liu
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China
| | - Jun Zhou
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong Province, 266003, China.
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Capannolo G, D'Amico A, Alameddine S, Di Girolamo R, Khalil A, Calì G, Trish IT, Coutinho CM, Herrera M, Liberati M, Lucidi A, Palacios-Jaraquemada J, Buca D, D'Antonio F. Placenta accreta spectrum disorders clinical practice guidelines: A systematic review. J Obstet Gynaecol Res 2023; 49:1313-1321. [PMID: 36796351 DOI: 10.1111/jog.15544] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/28/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To objectively assess the quality of the published clinical practice guidelines (CPGs) on the management of pregnancies complicated by placenta accreta spectrum (PAS)disorders. METHODS MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to the management of pregnancies with suspected PAS disorders were evaluated: risk factors for PAS, prenatal diagnosis, role of interventional radiology and ureteral stenting, and optimal surgical management. The assessment of risk of bias and quality assessment of the CPGs were performed using the (AGREE II) tool (Brouwers et al., 2010). To define a CPG as of good quality we adopted a cut-off score >60%. RESULTS Nine CPGs were included. Specific risk factors for referral were assessed by 44.4% (4/9) of CPGs, mainly consisting in the presence of placenta previa and a prior cesarean delivery or uterine surgery. About 55.6% of CPGs (5/9) suggested ultrasound assessment of women with risk factors for PAS in the second and third trimester of pregnancy and 33.3% (3/9) recommended magnetic resonance imaging (MRI); 88.9% (8/9) of CPGs recommended cesarean delivery at 34-37 weeks of gestation. There was not generally consensus on the use of interventional radiology and ureteral stenting before surgery for PAS. Finally, hysterectomy was the recommend surgical approach by 77.8% (7/9) of the included CPGs. CONCLUSION Most of the published CPGs on PAS are generally of good quality. There was general agreement among the different CPGs on PAS as a regard as risk stratification, timing at diagnosis and delivery but not on the indication for MRI, use of interventional radiology and ureteral stenting.
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Affiliation(s)
- Giulia Capannolo
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alice D'Amico
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Sara Alameddine
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Raffaella Di Girolamo
- Department of Public Health, School of Medicine, Federico II, University of Naples, Naples, Italy
| | - Asma Khalil
- Fetal Medicine Unit, Saint George's Hospital, London, UK
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - Ilan T Trish
- Department of Obstetrics and Gynecology, NYU School of Medicine, NYU Langone Health, New York, New York, USA
| | - Conrado M Coutinho
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo: Ribeirão Preto, São Paulo, Brazil
| | - Mauricio Herrera
- Maternal fetal medicine, Obstetric Department, Clinica Colsanitas Bogotà, Bogota, Colombia
| | - Marco Liberati
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Alessandro Lucidi
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | | | - Danilo Buca
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Francesco D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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26
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Terminology for abnormally invasive placenta: still confusing. Int J Obstet Anesth 2023; 53:103603. [PMID: 36379853 DOI: 10.1016/j.ijoa.2022.103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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West S, Martin A, Copping R, Gard G, Maher R, Seeho S. Staged treatment of placenta accreta spectrum: A combined surgical and radiological approach. Aust N Z J Obstet Gynaecol 2023. [PMID: 36695433 DOI: 10.1111/ajo.13646] [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: 07/14/2022] [Accepted: 12/26/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Placenta accreta spectrum (PAS) is a rare but serious complication of pregnancy. AIMS The aim of this study was to determine maternal and neonatal outcomes following a combined surgical and interventional radiology (IR) approach to managing PAS, and the risks associated with this technique. METHODS AND MATERIALS Retrospective cohort study of all cases of PAS in a tertiary maternity centre between January 2001 and July 2020. Women who underwent caesarean hysterectomy for histologically confirmed PAS with a staged surgical and IR approach were compared with those who underwent caesarean hysterectomy without IR. Maternal, neonatal outcomes, surgical and radiological complications were assessed. RESULTS Forty-six women were included in the study, and 30/46 (65.2%) underwent the staged surgical and IR approach. Women in the staged group had less overall blood loss (1794 mL vs 3713 mL; P < 0.001), less requirement for blood transfusion (40% vs 75%; P < 0.001), and a lower mean volume of packed red cells transfused (2.5 vs 6.1 units). Anaesthetic and operative times were longer for the staged group (468 vs 189 min: 272 vs 141 min P < 0.001), respectively. There were no differences in rates of neonatal or maternal complications between the two groups. CONCLUSION This study demonstrates that a staged procedure combining surgery and IR for PAS results in a considerable reduction in blood loss, need for transfusion, and units of packed red cells transfused compared with surgery alone. The staged procedure required significantly longer anaesthetic and operative times; however, there were no differences in maternal and neonatal morbidity.
