Abnormal Placental Implantation Research Articles

Understanding the complex interplay: An in-depth literature review of anemia's impact on maternal and fetal health throughout pregnancy

This comprehensive literature review highlights the intricate dynamics surrounding anemia and its multifaceted implications on maternal and fetal well-being during pregnancy. The analysis spans various factors influencing anemia, encompassing maternal age as a pivotal determinant. The ideal age for pregnancy, between 20-35 years, is explored as a crucial window for minimizing complications, with considerations for both physiological and psychological readiness. Conversely, pregnancies in women under 20 or over 35 are scrutinized for their heightened risks, involving physiological challenges and increased susceptibility to disorders like diabetes and hypertension. The review scrutinizes the role of anemia in precipitating complications such as placenta previa, characterized by abnormal placental implantation and associated with painless vaginal bleeding. Preeclampsia and eclampsia, distinctive hypertensive disorders, are examined, highlighting anemia's potential secondary role through hemolysis. Premature rupture of membranes (PROM) is also investigated, emphasizing anemia's association with disrupted immune responses, potentially contributing to membrane thinning and early rupture. Furthermore, the review explores the link between anemia during pregnancy and postpartum hemorrhage, elucidating the risks posed by reduced oxygen transport and the subsequent impact on uterine contractions. In conclusion, this literature review synthesizes existing knowledge to provide a comprehensive understanding of how anemia intertwines with various pregnancy-related complications, offering insights crucial for improved clinical management and maternal-fetal health outcomes.

Longitudinal assessment of spiral and uterine arteries in normal pregnancy using novel ultrasound tool.

To use superb microvascular imaging (SMI) to evaluate longitudinally spiral artery (SA) and uterine artery (UtA) vascular adaptation in normal human pregnancy, and to develop reference ranges for use at various gestational ages throughout pregnancy. The data for this study were obtained from the National Institutes of Health (NIH)-funded Human Placenta Project. Women aged 18-35 years, with a body mass index < 30 kg/m2 , without comorbidities, with a singleton gestation conceived spontaneously, and gestational age at or less than 13 + 6 weeks were eligible for inclusion. The current analysis was restricted to uncomplicated pregnancies carried to term. Exclusion criteria included maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation or delivery < 37 weeks. Women who fulfilled the inclusion criteria formed the reference population of the Human Placenta Project study. Each participant underwent eight ultrasound examinations during pregnancy. The pulsatility index (PI) of both the left and right UtA were obtained twice for each artery and the presence or absence of a notch was noted. Using SMI technology, the total number of SA imaged was recorded in a sagittal placental section at the level of cord insertion. The PI and peak systolic velocity (PSV) were also measured in a total of six SA, including two in the central portion of the placenta, two peripherally towards the uterine fundal portion, and two peripherally towards the lower uterine segment. A total of 90 women fulfilled the study criteria. Maternal UtA-PI decreased throughout the first half of pregnancy from a mean ± SD of 1.39 ± 0.50 at 12-13 weeks' gestation to 0.88 ± 0.24 at 20-21 weeks' gestation. The mean number of SA visualized in a sagittal plane of the placenta increased from 8.83 ± 2.37 in the first trimester to 16.99 ± 3.31 in the late-third trimester. The mean SA-PI was 0.57 ± 0.12 in the first trimester and decreased progressively during the second trimester, reaching a nadir of 0.40 ± 0.10 at 24-25 weeks, and remaining constant until the end of pregnancy. SA-PSV was highest in early pregnancy with a mean of 57.16 ± 14.84 cm/s at 12-13 weeks' gestation, declined to a mean of 49.38 ± 17.88 cm/s at 20-21 weeks' gestation and continued to trend downward for the remainder of pregnancy, reaching a nadir of 34.50 ± 15.08 cm/s at 36-37 weeks' gestation. A statistically significant correlation was noted between SA-PI and UtA-PI (r = 0.5633; P < 0.001). Multilevel regression models with natural cubic splines were used to create reference ranges of SA-PSV and SA-PI for given gestational ages. From early gestation, we have demonstrated the ability to image and quantify SA blood flow in normal pregnancy, and have developed reference ranges for use at various gestational ages throughout pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Usefulness of resuscitative endovascular balloon occlusion of the aorta (REBOA) in controlling puerperal bleeding in patients with abnormal placental implantation

