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You H, Wang Y, Han R, Gu J, Zeng L, Zhao Y. Risk factors for placenta accreta spectrum without prior cesarean section: A case-control study in China. Int J Gynaecol Obstet 2024; 166:1092-1099. [PMID: 38573157 DOI: 10.1002/ijgo.15493] [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: 12/01/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To identify the risk factors for placenta accreta spectrum (PAS) disorders in women without prior cesarean section (CS). METHODS This retrospective case-control study investigated patients without prior CS who gave birth at Peking University Third Hospital between January 1, 2015 and December 31, 2021. Patients diagnosed with PAS according to the clinical diagnostic criteria of the 2019 International Federation of Gynecology and Obstetrics (FIGO) classification were included as the study group. Patients were matched as the control group according to delivery date and placenta previa, in a 1:2 allocation ratio. Maternal characteristics were compared between the two groups. RESULTS The study included 348 patients in the study group and 696 in the control group. The multivariate analysis showed that the independent risk factors of PAS consisted of operative hysteroscopy (once: adjusted odds ratio [aOR] 2.38, 95% CI 1.28-4.24, P = 0.006; twice or more: aOR 5.43, 95% CI 1.04-28.32, P = 0.045), uterine curettage (once: aOR 2.54, 95% CI 1.80-3.58, P < 0.001; twice: aOR 3.01, 95% CI 1.81-5.02, P < 0.001; three or more times: aOR 9.18, 95% CI 4.64-18.18, P < 0.001), multifetal pregnancy (aOR 5.64, 95% CI 3.01-10.57, P < 0.001), adenomyosis (aOR 2.77, 95% CI 1.23-6.22, P = 0.014), in vitro fertilization (aOR 1.51, 95% CI 1.04-2.20, P = 0.030) and pre-eclampsia (aOR 2.72, 95% CI 1.36-5.45, P = 0.005), and the independent protective factor was being multiparous (aOR 0.37, 95% CI 0.25-0.54, P < 0.001). CONCLUSION After controlling the effect of placenta previa, we found that patients with PAS without prior CS had unique maternal characteristics. Classification and quantification of the intrauterine surgeries they have undergone is essential for identifying high-risk patients. Early identification of high-risk groups by risk factors has the potential to improve the prognosis considerably.
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Affiliation(s)
- Huanyu You
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obsterics, Beijing, China
| | - Rui Han
- Department of Obstetrics, Maternal and Child Health Hospital of Changzhi, Changzhi, China
| | - Jinyu Gu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Centre for Healthcare Quality Management in Obsterics, Beijing, China
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Sonehara R, Nakamura T, Iwase A, Nishida K, Takikawa S, Murakami M, Yoshita S, Muraoka A, Miyake N, Nakanishi N, Osuka S, Goto M, Kajiyama H. Predictive factors for massive hemorrhage in women with retained products of conception: a prospective study. Sci Rep 2022; 12:11859. [PMID: 35831326 PMCID: PMC9279309 DOI: 10.1038/s41598-022-15564-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
Retained products of conception (RPOC) is a common cause of postpartum bleeding, which may be life-threatening; however, no evidence-based guidelines exist to assist in evaluating the risk of massive hemorrhage in women with RPOC. In this prospective study, we aimed to evaluate the predictive factors for massive hemorrhage in women with RPOC. The primary and secondary endpoints were to validate the usefulness of power Doppler color scoring (PDCS) in evaluating hypervascularity and to identify other predictive factors (such as maximum RPOC diameter and serum βhCG and Hb level at first visit), respectively. Among the 51 women with RPOC included in this study, 16 (31.5%) experienced massive hemorrhage during follow-up. None of the women with PDCS 1 or 2 (18) experienced massive hemorrhage, whereas 16 (48.5%) women with PDCS 3 or 4 (33) did. Multiple logistic regression analysis showed that the odds ratio [95% confidence interval] (P value) for PDCS, assisted reproductive technology (ART), and low serum hemoglobin (Hb) levels were 22.39 [2.25 - 3087.92] (P = 0.004), 5.72 [1.28 - 33.29] (P = 0.022), and 4.24 [0.97 - 22.99] (P = 0.056), respectively. Further, the decision tree method identified PDCS, ART, and low serum Hb levels as potential predictive factors for massive hemorrhage. This study identified PDCS as useful predictor of massive hemorrhage in women with RPOC. With additional inclusion of factors such as ART and low serum Hb levels, the risk of massive hemorrhage may be effectively evaluated, leading to better management of women of reproductive age.
