Central Placenta Research Articles

Maternal Outcome of Pregnancy with Previous History of Caesarean Section with Central Placenta Previa Admitted into DMCH Gynae Department (6 months study)

Background: Placenta previa, a condition where the placenta is abnormally positioned in the lower uterine segment, poses significant risks to both maternal and neonatal health. It has become more prevalent with increasing cesarean deliveries, advanced maternal age, high parity, and assisted reproductive technologies. The impact of placenta previa on subsequent pregnancies, especially in women with a history of cesarean sections, remains an area of concern due to potential complications such as hemorrhage, transfusion needs, and adverse outcomes like peripartum hysterectomy. Objective: This study aimed to assess the maternal and neonatal outcomes in pregnancies with a history of cesarean sections complicated by central placenta previa, admitted to the Department of Obstetrics and Gynecology at DMCH from January 2023 to June 2023. Methodology: A Descriptive Cross sectional study was conducted using medical records from the Department of Obstetrics and Gynecology at DMCH. We analyzed data from 104 women with central placenta previa and previous cesarean sections. Diagnostic criteria were based on trans-abdominal or transvaginal ultrasound. Statistical analysis was performed using SPSS v21.0, employing chi-square and Mann–Whitney U tests for categorical and continuous variables, respectively. Multivariate analysis assessed the association between a history of placenta previa and adverse maternal and neonatal outcomes, with significance set at P < 0.05. Results: The majority of patients were aged between 29-39 years (58.7%). Most had a parity of 1 or 2 (75.0%) and were in their 3rd or 4th gravida category (64.4%). A predominant number were between 35-38 weeks gestation (68.3%). APH was present in 65.4% of patients, and the average number of transfusions required was 4. The uterus was preserved in 63.5% of cases. 36.5% cases peripartum hysterectomy was performed. Maternal outcomes showed a 93.3% improvement rate, with 6.7% mortality. Neonatal outcomes included 86.5% .....

Comparison of Placental Location on Ultrasound in Preeclampsia and Normotensive Pregnancy in Third Trimester.

Hypertensive disorders in pregnancy account for 15%-20% maternal and 20%-25% perinatal mortality. There is interest in predicting preeclampsia (PE) early in pregnancy to reduce PE and its subsequent complications. There is no cheap and easily available, reliable predictor for PE. Some studies have shown that the lateral location of placenta is associated with adverse pregnancy outcomes due to PE. The lateral placenta is yet to be proven as a strong predictor of PE to initiate preventive measures. Placental localization can be easily done on routine ultrasonography during pregnancy. In the light of these observations, a prospective study was done to study any association between PE and placental location by ultrasound in third trimester. Research Question: Is there any association between placental location on ultrasound and preeclampsia in third trimester? The objective is to study association between location of placenta and preeclampsia and compare placental location in normotensive pregnancies with that in PE in third trimester. A prospective comparative, case-control, observational study was conducted in the Department of Obstetrics and Gynecology at North DMC Medical College and Hindu Rao Hospital, Delhi, India, from August 2019 to April 2020. The study population included 200 pregnant women with singleton pregnancy in third trimester, without any medical disorders such as diabetes mellitus, hypertension, renal disease, cardiac disease, and coagulation disorder or smoking. One hundred women had preeclampsia and 100 were normotensive controls. Ultrasound was done after filling F form as per the Government of India guidelines to rule out sex determination, and placenta was localized by ultrasound. Placenta was classified as central when it was equally distributed between the right and left sides of the uterus irrespective of anterior, posterior, or fundal position and lateral when 75% or more of the placental mass was on one side of the midline. Placental location was compared in hypertensive and normotensive pregnancies. Out of the total 200 women, 152 (76%) had central and 48 (24%) had lateral placenta. Ninety-two percent of controls and 60% of cases had central placenta. Forty percent of cases and only 8% normotensive women had lateral placenta. Lateral placenta was five times more frequent in presence of PE as compared to normotensive controls. Out of 152 women with central placenta, 92 (60.5%) women were normotensive but with lateral placenta, only 8 (16.7%) had normal blood pressure. PE was present in 83% of women with lateral placenta and in only 39.47% with central placenta. This difference was statistically significant as P < 0.0001 as per Chi-square test. This reflects a significant association between lateral position of placenta and occurrence of PE. As per odds ratio (0.1304) patients without lateral placenta had 90% protection against preeclampsia. Central placenta is more common than lateral placenta. Lateral placenta is seen five times more frequently among hypertensive women and this difference is statistically significant. The absence of lateral placenta provides 90% protection against PE but the severity of PE was not affected by placental location..