Background and aimsAbnormalities of placental implantation, which make up the spectrum of placenta accreta, are associated with high maternal morbidity and mortality due to massive bleeding during delivery. Placing aortic occlusion balloons helps control the bleeding, facilitating surgical intervention. A new device, resuscitative endovascular balloon occlusion of the aorta (REBOA), minimizes the risks and complications associated with the placement of traditional aortic balloons and is also efficacious in controlling bleeding. The aim of this study is to evaluate the usefulness, efficacy, and safety of REBOA in puerperal bleeding due to abnormalities of placental implantation. Material and methodsBetween November 2019 and November 2021, our interventional radiology team placed six REBOA devices in six women scheduled for cesarean section due to placenta accrete. ResultsMean blood loss during cesarean section after REBOA (3507.5 mL) was similar to the amounts reported for other aortic balloons. The mean number of units of packed red blood cells required for transfusion was 3.5. Using REBOA provided the surgical team with adequate conditions to perform the surgery. There were no complications derived from REBOA, and the mean ICU stay was <2 days. ConclusionThe technical characteristics of the REBOA device make it a safe and useful alternative for controlling massive bleeding in patients with placenta accreta.

Placental basal plate myofibers and risk of hypertensive disorders of pregnancy

Basal plate myofiber (BPMF) refers to the myometrial fibers attachment to the basal plate on placental pathology evaluation. The presence of BPMF may represent occult invasion of placenta or may reflect abnormal placental implantation in a prior pregnancy. It is possible that abnormalities in trophoblast biology associated with BPMF may also alter the physiologic transformation of the spiral arteries in these pregnancies. This study is designed to evaluate the association of BPMF with preeclampsia and gestational hypertension, which are conditions associated with abnormal spiral artery remodeling.

Updates in placenta accreta spectrum – from diagnosis to treatment

Placenta accreta spectrum (PAS), also known as “morbidly adherent placenta”, represents a pathological entity that includes different types of abnormal placental implantation. The worldwide incidence of PAS is increasing rapidly, with the rise in the number of caesarean sections performed. More than 90% of PAS cases occur in women with at least one previous caesarean delivery. This pathological condition is associated with a high rate of maternal morbidity and mortality, presenting a unique challenge for its diagnosis and management. The major symptom is represented by antepartum vaginal bleeding. The diagnosis of PAS is made by imaging methods such as transabdominal or transvaginal ultrasound and magnetic resonance imaging. From the point of view of management, the timely confirmation of the diagnosis is vital to plan the delivery and to avoid a major life-threatening postpartum hemorrhage.

Does a Caesarean Section Scar Affect Placental Volume, Vascularity and Localization?

Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age.

Prevalence Of Placenta Previa In Pregnant Women With Previous Self Selected Caesarean

Background: with the increasing numbers of elected caesarean the cases of abnormal placental implantation such as previa is also increasing. Mortality and morbidity of mother increase with placenta previa due to increase in the incidence of bleeding during pregnancy. &#x0D; Objective: this study was performed to evaluate the prevalence between repeated elective caesarean section and abnormal implantation of plancenta / previa. &#x0D; Material and Patients: It is a cross-sectional study conducted over a period of 4 months from February 2022 to May 2022. A sample size of 35 patients was collected using purposive sampling technique. Data was collected from Lady Atchison Hospital Lahore and Christian Memorial Hospital. Patients with history of elected caesarean without any medical emergency were included in the current study. Patients with multiple gestations, patients with placental abruption, female with gestational age less than 28 weeks, smoker, diabetic patients and hypertensive patients were excluded. Data was analyzed using SPSS 20&#x0D; Results: In the present study 35 patients were selected .Out of total 35 participants females aged 30yrs were more prevalent.. Regarding gestational age most femalesin this study had gestational age 28weeks In total 35 participants Placenta Previa was seen in 20 participates. Most cases of placenta Previa are seen in females who are gravida4 and para3.&#x0D; Conclusion: The study concluded that elected C-section and placenta previa are closely linked. It showed that pregnancies at the gestational age of 28 – 29 weeks have high privilege of placenta previa.