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Affiliation(s)
- Reina Sonehara
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoko Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Akira Iwase
- Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, 371-8511, Japan
| | - Kazuki Nishida
- Department of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | | | - Mayuko Murakami
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Sayako Yoshita
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ayako Muraoka
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Natsuki Miyake
- Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Natsuki Nakanishi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoko Osuka
- Department of Maternal and Perinatal Medicine, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Morgan EA, Sidebottom A, Vacquier M, Wunderlich W, Loichinger M. The effect of placental location in cases of placenta accreta spectrum. Am J Obstet Gynecol 2019; 221:357.e1-357.e5. [PMID: 31344349 DOI: 10.1016/j.ajog.2019.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/22/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Placenta accreta spectrum affects approximately 3 in 1000 pregnancies. There is a paucity of data evaluating the effect of placental location on diagnosis, risk factors, and resultant outcomes in cases of placenta accreta spectrum. OBJECTIVE We analyzed placenta accreta spectrum cases to assess whether risk factors or maternal outcomes varied based on placental location. MATERIALS AND METHODS We performed a retrospective chart review of pathology-confirmed cases of placenta accreta spectrum from patients delivering at 2 large urban hospitals in the same healthcare system from 2007 to 2017. Placental location was defined by ultrasound images and confirmed by pathology reports. Location was categorized as anterior, posterior, or anterior/posterior for those with placental location at both sites. Fisher exact tests and analysis of variance were used to examine associations with measures of diagnosis, risk factors, and maternal outcomes. RESULTS A total of 86 pathology-confirmed placenta accreta spectrum cases were reviewed. The distribution of placental location on ultrasound was as follows: 19% posterior, 59% anterior, and 22% anterior/posterior. We found that prior cesarean delivery was lower with posterior placenta accreta spectrum (63% vs 94% vs 84% in the anterior and anterior/posterior groups respectively; (P = .007); however, in vitro fertilization rates were significantly higher (38% vs 2% vs 5% in the anterior and anterior/posterior groups respectively; P = .001). There was also lower incidence of percreta with posterior placenta accreta spectrum compared to the anterior and anterior/posterior groups (19% vs 47% vs 58% respectively; P = .055). Posterior cases were less likely to have placenta accreta spectrum suspected prenatally (50%) compared to anterior (80%) and anterior/posterior (89%) cases (P = .019). Despite late diagnosis, ureteral injury was the only surgical complication that was more common in patients with posterior placenta accreta spectrum (13% vs 0% vs 5% for anterior and anterior/posterior groups respectively; P = .037). CONCLUSION Placenta accreta spectrum with posterior placental location is associated with delayed diagnosis, surgical complications, assisted reproductive technology, and lower numbers of prior cesarean deliveries relative to anterior location. These differences in outcomes and risk factors based on placental location may allow for heightened clinical awareness, and improved diagnosis and management.
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De Mucio B, Serruya S, Alemán A, Castellano G, Sosa CG. A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. Int J Gynaecol Obstet 2019; 147:281-291. [DOI: 10.1002/ijgo.12948] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/14/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Bremen De Mucio
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WRH)Pan American Health Organization Montevideo Uruguay
| | - Suzanne Serruya
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WRH)Pan American Health Organization Montevideo Uruguay
| | - Alicia Alemán
- Department of Preventive MedicineSchool of MedicineUniversity of the Republic Montevideo Uruguay
| | - Graciela Castellano
- Department of Preventive MedicineSchool of MedicineUniversity of the Republic Montevideo Uruguay
| | - Claudio G. Sosa
- Latin American Center of Perinatology, Women and Reproductive Health (CLAP/WRH)Pan American Health Organization Montevideo Uruguay
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Li Y, Su D, Sun Y, Hu Z, Wei Z, Jia J. Influence of different preoperative fasting times on women and neonates in cesarean section: a retrospective analysis. BMC Pregnancy Childbirth 2019; 19:104. [PMID: 30922264 PMCID: PMC6440150 DOI: 10.1186/s12884-019-2254-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/19/2019] [Indexed: 01/13/2023] Open
Abstract
Background This study was to evaluate the impact of different preoperative fasting conditions on women and neonates through a retrospective analysis. Methods A total of 1599 women were divided into 5 groups according to different preoperative fasting times: group A: solid food ≥8 h; clear fluids ≥6 h; B: solid food ≥8 h; clear fluids ≥2 h < 6 h; C: solid food ≥6 h < 8 h; clear fluids < 2 h; D: solid food ≥2 h < 6 h; clear fluids < 2 h; E: solid food < 2 h; clear fluids < 2 h. Results Incidence rate of vomiting of women was lower in group C (solid food ≥6 h < 8 h and clear fluids < 2 h) than other groups (P < 0.05). Compared with the fasting for a long time (groups A and B: solid food > 8 h and clear fluids > 2 h at least), the incidence rate of hypoglycemia and acidosis of neonates in group C displayed a certain decrease (P < 0.05). Although shorter fasting times (solid food < 6 h at least) reduced the incidence of hypoglycemia and acidosis in neonates, it increased the risk of vomiting of women. Conclusion The preoperative fasting of solid food ≥6 h < 8 h and clear fluids < 2 h reduces the incidence of vomiting in women’s anesthesia and the risk of hypoglycemia and acidosis in neonates.