Displasia mesenquimal placentaria. A propósito de un caso

Placental mesenchymal dysplasia is a rare condition that, due to placental characteristics, can be confused with a molar disease. Among the most frequent findings is an enlarged placenta and the presence of “grape-shaped vesicles”. The suspected diagnosis is made through ultrasound, but the definitive diagnosis will be given by the anatomo-pathological study. We present the case of a 30-year-old patient, IIG IP, who came at 30 weeks plus 4 days of gestation, who underwent an obstetric echosonogram showing a total occlusive central placenta with a large hydropic appearance, a transverse fetus with intrauterine growth restriction and later anhydramnios; for which obstetric resolution was decided by segmental cesarean section, obtaining a female newborn with a birth weight of 1,100 g and placenta with multiple vesicles, for which an anatomopathological study was carried out, that reported placental mesenchymal dysplasia.

Successful delivery after in vitro fertilization-embryo transfer in a woman with metachronous primary cancer of ovary and endometrium: a case report

BackgroundThe appearance of malignancies at various times in the same individual, excluding metastases of the initial primary cancer, is termed multiple primary cancers. Double primary gynecological cancers cause inevitable damage to female reproductive function, and the preservation of fertility in such patients remains a challenging issue as relatively few cases have been reported. This case report provides management options for dual primary ovarian and endometrial cancers, including the choice of ovulation induction protocols, considerations during pregnancy and parturition, with the aim of providing assistance to clinicians.Case presentationWe report a case of a 39-year-old woman with primary infertility and a medical history of right-sided ovarian mucinous borderline tumor with intraepithelial carcinoma, left-sided ovarian mucinous cystadenoma and endometrial cancer, who successfully conceived with in vitro fertilization-embryo transfer (IVF-ET) after three different ovulation induction protocols. During her pregnancy, she was complicated by central placenta praevia with placental implantation and eventually delivered a healthy female infant by caesarean section at 33 gestational weeks.ConclusionsFor patients with double primary gynecological cancers who have an intense desire for fertility, the most appropriate oncological treatment should be applied according to the patient’s individual situation, and fertility preservation should be performed promptly. Ovulation induction protocol should be individualized and deliberate, with the aim of ensuring that the patient’s hormone levels do not precipitate a recurrence of the primary disease during induction of ovulation and maximizing fertility outcomes. In addition, the risk of postpartum hemorrhage due to placental factors cannot be neglected in such patients.

On the Issue of Optimizing Surgical Tactics and Blood-Saving Techniques in Case of Placenta Ingrowth Into the Uterine Scar

AIM OF STUDY The study of the results of delivery of pregnant women with placenta ingrowth in the uterine scar depending on the clinical status and the methods of blood saving.MATERIAL AND METHODS The design of a selective retrospective study included 54 pregnant women with central placenta previa and uterine scar after caesarean section (CS), with histologically confirmed results of placenta accreta. Among blood-saving methods we used: ligation of three pairs of main vessels of the uterus, ligation of the internal iliac arteries, complex compression hemostasis according to R.G. Shmakov, temporary clamping of the common iliac arteries.RESULTS CS with fundal incision was performed in 47 women (87.0%) out of 54. Hysterectomy was performed in 17 women (31.5%) out of 54. In the remaining 37 cases (68.5%), metroplasty and organ preservation were performed. There was no relaparotomy; there was no maternal mortality; perinatal mortality was 4 (7.4%); forced opening, bladder resection were performed in 7 (13.0%) cases; opening of the bladder without wall resection — in 2 (3.7%); 2 near miss cases; there were no complications associated with temporary clamping of the common iliac arteries; endometritis (recovery after conservative treatment) was revealed in 2 women (3.7%). Histologic examination results: 15 (27.8%) of placenta accreta, 30 (55.6%) of placenta increta, 8 (14.8%) of placenta percreta. In 8 cases, there was a combination of placenta increta into the uterine scar region of different depths, and in 2 (3.7%) cases, a combined deeply invasive lesion of the posterior wall of the lower segment and the body of the uterus.CONCLUSION Complex compression hemostasis according to R.G. Shmakov is the most rational and promising method of blood saving, acceptable among the majority of patients with placenta accreta spectrum. Temporary clamping of the common iliac arteries is advisable in case of damage to the posterior wall of the bladder. Preservation of the uterus: in case of a deeply invasive lesion, including cases of combined damage to the posterior wall of the lower segment of the uterus or the body of the uterus, significant blood loss before the woman enters the hospital, it is not an imperative of surgical tactics.