Maternal and Perinatal Outcomes in Placenta Previa: A Retrospective Study at a Tertiary Care Centre of Western India

Introduction: Placenta previa is a condition characterised by abnormal placental implantation and usually presented as painless vaginal bleeding in second or third trimester of pregnancy. Various studies have reported adverse outcomes in the cases of placenta previa. Aim: To find incidence, maternal and perinatal outcomes in placenta previa. Materials and Methods: This retrospective study was carried out during April-June 2021 at a Government Tertiary care centre in Maharashtra. Total 260 cases of placenta previa managed at the institute between 1st January 2017 to 31st December 2019 were included in study. Primary data from labour room and operation theatre was collected and detailed case papers were accessed from medical records section. Data was analysed using Microsoft Excel Windows 2013. Results: Incidence of placenta previa was 1.09%. Majority of cases were from age group of 26-30 years, booked, gravida 2-3, belonging to low socio-economic status and without any history of risk factors. In 81.15% cases Lower Segment Cesarean Section (LSCS) was required. Post Partem Haemorrhage (PPH) (32.30%) and need for blood transfusion (86.15%) were major complications. Maternal mortality in cases of placenta previa was 4.23%. In perinatal outcome, prematurity was reported 44.30% cases while 57.46% needed NICU admission. Perinatal mortality was 17.53%. Conclusion: There is need for regular Antenatal Care (ANC) check-up and timely referral to tertiary care obstetrical care centre with availability of Blood bank and NICU for better outcome.

Association between placental implantation abnormalities and hypertensive disorders of pregnancy.

This study aimed to investigate the association between placental implantation abnormalities (PIAs) and gestational hypertension-preeclampsia (GH-PE) in pregnant women. Patients were recruited from 2010 to 2019 into this retrospective study at the International Peace Maternity & Child Health Hospital. PIAs were classified as follows: placenta previa (PP), low-lying placenta (LP), placenta accreta, and placenta adherence (PA). Logistic regression models were constructed to analyze the associations between placental abnormalities and GH-PE. Propensity score matching (PSM) was conducted to reduce confounders. The relationship between PP with placenta accreta spectrum (PAS) and GH-PE were assessed. In total, 5527 women were recruited, and 2614 women had an abnormal placenta (992 with LP; 749 with PP 839 and PA; and 34 with placenta accreta). There were 296 patients with GH-PE in those groups. After adjustments for confounding factors, women with PP had a lower risk of PE (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.19-0.86, p=0.025) than those in the control group. Women with PA had a higher risk of GH-PE (OR: 1.45; 95% CI: 1.05-1.99, p=0.022). In addition, we categorized PP into marginal, complete, and partial PP and investigated these associations. We found a lower risk of PE in complete PP (OR: 0.09, 95% CI: 0.01-0.44, p=0.020) than in marginal or partial PP. There was no significant difference regarding GH-PE in the PP with PAS group (OR=0.67, 95% CI: 0.82-2.34, p=0.525). PP, especially complete PP, is associated with a lower risk of PE. PA is associated with higher risks of GH-PE.

The diagnostic accuracy of mean arterial pressure in second trimester for prediction of preeclampsia in females.

Objective: To assess the diagnostic accuracy of mean arterial pressure in second trimester for prediction of pre-eclampsia in females. Study Design: Cross-sectional study. Setting: Department of Obstetrics &amp; Gynecology Unit III, Allied hospital, Faisalabad. Period: October 2016 to September 2017. Material &amp; Methods: Total 386 patients were enrolled after obtaining informed consent. Booked females of age 18-40 years, parity&lt;5 presenting at gestational age &gt;16 weeks (on LMP) for antenatal checkup were included in study. Patients with multiple gestation (on medical record and USG), Females with chronic hypertension (BP≥140/90mmHg), chronic or gestational diabetes (BSR&gt;186mg/dl), Females having oligohydramnios (AFI&lt;5cm) or polyhydramnios (AFI&gt;21cm) on USG, females having abnormal placental implantation or placental abruption (on USG) were excluded. The mean age of the patients was 28.59±6.93 years. The MAP of the patients was 94.88±14.68 mmHg. Results: The sensitivity, specificity and diagnostic accuracy of MAP was 92.89%, 89.12% and 91.45% respectively taking preeclampsia as gold standard. Conclusion: The mean arterial pressure in second trimester is very effective and useful screening method for prediction of preeclampsia with high values of sensitivity, specificity and diagnostic accuracy.