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Affiliation(s)
- Simon West
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
| | - Amy Martin
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia
| | - Ross Copping
- Liverpool Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Greg Gard
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia
| | - Richard Maher
- Royal North Shore Hospital Department of Medical Imaging, Sydney, New South Wales, Australia
| | - Sean Seeho
- Royal North Shore Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,University of Sydney Northern Clinical School, Sydney, New South Wales, Australia.,Womens and Babies Research, Kolling Institute of Medical Research, Sydney, New South Wales, Australia
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Horwood G, Singh S. Maximally Invasive Surgery for the Minimally Invasive Gynecologist. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Geneviève Horwood
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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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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Salmanian B, Einerson BD, Carusi DA, Shainker SA, Nieto-Calvache AJ, Shrivastava VK, Subramaniam A, Zuckerwise LC, Lyell DJ, Khandelwal M, Fitzgerald GD, Hessami K, Fox KA, Silver RM, Shamshirsaz AA. Timing of delivery for placenta accreta spectrum: the Pan-American Society for the Placenta Accreta Spectrum experience. Am J Obstet Gynecol MFM 2022; 4:100718. [PMID: 35977702 DOI: 10.1016/j.ajogmf.2022.100718] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Society for Maternal-Fetal Medicine recommends cesarean delivery with potential hysterectomy scheduled in the late preterm period between 34 0/7 and 35 6/7 weeks of gestation for prenatally suspected placenta accreta spectrum. OBJECTIVES We aimed to investigate clinical compliance with the recommended delivery timing window for placenta accreta spectrum and its impact on maternal and neonatal outcomes. STUDY DESIGN We performed a retrospective multicenter review of data from referral centers within the Pan-American Society for Placenta Accreta Spectrum. Patients with placenta accreta spectrum with both antenatal diagnosis and confirmed histopathologic findings were included. We investigated adherence to the Society for Maternal-Fetal Medicine-recommended gestational age window for delivery, and compliance was further stratified by scheduled and unscheduled delivery. We compared the outcomes for patients with scheduled delivery within vs immediately 2 weeks outside the recommended window. RESULTS Among 744 patients with a prenatal diagnosis of placenta accreta spectrum and placental histopathologic confirmation, 488 (66%) had scheduled delivery. Among all prenatally diagnosed placenta accreta spectrum patients, 252 (39%) delivered within the recommended window of 34 0/7 and 35 6/7 weeks gestation. For the subgroup of patients who underwent scheduled delivery (n=426), 209 (49%) had delivery in this window, 120 (28%) delivered before 34 weeks, and 97 (23%) delivered at or later than 36 weeks. In the patients with scheduled delivery, 27% of placenta accreta spectrum patients with accreta delivered in the 2 weeks immediately after the recommended window (36 0/7-37 6/7 weeks), and 22% of placenta accreta spectrum pregnancies with increta/percreta delivered in the 2 weeks immediately before the recommended delivery (32 0/7-33 6/7 weeks). The maternal outcomes among those who delivered within the recommended range vs those delivering 2 weeks before and after the recommended range were similar, regardless of placenta accreta spectrum severity. CONCLUSION Less than half of placenta accreta spectrum patients had scheduled delivery within the recommended gestational age of 34 0/7 to 35 6/7 weeks. The reasons for deviation from recommendations and the risks and benefits of individualized timing of delivery on the basis of risk factors and predicted outcomes warrant further investigation.
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Affiliation(s)
- Bahram Salmanian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (Drs Salmanian, Hessami, Fox, and Shamshirsaz)
| | - Brett D Einerson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah Health, Salt Lake City, UT (Drs Einerson and Silver)
| | - Daniela A Carusi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Dr Carusi)
| | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (Dr Shainker)
| | - Albaro J Nieto-Calvache
- Department of Obstetrics and Gynecology, Fundación Clínica Valle del Lili, Universidad ICESI, Cali, Colombia (Dr Nieto)
| | - Vineet K Shrivastava
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Miller Children's and Women's Hospital, Long Beach, CA (Dr Shrivastava)
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Dr Subramaniam)
| | - Lisa C Zuckerwise
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN (Dr Zuckerwise)
| | - Deirdre J Lyell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA (Dr Lyell)
| | - Meena Khandelwal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Cooper University Hospital, Princeton, NJ (Dr Khandelwal)
| | - Garrett D Fitzgerald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Fitzgerald)
| | - Kamran Hessami
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (Drs Salmanian, Hessami, Fox, and Shamshirsaz)
| | - Karin A Fox
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (Drs Salmanian, Hessami, Fox, and Shamshirsaz)
| | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah Health, Salt Lake City, UT (Drs Einerson and Silver)
| | - Alireza A Shamshirsaz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX (Drs Salmanian, Hessami, Fox, and Shamshirsaz).