Association of placental laterality with pre-eclampsia

Background: The aim of this study was to observe association between placental laterality and pre-eclampsia in pregnant women. Methods: In this retrospective study, hospital records of 300 pregnant patients who were admitted in our hospital with mild or severe pre-eclampsia between January 2019 to February 2021 were analysed. Results: Ultrasonography performed on these pregnant women between 18 and 24 weeks revealed that 177 (59%) had a lateral placenta and 123 (41%), a central placenta, indicating that pre-eclampsia occurred more frequently in patients with a lateral placental position. Also, pre-eclampsia occurred more frequently in primigravida (first-time moms) than in multigravida (second or subsequent pregnancies), with 132 (44%) primigravida, 106 (35%) second gravida and 62 (21%) multigravidas. Conclusions: This study revealed that the majority of pre-eclampsia patients had placentas that were positioned laterally, indicating a correlation between the two.

Herlyn-Werner-Wunderlich syndrome and central placenta previa in a COVID-19 positive pregnant woman: a case report

Herlyn-Werner-Wunderlich syndrome and central placenta previa in a COVID-19 positive pregnant woman: a case report

Retraction Note: The effect of uterine artery ligation in patients with central placenta pevia: a randomized controlled trial

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12884-018-1989-5.

Variability in contrast and apparent diffusion coefficient of kiwifruit used as prostate MRI phantom: 1-week validation.

Kiwifruit has been proposed as a phantom for prostate magnetic resonance imaging (MRI) to adjust multiparametric MRI factors. This study evaluated the variability in contrasts and apparent diffusion coefficients (ADCs) via repeated scans of kiwifruits for 1 week. All scans were performed using a 3T MRI system. Six kiwifruits were prepared as phantoms. Each kiwifruit was scanned consecutively for 1 week, and T2-weighted and diffusion-weighted images were acquired. Contrasts between the peripheral placenta (PP) and central placenta (CP), and between the outer pericarp (OP) and CP were calculated. The ADCs of the PP, OP, and CP were also determined. The Friedman test with Scheffé's post hoc comparison was used to assess contrast and ADC variability over 1 week; no significant differences between the contrasts or ADCs were found. Thus, each kiwifruit phantom exhibited low variability when used as a prostate MRI phantom.

Placental location and obstetrical-neonatal outcomes: A retrospective study.

To explore the potential association of lateral placentation with pregnancy outcome. The database of a tertiary medical center was searched for women who gave birth to a singleton neonate from 2012 to 2020 for whom placental location was documented during antepartum sonographic examination. Clinical data were compared between patients with a central (anterior/posterior/fundal) or lateral placenta using standard statistics. The primary outcome measure was neonatal birthweight, and secondary outcome measures were pregnancy complications and mode of delivery. The cohort included 12 306 women: 11 608 (94%) with a central placenta and 698 (5.6%) with a lateral placenta. The lateral placenta group had higher rates (P <0.05) of prior and current cesarean delivery, assisted delivery, and preterm birth. On multivariate regression analyses, placental location (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.11-1.66) and maternal age (aOR, 1.02; 95% CI, 1.01-1.03) were associated with risk of preterm birth. Lateral placenta (aOR, 1.22; 95% CI, 1.02-1.47), maternal age (aOR, 1.07; 95% CI, 1.06-1.08), parity (aOR, 0.32; 95% CI, 0.28-0.35), and prior cesarean delivery (aOR, 12.00; 95% CI, 10.60-13.60) were associated with risk of current cesarean delivery. The findings suggest that lateral placentation may pose a risk of preterm birth and cesarean delivery compared with central placentation.