Prophylactic Caesarean Iliac Artery Balloon Insertion in Patients with Abnormal Placental Implantation

Prophylactic Caesarean Iliac Artery Balloon Insertion in Patients with Abnormal Placental Implantation

Cell-based endometrial regeneration: current status and future perspectives.

Endometrial-related disorders including Asherman's syndrome, thin endometrium, pelvic organ prolapse, and cesarean scar pregnancies can be accompanied by different symptoms such as amenorrhea, infertility, abnormal placental implantation and recurrent miscarriage. Different methods have been introduced to overcome these problems such as surgery and hormonal therapy but none of them has shown promising outcomes. On the other hand, the development of novel regenerative therapeutic strategies has opened new avenues for the treatment of endometrial-related deficiencies. In this regard, different types of scaffolds, acellular matrices and also cell therapy with adult or stem cells have been investigated for the treatment of endometrial-related deficiencies. In this paper, we review the current status of cell-based endometrium regeneration using scaffold dependent and scaffold-free methods and future perspectives in this field. Moreover, we discuss the endometrial diseases that can be candidates for cell-based treatments. Also, the cells with the potential for endometrial regeneration are explained.

76 The Transcriptome of Hypertensive Placentas: Superimposed preeclampsia as a transcriptionally distinct condition

To characterize differences in placental RNA expression in pregnancies without hypertension, with chronic hypertension, and with subtypes of preeclampsia. We identified women in our pregnancy biorepository with hypertensive disorders affecting singleton, euploid gestations along with matched controls. Unsupervised clustering was used to determine the need for exclusion based on clinically relevant variation, leading to the exclusion of smokers and those with autoimmune disease. Subjects were grouped as: normotensive (NT), chronic hypertensive (cHTN), preterm preeclamptic with severe features (PTSF), term preeclamptic with severe features (TSF), preterm superimposed preeclamptic (PTSI), or term superimposed preeclamptic (TSI). Bulk RNA sequencing was performed on the Illumina NovaSeq S4-150 platform. Reads were aligned to the hg38 reference genome and quality controlled using standard methods. Analysis was conducted with DESeq2, calculating log2 fold changes for all hypertensive disorders relative to NT placentas. Adjusted P-values <0.05 were considered significant. 48 placentas were analyzed: 12 NT, 13 cHTN, 5 PTSF, 11 TSF, 3 PTSI, and 4 TSI. 2,290 genes had significant differences in expression between those with and without hypertensive disease (see Figure 1). The majority of significant genes were downregulated in TSI and PTSI versus NT, a finding replicated when TSI and PTSI were compared to cHTN. Conversely, most TSF and PTSF genes were upregulated compared to the NT group. Many of the upregulated genes in TSF and PTSF with the greatest adjusted P-values are known markers of abnormal placental implantation and function (e.g., PAAPA, KISS1, CLIC3), while the downregulated genes with the greatest adjusted P-value in TSI and PTSI are largely uncharacterized in pregnancy (see Figure 2). Superimposed preeclampsia appears to be a state of gene suppression whereas preeclampsia with severe features is associated with abnormal upregulation of gene expression. This suggests that superimposed preeclampsia may represent a distinct entity from preeclampsia.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Placenta Creta: A Spectrum of Lesions Associated with Shallow Placental Implantation.