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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: 6] [Impact Index Per Article: 3.0] [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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Han X, Guo Z, Yang X, Yang H, Ma J. Association of Placenta Previa With Severe Maternal Morbidity Among Patients With Placenta Accreta Spectrum Disorder. JAMA Netw Open 2022; 5:e2228002. [PMID: 35994286 PMCID: PMC9396360 DOI: 10.1001/jamanetworkopen.2022.28002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Placenta previa is widely acknowledged as a risk factor for placenta accreta spectrum (PAS) disorders, which are severe maternal complications; however, data are limited regarding whether placenta previa is associated with a higher risk of worse maternal outcomes among patients with PAS disorders. OBJECTIVE To examine the association between placenta previa and the risk of severe maternal morbidities (SMMs) and higher resource use among patients with PAS disorders. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study extracted records of 3793 patients with PAS diagnosis and delivery indicators between October 1, 2015, and December 31, 2019, from the US National Inpatient Sample database. EXPOSURES Placenta previa. MAIN OUTCOMES AND MEASURES Data on 21 Centers for Disease Control and Prevention-defined SMMs and 25 study-defined surgical morbidities associated with PAS were extracted. Six surgical procedures (cystoscopy, intra-arterial balloon occlusion, cesarean delivery, hysterectomy, cystectomy, and oophorectomy), hospital length of stay, and inpatient costs were compared. Multivariable Poisson regression models built in the generalized estimating equation framework were used. RESULTS Among 3793 patients with PAS (median [IQR] age at admission, 33 [29-37] years), 621 women (16.4%) were Black, 765 (20.2%) were Hispanic, 1779 (46.9%) were White, 441 (11.6%) were of other races and/or ethnicities (47 [1.2%] were American Indian, 220 [5.8%] were Asian or Pacific Islander, and 174 [4.6%] were of multiple or other races and/or ethnicities), and 187 (4.9%) were of unknown race and ethnicity. A total of 1323 patients (34.9%) had placenta previa and 2470 patients (65.1%) did not; of those with placenta previa, 405 patients (30.6%) had invasive PAS. Patients with vs without placenta previa had a significantly higher rate and risk of any SMM (935 women [70.7%] vs 1087 women [44.0%]; P < .001; adjusted risk ratio [aRR], 1.19; 95% CI, 1.12-1.27) and any surgical morbidity (1170 women [88.4%] vs 1667 women [67.5%]; P < .001; aRR, 1.18; 95% CI, 1.13-1.23). With regard to specific outcomes, those with vs without placenta previa had a significantly higher rate of peripartum hemorrhage (878 patients [66.4%] vs 1217 patients [49.3%]; P < .001), blood product transfusion (413 patients [31.2%] vs 610 patients [24.7%]; P < .001), shock (83 patients [6.3%] vs 108 patients [4.4%]; P = .01), disseminated intravascular coagulation or other coagulopathy (77 patients [5.8%] vs 105 patients [4.3%]; P = .04), and urinary tract injury (44 patients [3.3%] vs 41 patients [1.7%]; P = .002). Patients with vs without placenta previa were more likely to undergo cesarean delivery (1292 patients [97.7%] vs 1787 patients [72.3%]; P < .001), hysterectomy (786 patients [59.4%] vs 689 patients [27.9%]; P < .001), cystoscopy (301 patients [22.8%] vs 203 patients [8.2%]; P < .001), cystectomy (157 patients [11.9%] vs 98 patients [4.0%]; P < .001), and intra-arterial balloon occlusion (121 patients [9.1%] vs 77 patients [3.1%]; P < .001) and to have significantly longer hospital length of stay (median [IQR], 5 [4-11] days vs 3 [3-5] days; P < .001) and total inpatient costs (median [IQR], $17 496 [$10 863-$30 619] vs $9728 [$6130-$16 790]; P < .001). Hypertensive disorder of pregnancy was associated with a decreased risk of placenta previa (aRR, 0.67; 95% CI, 0.46-0.96) among patients with PAS. CONCLUSIONS AND RELEVANCE In this study, placenta previa was associated with an increased risk of maternal and surgical morbidities and higher resource use among women with PAS. These findings suggest that interventions to alleviate maternal and surgical morbidities are especially needed for patients with placenta previa-complicated PAS disorders.