Study of Placental Laterality as a Predictor for Development of Pre-Eclampsia at a Tertiary Care Centre

Introduction: Hypertensive disorders of pregnancy is the commonest medical complication. Pre-eclampsia in India is reported to be 8-10%. Out of which hypertension in pregnancy was 7.8% with pre-eclampsia in 5.4%. India has the highest number of preterm births in the World. Hypertension in pregnancy (gestational hypertension – 4.8%, eclampsia – 4.8%, chronic hypertension – 5%, &amp; pre-eclampsia – 36%) are the major risk factors of the preterm births in India. Aims and Objectives: To evaluate placental location (by ultrasound at 18-24 weeks) &amp; its corelation in predicting development of pre-eclampsia. Methodology: This prospective study on 108 low risk antenatal women with ultrasonography with documented placental location. After determining the placental location (ultrasound scanning at 18 – 20 weeks) were classified into two groups. Women having central placenta in the central region were assigned to group A &amp; women having lateral placenta to group B. All women were observed regularly during pregnancy up to delivery. Development of signs and symptoms of pre-eclampsia were looked for. Results in 2 groups were compared for statistical significance. Results: Laterally placed placenta showed higher Systolic BP and Diastolic BP as compared to centrally placed placenta at every GA. But 36-37 Gestational Age only provide statistically significant results. Conclusion: In the present study, 61.1% women who eventually developed pre-eclampsia had a lateral placenta while 37% women had a centrally placenta. Laterally placed placenta showed higher Systolic BP and Diastolic BP as compared to centrally placed placenta which provide statistically significant results.

Clinical case of expectant tactics of scar pregnancy and childbirth in the III trimester

One of the rare complications of a previous cesarean section is pregnancy with implantation in the area of the postoperative scar. The literature describes isolated reports of this pathology, which relate to early pregnancy. The forecast and tactics of their management are debatable issues.This article presents a case of successful monitoring of pregnancy and childbirth of a patient with a combined pathology: the placenta in the area of the cesarean scar with its diastase and central placenta previa with the germination of the uterine wall.The 34-year-old pregnant woman (III pregnancy and II expected childbirth) during ultrasound examination central a placenta previa was diagnosed. It had ingrowth into the uterine wall creating defect of the cesarean scar. Informed about the possible risks, patient strongly insisted on prolonging the pregnancy. Since 23 weeks she was in an obstetric hospital for the possibility of urgent surgery. Within 37 weeks, a planned caesarean section was performed by bottom access with subsequent extirpation of the uterus. Literary data from different countries almost all describe the completion of cesarean scar pregnancy in the first and second trimesters. Due to the rarity, heterogeneity of groups and the lack of a single protocol for the management of this pathology, combined or modified approaches to treatment are more often used. Primary prevention should begin at the stage of preventing a high frequency of cesarean section, reviewing the indications for it and conducting a truly justified surgery. Preconceprion care should be mandatory when planning the next pregnancy. Great attention should be paid to the localization of the chorion in the protocol of the screening ultrasound examination of the first trimester if there is uterine scar. In the case of a cesarean scar pregnancy, we cannot recommend an expectant tactics at this stage. Any method that eliminates cesarean scar pregnancy, especially in the early term, will saving the body and future fertility, as well as reduces morbidity and mortality.

Study on the application of King\u2019s combined uterine suture for hemostasis during cesarean section

IntroductionPostpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section.MethodsWe examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section.ResultsThe results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy.ConclusionWe have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.