Background On placental histology, placenta creta (PC) ranges from clinical placenta percreta through placenta increta and accreta (clinical and occult) to myometrial fibers with intervening decidua. This retrospective study aimed to investigate the clinicopathologic correlations of these lesions. Methods A total of 169 recent consecutive cases with PC (group 1) were compared with 1661 cases without PC examined during the same period (group 2). The frequencies of 25 independent clinical and 40 placental phenotypes were statistically compared between the groups using chi-square test or analysis of variance where appropriate. Results Group 1 placentas, as compared with group 2 placentas, were statistically significantly (p < 0.05) associated with caesarean sections (11.2% vs. 7.5%), antepartum hemorrhage (17.7% vs 11.6.%), gestational hypertension (11.2% vs 4.3%), preeclampsia (11.8% vs 2.6%), complicated third stage of labor (18.9% vs 6.4%), villous infarction (14.2% vs 8.9%), chronic hypoxic patterns of placental injury, particularly the uterine pattern (14.8%, vs 9.6%), massive perivillous fibrin deposition (9.5% vs 5.3%), chorionic disc chorionic microcysts (21.9% vs 15.9%), clusters of maternal floor multinucleate trophoblasts (27.8% vs 21.2%), excessive trophoblasts of chorionic disc (24.3% vs 17.3%), segmental fetal vascular malperfusion (27.8% vs 19.9%), and fetal vascular ectasia (26.2% vs 15.2%). Conclusion Because of the association of PC with gestational hypertensive diseases, acute and chronic placental hypoxic lesions, increased extravillous trophoblasts in the chorionic disc, chorionic microcysts, and maternal floor trophoblastic giant cells, PC should be regarded as a lesion of abnormal placental implantation and abnormal trophoblast invasion rather than decidual deficiency only.

Management of massive hemorrhage in pregnant women with placenta previa.

Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation. This condition can lead to serious obstetric complications, including maternal mortality and morbidity. The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking. The prevalence of previa parturients has increased due to the rising rates of cesarean section and advanced maternal age. For these reasons, we need to identify the risk factors for previa and identify adequate management strategies to respond to blood loss during surgery. This review evaluated the diagnosis of placenta previa and placenta accreta and assessed the risk factors for previa-associated bleeding prior to cesarean section. We then presented intraoperative anesthetic management and other interventions to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion.

Enhancement of heat shock protein 70 attenuates inducible nitric oxide synthase in preeclampsia complicated with fetal growth restriction

Objectives Preeclampsia (PE) and fetal growth restriction (FGR) have abnormal placental implantation and endothelial dysfunction in common. However, their etiologies are not well understood. Both heat shock protein 70 (Hsp70) and nitric oxide (NO) are suggested to play a major role in the regulation of maternal and fetoplacental hemodynamics. In this study, the association of PE with FGR and Hsp70 or NO was analyzed. Methods A total of 30 cases of PE, 25 cases of PE complicated with FGR and 50 cases of normal pregnant women were chose, and PE and normal animal models were constructed. Subsequently, the levels of Hsp70 and NO in serum and placental tissues of humans and animals were measured and compared. Further, rats were injected with pLV-NC-shRNA, pLV-Hsp70-shRNA, pLV-EFIa-NC, and pLV-EFIa-Hsp70, respectively, the weight of each conceptus, number of pups, fetal crown to tail length, total weight of the placenta/fetus unit, and the content of NO were analyzed. Results The expression of Hsp70 in serum and placental tissues of PE complicated with or without FGR group was increased, whereas the content of NO was decreased compared to the normal group. The fetal weight (FW) of the Hsp70 targeted suppression group was higher than the other two groups, whereas the placental weight (PW) was reversed. Also, NO synthase (NOS) expression was decreased in the Hsp70 over-expression group. Conclusions We speculated that the enhancement of Hsp70 might be related to the development of PE combined with FGR through inhibiting the synthesis of NOS.

Doppler and Ultrasound Assessment of Placental Implantation Abnormalities in Post Caesarean

Placenta accreta has now become an important aetiology of maternal morbidity and mortality. The condition is defined as abnormal adherence of the placenta to the uterus.useColour Doppler and ultrasound for assessment of placental implantation abnormalities in post caesarean females.The examine including 50 female patients with agdistis went starting with 19 will 40 a considerable length of time 0ld (mean agdistis 55±10. 28) who need a sonographic criteria of placenta Previa, all ladies were subjected with finish history taking, guiding and assent starting with those lady Furthermore her husband, Grey-scale Furthermore shade doppler ultrasonography might have been performed. Around the 50 patients with placenta previa, 40 patients indicated follower placenta, 30 patients with placenta accreta, 2 patients for placenta increta and the keep going 8 patients indicated placenta percreta for bladder intrusion. The 8 patients for placenta percreta indicated bladder Attack Furthermore needed grade bladder repair shed Throughout the operation. Those conclusive analysis for placenta previa without accreta might have been settled on clinched alongside 10 out of the 50 patients. Greyscale ultrasonography need 77. 8 % affectability emulated by force doppler for 66. 7 % affectability. Both gray scale Also color doppler ultrasonography were exceptionally imperative to diagnosing placenta accreta prenatal to decrease maternal fetal mortal sin Furthermore horribleness Anyway shade doppler may be higher affectability and specificity.