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Affiliation(s)
- Xueyan Han
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Zhirong Guo
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Peking University First Hospital, Beijing, China
| | - Xinrui Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Peking University First Hospital, Beijing, China
| | - Jingmei Ma
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Peking University First Hospital, Beijing, China
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Mitoma T, Hayata K, Yokohata S, Ohira A, Kashino C, Kirino S, Tani K, Maki J, Eto E, Masuyama H. Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature. BMC Pregnancy Childbirth 2022; 22:535. [PMID: 35780086 PMCID: PMC9250175 DOI: 10.1186/s12884-022-04864-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE. CASE PRESENTATION A twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus. CONCLUSION A review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.
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Affiliation(s)
- Tomohiro Mitoma
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan.
| | - Kei Hayata
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Satomi Yokohata
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Akiko Ohira
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Chiaki Kashino
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Satoe Kirino
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Department of Obstetrics and Gynecology, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama city, Okayama, 700-8558, Japan
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Munoz JL, Blankenship LM, Ramsey PS, McCann GA. Importance of the gynecologic oncologist in management of cesarean hysterectomy for Placenta Accreta Spectrum (PAS). Gynecol Oncol 2022; 166:460-464. [PMID: 35781164 DOI: 10.1016/j.ygyno.2022.06.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Placenta Accreta Spectrum (PAS) is an invasive placental disorder characterized by significant maternal and fetal morbidity. Utilization of multidisciplinary teams has been shown to optimize patient outcomes. Our objective was to assess the impact of cesarean hysterectomy performed by gynecologic oncologists versus Ob/Gyn specialists in maternal morbidity. METHODS A retrospective cohort study was performed of singleton, non-anomalous pregnancies complicated by PAS University of Texas Health San Antonio Placenta Accreta program from 2010 to 2021. Our primary outcome was a maternal morbidity composite of any of the following: estimated blood loss >2 L, ICU admission, intraoperative acidosis and post-operative length of stay >4 days. In addition, demographic and pregnancy data were obtained. Univariate and multivariate analyses were performed to identify the individual impact of variables such as general anesthesia, episodes of vaginal bleeding, uterine artery embolization, emergent delivery and placenta percreta pathology. RESULTS 122 pregnancies complicated by PAS who underwent cesarean hysterectomy were identified from 2010 to 2021. Gynecologic oncologists were the primary surgeons for 62 (50.8%) of these cases. The involvement of gynecologic oncologists increased over the time period from 16% to 80%. Gynecologic oncologists were more like to be involved in cases with an antenatal diagnosis of placenta percreta (11.7 vs 37.1%, p = 0.001) and these cases were characterized by increased composite maternal morbidity (65 vs 83.9%, p = 0.02). These cases were also significantly longer (151 vs 271 min, p < 0.0001), involved greater usage of urinary stents (36.7 vs 66.1%, p = 0.002) and had longer post-operative lengths of stay (3 vs 4 days, p < 0.0001). PAS cesarean hysterectomies by gynecologic oncologists were less likely to be supracervical (25 vs 3.2%, p = 0.0005). Multivariate analysis controlling for placenta percreta, uterine artery embolization, vaginal bleeding and emergent delivery showed no difference in composite maternal morbidity (aOR = 0.95, 95%CI [0.35-2.52]) and lower rates of intraoperative acidosis (aOR = 0.36, 95%CI [0.14-0.93]) or post-operative length of stay >4 days (aOR = 0.37, 95%CI [0.15-0.91]). CONCLUSIONS Gynecologic oncologists play a critical role in the surgical management of PAS cesarean hysterectomies. When compared to Ob/Gyn specialists, gynecologic oncologists are more likely to act as primary surgeons in complex cases similar morbidity and greater post-operative outcomes.
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Affiliation(s)
- Jessian L Munoz
- University of Texas Health Sciences Center at San Antonio, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University Health System, San Antonio, TX, United States of America.