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Affiliation(s)
- Yi Li
- Department of Gynecology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Danchen Su
- Department of Anesthesiology, Guangdong Women and Children Hospital, No.13 Guangyuan West Road, Guangzhou, 510010, China
| | - Yijuan Sun
- Department of Anesthesiology, Guangdong Women and Children Hospital, No.13 Guangyuan West Road, Guangzhou, 510010, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children Hospital, No.13 Guangyuan West Road, Guangzhou, 510010, China
| | - Zaomei Wei
- Department of Anesthesiology, Guangdong Women and Children Hospital, No.13 Guangyuan West Road, Guangzhou, 510010, China
| | - Jie Jia
- Department of Anesthesiology, Guangdong Women and Children Hospital, No.13 Guangyuan West Road, Guangzhou, 510010, China.
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Lesieur E, Blanc J, Loundou A, Claquin A, Marcot M, Heckenroth H, Bretelle F. Teaching and performing audits on caesarean delivery reduce the caesarean delivery rate. PLoS One 2018; 13:e0202475. [PMID: 30148837 PMCID: PMC6110479 DOI: 10.1371/journal.pone.0202475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/03/2018] [Indexed: 12/26/2022] Open
Abstract
Aim To assess the factors associated with lower rate of caesarean deliveries in the South of France, based on the characteristics and organisation of the region’s 40 maternity facilities and the characteristics of the practitioners in these facilities. Method A retrospective study from 1 January 2012 to 31 December 2015. Data were collected by the Mediterranean network and a declarative survey was completed by each maternity facility in the region to study factor which could be associated with lower caesarean rate by univariate and multivariate analysis. Results 250 564 women gave birth during this period, of which 55 097 by caesarean section. The mean caesarean delivery rate over the four years was 22.0%. The rate was significantly higher in private maternity facilities [23.9% (21.9%– 25.8%), p<0.05] and type III (maximum care level) maternity facilities [24.2% (21.3%– 27.1%), p<0.05]. After a stepwise regression, the factors associated with a decrease in the caesarean delivery rate were audits concerning caesarean delivery (19.83%, β = - 2.48, p = 0.03 over the four years) and the provision of training to trainee doctors at the maternity facility (20.28%, β = - 1.08, p = 0.04 over the four years). Conclusion Performing audits in relation to caesarean deliveries could affect the caesarean. Teaching trainee doctors could be an indicator of quality of caesarean practices. They should be encouraged in maternity facilities to reduce the rate of caesareans.
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Affiliation(s)
- Emmanuelle Lesieur
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- * E-mail:
| | - Julie Blanc
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- EA 3279 –Public Health, chronic diseases and quality of life–Research Unit, Aix-Marseille University, Marseille, France
| | - Anderson Loundou
- EA 3279 –Public Health, chronic diseases and quality of life–Research Unit, Aix-Marseille University, Marseille, France
| | - Arnaud Claquin
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
| | - Michele Marcot
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
| | - Helene Heckenroth
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
| | - Florence Bretelle
- Department of Gynaecology and Obstetrics, Gynépole, Assistance Publique-Hôpitaux de Marseille, AMU, Aix- Marseille Université, Marseille, France
- Mediterannée Perinatal Networks « Reseau Mediterannée », PACA Corse Monaco, France
- UM63, CNRS 7278, IRD 198, INSERM 1095, Clinical infectious disease, Research Unit, Aix-Marseille University, Marseille, France
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Kellie FJ. Interventions for improving pregnancy outcomes in antenatally diagnosed or suspected morbidly adherent placenta. Hippokratia 2017. [DOI: 10.1002/14651858.cd012159.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Frances J Kellie
- The University of Liverpool; Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health; First Floor, Liverpool Women's NHS Foundation Trust Crown Street Liverpool UK L8 7SS
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