Endometrium-free uterine closure technique and abnormal placental implantation in subsequent pregnancies

Background Abnormal placentation can result in massive hemorrhage, which is the leading cause of severe maternal morbidities and mortality in its management. Over the past 50 years, the incidence of placenta previa (PP), abnormal implantation of the placenta, and cesarean scar pregnancy have continued to rise. This coincides with the well-documented parallel rise in the rate of cesarean deliveries, the performance of multiple repeat cesarean deliveries and the adoption of newer uterine closure techniques. However, no studies have examined the role of uterine closure techniques in abnormal placentation in women with a history of a prior cesarean delivery. Objective To assess the practicality of one specific uterine closure technique at cesarean delivery and to evaluate the relationship between previous cesarean delivery and subsequent development of abnormal implantation of the placenta, as well as neonatal and other perioperative outcomes after receiving an endometrium-free uterine closure technique. Methods This retrospective observational study considered cesarean deliveries (n = 727) and subsequent vaginal births after cesarean delivery (n = 109) among total deliveries (n = 4496) performed in private practice at NYU Langone Health from 1985 to 2015. All cesarean deliveries were performed using the endometrium-free uterine closure technique. The primary outcome was the incidence of abnormal implantation of the placenta in subsequent pregnancies. The secondary outcomes were neonatal and maternal complications, specifically postoperative hemoglobin and hematocrit concentration losses. The association between independent variables and outcomes were evaluated using mixed-effect regression models. Results In contrast to published data, independent of the number of repeat cesarean deliveries, the presence of 26 (3.1%) PPs and of 366 (43.8%) anterior placentas, there were no patients with abnormal implantation of the placenta in a cesarean scar, neither prenatally nor at delivery. Maternal hemorrhage, postoperative and neonatal complications did not reach clinical significance. The statistical analysis revealed that, when compared with women who had fewer repeat cesarean deliveries using endometrium-free uterine closure technique, those with the most had a lesser risk of forming PP and less blood loss, as measured by both hematocrit and hemoglobin evaluation. Conclusion In this retrospective cohort study, the exclusion of the endometrium during the endometrium-free uterine closure technique was associated with fewer placental abnormalities in subsequent pregnancies and reduced life-threatening maternal morbidity for future cesarean deliveries.

Low Bioactive Vitamin D Is Associated with Pregnancy-Induced Hypertension in a Cohort of Pregnant HIV-Infected Women Sampled Over a 23-Year Period.

To examine the association of vitamin D insufficiency and risk of pregnancy-induced hypertension (PIH) among human immunodeficiency virus (HIV)-infected pregnant women. This is a retrospective cohort study evaluating the impact of low maternal vitamin D levels on PIH and perinatal outcomes among HIV-infected pregnant women receiving care at an urban HIV center from 1991 to 2014. A total of 366 pregnant women were included, of which 11% developed PIH. Lower levels of 25-hydroxyvitamin D (25(OH)D) and bioactive 1,25-dihydroxyvitamin D (1,25(OH)2D) were associated with increased HIV disease activity. 25(OH)D levels were not significantly associated with the incidence of PIH. Higher 1,25(OH)2D levels were associated with reduced incidence of PIH in univariate (odds ratio, OR: 0.87 [95% confidence interval, CI: 0.79-0.95], p = 0.004) and multivariate (OR: 0.88 [95% CI: 0.80-0.97], p = 0.010) analyses. No association was found between 25(OH)D levels and other obstetric outcomes. Lower 1,25(OH)2D levels were associated with group B Streptococcus colonization (OR: 0.92 [95% CI: 0.86-0.99]) and low birth weight (LBW) (OR: 0.90 [95% CI: 0.83-0.98]) on multivariate analysis. Mean 1,25(OH)2D levels were significantly lower in women with preterm delivery and LBW infants. Lower bioactive vitamin D levels are related to PIH in HIV-infected women. This association may be related to the coexistence of abnormal placental vitamin D metabolism and abnormal placental implantation.

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?