| | - Logan M Blankenship
- University of Texas Health Sciences Center at San Antonio, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University Health System, San Antonio, TX, United States of America
| | - Patrick S Ramsey
- University of Texas Health Sciences Center at San Antonio, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University Health System, San Antonio, TX, United States of America
| | - Georgia A McCann
- University of Texas Health Sciences Center at San Antonio, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University Health System, San Antonio, TX, United States of America
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Lu T, Wang Y, Guo A, Deng Y, Wu C, Li X, Liu S. Correlation of placental thickness and PAS disorders: findings from MRI. Abdom Radiol (NY) 2022; 47:1150-1156. [PMID: 35072784 DOI: 10.1007/s00261-022-03420-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify if placental thickness measured from MRI images correlates with placenta accreta spectrum (PAS) disorders. METHODS Placental thickness of 245 patients was retrospectively measured from October 2016 to March 2020. The measurement was made at the thickest portion of the placenta on the mid-sagittal plane of the placenta from MRI by two independent radiologists. Surgical report and pathology of the delivered placenta were used as a reference standard. Association between clinical features, placental thickness, and PAS disorders was evaluated with univariate and multivariate analyses. The inter-reader and intra-reader reproducibility of the measurements and receiver operating characteristic curve analysis were also performed. RESULTS Placental thickness was significantly higher in patients with PAS disorders (3.45 cm) than that in patients without PAS disorders (2.90 cm) (p < 0.05). Multivariate analyses revealed that prior cesarean section, placenta previa, and placental thickness > 4 cm were independent risk factors for PAS disorders. The inter-reader and intra-reader reproducibility of placental thickness measurement were 0.979 (95% CI 0.960-0.989) and 0.981 (95% CI 0.9640-0.990), respectively. CONCLUSION The reproducibility of the measurement made from MRI images was high between two radiologists. Patients with PAS disorders had increased placental thickness. Placental thickness > 4 cm correlated with PAS disorders.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China.
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Aiwen Guo
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Yan Deng
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Chengqian Wu
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Xiangqi Li
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, Chengdu, 610072, China
| | - Siyun Liu
- GE Healthcare, Beijing, 100176, China
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Early Warning Model of Placenta Accreta Spectrum Disorders Complicated with Cervical Implantation: A Single-Center Retrospective Study. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8128689. [PMID: 35154621 PMCID: PMC8837428 DOI: 10.1155/2022/8128689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Background Placenta accreta spectrum (PAS) disorders seriously threaten the safety of the mother and infant in the perinatal period. Moreover, PAS is associated with poor maternal and perinatal outcomes once complicated with cervical implantation. Dismally, there are few reports about PAS complicated with cervical involvement currently, and the early warning models are also rarely reported. To screen the risk factors of PAS complicated with cervical implantation and construct an early risk warning model, we performed the analysis of clinical indicators and images of PAS patients by artificial intelligence (AI) data processing methods. Methods The clinical data of 166 patients with PAS in our hospital from January 2016 to September 2020 were retrospectively analyzed. The patients were divided into cervical implantation group and lower uterine implantation group according to the position of placenta implantation. Then, we compared the pregnancy outcomes of the two groups, screened the possible related factors of PAS complicated with cervical implantation by univariate analysis, and established the early warning model by logistic regression analysis. Results The maternal outcome of PAS complicated with cervical implantation was worse than that of the lower uterine implantation group. Through univariate analysis and logistic regression analysis, we found that the cervical width, abundant cervical blood flow, and bladder line interruption were all risk factors of PAS complicated with cervical implantation, and their contribution to the establishment of the regression model was statistically significant. Conclusion PAS complicated with cervical implantation was extremely severe. Early identification of risk factors and establishment of a risk warning model have certain guiding significance for clinical formulation of a reasonable treatment plan.
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Wang X, Yan J, Zhao X, Zheng W, Zhang H, Xin H, Zhang W, Hu Y, Yang H. Maternal outcomes of abnormally invasive placenta in China and their association with use of abdominal aortic balloon occlusion. J Matern Fetal Neonatal Med 2022; 35:9376-9382. [PMID: 35105248 DOI: 10.1080/14767058.2022.2035355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare maternal outcomes of abnormally invasive placenta in China in 2012, 2015, and 2018, and further examine the association between use of abdominal aortic balloon occlusion (AABO) and the risk of maternal outcomes. MATERIALS AND METHODS A retrospective analysis included 830 women diagnosed as abnormally invasive placenta from 5 tertiary care centers in China in 2012, 2015 and 2018. Participants were divided into AABO group and non-AABO group according to whether they were treated with AABO or not. Logistic regression models were used to assess the association of use of AABO with postpartum hemorrhage, blood transfusion, hysterectomy and repeated surgery. RESULTS Among 830 participants, 66.0% (548/830) and 34.0% (282/830) of women were diagnosed with placenta increta and percreta, respectively; 33.3% (276/830) of women with abnormally invasive placenta were treated with AABO. In 2012, 2015, and 2018, the rate of blood transfusion was 83.1, 59.8, and 56.2%; the rate of hysterectomy was 50.8, 11.2, and 2.4%; and the rate of repeated surgery was 10.2, 9.4, and 0.9%. Use of AABO was associated with lower risk of postpartum hemorrhage (OR = 0.59, 95% CI: 0.35-0.99), blood transfusion (OR = 0.72, 95% CI: 0.52-0.99), hysterectomy (OR = 0.04, 95% CI: 0.01-0.14) and repeated surgery (OR = 0.14, 95% CI: 0.05-0.41) after adjustment for potential confounders. CONCLUSION The rates of blood transfusion, hysterectomy and repeated surgery progressively decreased from 2012 to 2018 in Chinese women with abnormally invasive placenta. Use of AABO was associated with lower risk of postpartum hemorrhage, blood transfusion, hysterectomy and repeated surgery.
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Affiliation(s)
- Xueyin Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xianlan Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiran Zheng
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huijing Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Hong Xin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Hebei Medical University, Hebei Province, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Dormer JD, Villordon M, Shahedi M, Leitch K, Do QN, Xi Y, Lewis MA, Madhuranthakam AJ, Herrera CL, Spong CY, Twickler DM, Fei B. CascadeNet for hysterectomy prediction in pregnant women due to placenta accreta spectrum. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12032:120320N. [PMID: 36798853 PMCID: PMC9929645 DOI: 10.1117/12.2611580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In severe cases, placenta accreta spectrum (PAS) requires emergency hysterectomy, endangering the life of both mother and fetus. Early prediction may reduce complications and aid in management decisions in these high-risk pregnancies. In this work, we developed a novel convolutional network architecture to combine MRI volumes, radiomic features, and custom feature maps to predict PAS severe enough to result in hysterectomy after fetal delivery in pregnant women. We trained, optimized, and evaluated the networks using data from 241 patients, in groups of 157, 24, and 60 for training, validation, and testing, respectively. We found the network using all three paths produced the best performance, with an AUC of 87.8, accuracy 83.3%, sensitivity of 85.0, and specificity of 82.5. This deep learning algorithm, deployed in clinical settings, may identify women at risk before birth, resulting in improved patient outcomes.
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Affiliation(s)
- James D. Dormer
- Department of Bioengineering, The University of Texas at Dallas, TX
| | | | - Maysam Shahedi
- Department of Bioengineering, The University of Texas at Dallas, TX
| | - Ka’Toria Leitch
- Department of Bioengineering, The University of Texas at Dallas, TX
| | - Quyen N. Do
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew A. Lewis
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Ananth J. Madhuranthakam
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Christina L. Herrera
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Catherine Y. Spong
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Diane M. Twickler
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Baowei Fei
- Department of Bioengineering, The University of Texas at Dallas, TX
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX
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Leitch K, Shahedi M, Dormer JD, Do QN, Xi Y, Lewis MA, Herrera CL, Spong CY, Madhuranthakam AJ, Twickler DM, Fei B. Placenta Accreta Spectrum and Hysterectomy Prediction Using MRI Radiomic Features. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12033:120331I. [PMID: 36844110 PMCID: PMC9956938 DOI: 10.1117/12.2611587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In women with placenta accreta spectrum (PAS), patient management may involve cesarean hysterectomy at delivery. Magnetic resonance imaging (MRI) has been used for further evaluation of PAS and surgical planning. This work tackles two prediction problems: predicting presence of PAS and predicting hysterectomy using MR images of pregnant patients. First, we extracted approximately 2,500 radiomic features from MR images with two regions of interest: the placenta and the uterus. In addition to analyzing two regions of interest, we dilated the placenta and uterus masks by 5, 10, 15, and 20 mm to gain insights from the myometrium, where the uterus and placenta overlap in the case of PAS. This study cohort includes 241 pregnant women. Of these women, 89 underwent hysterectomy while 152 did not; 141 with suspected PAS, and 100 without suspected PAS. We obtained an accuracy of 0.88 for predicting hysterectomy and an accuracy of 0.92 for classifying suspected PAS. The radiomic analysis tool is further validated, it can be useful for aiding clinicians in decision making on the care of pregnant women.
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Affiliation(s)
- Ka’Toria Leitch
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Maysam Shahedi
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - James D. Dormer
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
| | - Quyen N. Do
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Yin Xi
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew A. Lewis
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Christina L. Herrera
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Catherine Y. Spong
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Diane M. Twickler
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Baowei Fei
- Department of Bioengineering, The University of Texas at Dallas, Richardson, TX
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX
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Munoz JL, Pfeiffer AF, Curbelo J, Ramsey PS, Ireland KE. Neuraxial to general anesthesia conversion has equitable intraoperative and improved post-operative outcomes compared to general anesthesia in cesarean hysterectomy for placenta accreta spectrum (PAS). J Matern Fetal Neonatal Med 2021; 35:8640-8644. [PMID: 34657560 DOI: 10.1080/14767058.2021.1990885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Placenta Accreta Spectrum (PAS) represents a series of placental disorders with an estimated incidence of 1:1000. Delivery and subsequent cesarean hysterectomy for PAS is associated with significant maternal morbidity and mortality. Neuraxial anesthesia may be utilized initially with subsequent conversion to general anesthesia after delivery of the fetus as an alternative to initiating with general anesthesia. METHODS We performed a case-control study and analyzed 85 cases of pathology-confirmed PAS patients who underwent a cesarean hysterectomy in singleton, non-anomalous, viable pregnancies. All patients were delivered at our institution's established Placenta Accreta Program from 2005 to 2020. RESULTS Fifty-two (61%) patients underwent general anesthesia and 33 (39%) patients underwent neuraxial anesthesia (collectively spinal, epidural, and combined spinal-epidural) converted to general anesthesia after cesarean delivery. Baseline demographics between groups were similar. Pre-operative ASA airway assessment of III/IV was equivalent between groups (94 and 82%, p = .08). Intraoperatively, neuraxial conversion and general anesthesia were equal with respect to operative time (241 vs. 261 min, p = .47), estimated blood loss (6039 vs. 8134 mL, p = .51), and composite maternal morbidity (84.6 vs. 75.8%, p = .40). Post-operatively, ICU admission (47 vs. 46%, p = 1.0) and intensive care length of stay was equivalent (p = .07), yet the total post-operative length of stay was significantly reduced in patients who underwent neuraxial anesthesia (3.76 vs. 6.35 days, p = .02). In addition, while general anesthesia was associated with a greater sonographic suspicion for placenta percreta (40 vs. 12%, p = .007), final pathology was equivalent (52 vs. 60%, p = .5). CONCLUSIONS Taken together, our data show neuraxial conversion to general anesthesia has equivalent intra-operative parameters with improved post-operative outcomes when compared to general anesthesia alone in the case of cesarean hysterectomy for Placenta Accreta Spectrum disorders.
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Affiliation(s)
- Jessian L Munoz
- Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, University Health System, San Antonio, TX, USA
| | - Alixandria F Pfeiffer
- Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, University Health System, San Antonio, TX, USA
| | - Jacqueline Curbelo
- Department of Anesthesiology, University of Texas Health Sciences Center at San Antonio, University Health System, San Antonio, TX, USA
| | - Patrick S Ramsey
- Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, University Health System, San Antonio, TX, USA
| | - Kayla E Ireland
- Department of Obstetrics & Gynecology, University of Texas Health Sciences Center at San Antonio, University Health System, San Antonio, TX, USA
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Brown AD, Hart JM, Modest AM, Hess PE, Abbas AM, Nieto-Calvache AJ, Bhide A, Lim B, Dunjin C, Palacios-Jaraquemada J, Sentilhes L, Soma-Pillay P, Aryananda RA, Hantoushzadeh S, Wang S, Shamshirsaz AA, Shainker SA. Geographic variation in management of patients with placenta accreta spectrum: An international survey of experts (GPASS). Int J Gynaecol Obstet 2021; 158:129-136. [PMID: 34610154 DOI: 10.1002/ijgo.13960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe global geographic variations in the diagnosis and management of placenta accreta spectrum (PAS). METHODS An international cross-sectional study was conducted among PAS experts practicing at medical institutions in member states of the United Nations. Survey questions focused on diagnostic evaluation and management strategies for PAS. RESULTS A total of 134 centers participated. Participating centers represented each of the United Nations' designated regions. Of those, 118 (88%) reported practicing in a medium-volume or high-volume center. First-trimester PAS screen was reported in 35 (26.1%) centers. Respondents consistently implement guideline-supported care practices, including utilization of ultrasound as the primary diagnostic modality (134, 100%) and implementation of multidisciplinary care teams (115, 85.8%). Less than 10% of respondents reported routinely managing PAS without hysterectomy; these centers were predominantly located in Europe and Africa. Antepartum management and availability of mental health support for PAS patients varied widely. CONCLUSION Worldwide, there is a strong adherence to PAS care guidelines; however, regional variations do exist. Comparing variations in care to outcomes will provide insight into the clinically significant practice variability.
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Affiliation(s)
- Alec D Brown
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jessica M Hart
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Philip E Hess
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ahmed M Abbas
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Boon Lim
- Canberra Hospital, Australian National University, Canberra, Australia
| | - Chen Dunjin
- Guangzhou Medical University, Guangzhou, China
| | | | - Loïc Sentilhes
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | - Shan Wang
- Shandong First Medical University, Tai'an, China
| | | | - Scott A Shainker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Kasraeian M, Hashemi A, Hessami K, Alamdarloo SM, Vahdani R, Vafaei H, Najib FS, Shiravani Z, Razavi B, Homayoon N, Nayebi M, Bazrafshan K, Jahromi MA. A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women. BMC WOMENS HEALTH 2021; 21:243. [PMID: 34130685 PMCID: PMC8207599 DOI: 10.1186/s12905-021-01389-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.
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Affiliation(s)
- Maryam Kasraeian
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefe Hashemi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Professor Alborzi Clinical Microbiology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran. .,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Razie Vahdani
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Homeira Vafaei
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Sadat Najib
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Behnaz Razavi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Nahid Homayoon
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Mahsa Nayebi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh Jahromi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Munoz JL, Kimura AM, Xenakis E, Jenkins DH, Braverman MA, Ramsey PS, Ireland KE. Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program. J Matern Fetal Neonatal Med 2021; 35:6455-6460. [PMID: 33902384 DOI: 10.1080/14767058.2021.1915275] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a group of placental invasion pathologies associated with significant morbidity to both mother and fetus. The majority of patients with PAS will require a blood transfusion at time of delivery and subsequent cesarean hysterectomy. The optimal approach to maternal acute blood loss resuscitation is currently unknown. METHODS Here, we present a cohort analysis of 34 patients with pathology-confirmed PAS treated with either whole blood (n = 16) or component therapy (n = 18) for initial intraoperative resuscitation. RESULTS We observed comparable results in post-operative outcomes with fewer overall transfusions and subsequently, lower volumes of resuscitation (p=.03) with whole blood initial resuscitation. CONCLUSIONS Whole blood transfusion may represent a viable option for initial resuscitation with lower resuscitation volumes and transfusion-associated complications without directly effecting post-operative outcomes in cases of PAS.
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Affiliation(s)
- Jessian L Munoz
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Alison M Kimura
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Elly Xenakis
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Donald H Jenkins
- Division of Trauma and Emergency Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Maxwell A Braverman
- Division of Trauma and Emergency Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Patrick S Ramsey
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Kayla E Ireland
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
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Timofeeva AV, Fedorov IS, Pirogova MM, Vasilchenko ON, Chagovets VV, Ezhova LS, Zabelina TM, Shmakov RG, Sukhikh GT. Clusterin and Its Potential Regulatory microRNAs as a Part of Secretome for the Diagnosis of Abnormally Invasive Placenta: Accreta, Increta, and Percreta Cases. Life (Basel) 2021; 11:life11040270. [PMID: 33805203 PMCID: PMC8064394 DOI: 10.3390/life11040270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/18/2022] Open
Abstract
Magnetic resonance imaging (MRI) and ultrasound methods used for the diagnosis of an abnormally invasive placenta (AIP) have a wide range of sensitivity (Se, 33–93%) and specificity (Sp, 71–100%) levels, which results in a high risk of unfavorable maternal and perinatal outcomes. The relevance of optimizing the diagnosis of AIP is beyond doubt. Given the epigenetic nature of trophoblast invasion, we aimed to quantitate microRNAs and proteins of their target genes that are potentially associated with AIP in blood plasma samples from 64 pregnant women at gestation weeks 30–34 by reverse transcription coupled with polymerase chain reaction (RT-PCR) and Western blotting, respectively. Statistically significant increases in the expression levels of hsa-miR-17-5p, hsa-miR-21-5p, hsa-miR-25-3p, hsa-miR-92a-3p, and hsa-miR-320a-3p were revealed in the groups of women with AIP (accreta, increta, percreta) relative to the group of women with scars on the uterus or to the group with placenta previa. Opposite changes in the expression level of “gene–target protein/miRNA” pairs were found for the α-subunit of the clusterin secretory form and any of the hsa-miR-21-5p, hsa-miR-25-3p, hsa-miR-92a-3p, hsa-miR-320a-3p, and hsa-miR-17-5p in all cases of AIP. The developed logistic regression models to diagnose AIP cases of various severity gave Se values of 88.8–100% and Sp values of 91.6–100% using a combination of hsa-miR-21-5p, hsa-miR-92a-3p, hsa-miR-320a-3p, or clusterin levels.
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Affiliation(s)
- Angelika V. Timofeeva
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
- Correspondence: or ; Tel.: +7-4955314444
| | - Ivan S. Fedorov
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Mariya M. Pirogova
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Oksana N. Vasilchenko
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Vitaliy V. Chagovets
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Larisa S. Ezhova
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Tatiana M. Zabelina
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Roman G. Shmakov
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
| | - Gennadiy T. Sukhikh
- Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Ac. Oparina 4, 117997 Moscow, Russia; (I.S.F.); (M.M.P.); (O.N.V.); (V.V.C.); (L.S.E.); (T.M.Z.); (R.G.S.); (G.T.S.)
- Department of Obstetrics, Gynecology, Perinatology and Reproductology, First Moscow State Medical University Named after I.M. Sechenov, 119991 Moscow, Russia
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