LATERAL POSITION OF PLACENTA DETECTED ON ULTRA-SONOGRAM AT 18 TO 24 WEEKS OF PREGNANCY AS A PREDICTOR FOR DEVELOPMENT OF PREECLAMPSIA

The placenta is an important organ that connects the mother to the fetus. It is a well-known cause of pregnancy hypertension. The position of the placenta and the development of preeclampsia are linked in several studies. The purpose of this study was to determine whether the percentage delay as determined by ultrasound could be used as a predictor of the development of preeclampsia. A retrospective and prospective, and observational study was done in Choithram Hospital &amp; Research Centre, Indore. The study was done on 130 pregnant women, out of which 62 females had laterally located placenta and 68 had centrally located placenta selected randomly from November 2015 to November 2017. Preeclampsia developed in 68.09 percent of women in the lateral placenta group. Only 31.91 percent of women in the group with the central placenta developed preeclampsia. As a result, females with a laterally positioned placenta had a 3.7 times higher risk of having PIH than those with a centrally situated placenta. With a laterally placed placenta, the overall chance of having PIH was 3.769. This study, laterally located placenta increased association of development of preeclampsia in patients than centrally located placenta which reduces the hospital burden, and long term consequences of the disease thereby reducing the huge cost of critical care for mother and newborn. Thus, making ultrasonography a cost effective, practical, painless, beneficial and reliable screening tool.

Comparison of Magnetic Resonance Imaging of the Lower Uterine Segment in Pregnant Women with Central Placenta Previa with and without Placenta Accreta Spectrum from a Single Center.

BackgroundPlacenta accreta spectrum (PAS) includes placenta increta, placenta percreta, and placenta accreta. PAS is due to abnormal decidualization and can lead to severe maternal hemorrhage and occurs in up to 3% of women with central placental previa (CPP). This study from a single center aimed to compare the magnetic resonance imaging (MRI) changes in the lower uterine segment in pregnant women with CPP, with and without PAS.Material/MethodsThis retrospective study includes 90 pregnant women with PAS and 66 pregnant women without PAS. All participants were confirmed to have CPP by MRI. Eight MRI parameters were assessed and compared with perinatal outcomes for mothers and newborns.ResultsThe pregnancies in the non-PAS group had less operative time (P=0.001), less intrapartum hemorrhage (P<0.001), and less blood transfusion than the PAS group (P<0.001). The 8 MRI variables with different odds ratios were placenta thickness (4.20), cervical lengths (3.27), placental dark T2 bands area (5.10), cervical marginal sinus (3.04), bladder bulge (3.55), myometrial thinning (6.41), lower uterine segment bulge (4.61), and placental signals in the cervix (9.14). The sensitivity and specificity of MRI in the diagnosis of PAS were 82.22% and 91.09%, respectively, by the combined 8 MRI features, and the area under the curve (AUC) was 0.816.ConclusionsThe findings from this study showed that MRI of the lower uterine segment had high sensitivity and specificity for the diagnosis of PAS in pregnant women with CPP.

Prophylactic temporary abdominal aortic balloon occlusion for patients with pernicious placenta previa: a retrospective study

BackgroundPernicious placenta previa (PPP) can increase the risk of perioperative complications. During caesarean section in patients with adherent placenta, intraoperative blood loss, hysterectomy rate and transfusion could be reduced by interventional methods. Our study aimed to investigate the influence of maternal hemodynamics control and neonatal outcomes of prophylactic temporary abdominal aortic balloon (PTAAB) occlusion for patients with pernicious placenta previa.MethodsThis was a retrospective study using data from the Peking University People’s Hospital from January 2014 through January 2020. Clinical records of pregnant women undergoing cesarean section were collected. Patients were divided into two groups: treatment with PTAAB placement (group A) and no balloon placement (group B). Group A was further broken down into two groups: prophylactic placement (Group C) and balloon occlusion (group D).ResultsClinical records of 33 cases from 5205 pregnant women underwent cesarean section were collected. The number of groups A, B, C, and D were 17, 16, 5 and 12.We found that a significant difference in the post-operative uterine artery embolism rates between group A and group B (0% vs.31.3%, p = 0.018). There was a significant difference in the Apgar scores at first minute between group A and group B (8.94 ± 1.43 vs 9.81 ± 0.75,p = 0.037),and the same significant difference between two groups in the pre-operative central placenta previa (29.4% vs. 0%,p = 0.044), complete placenta previa (58.8% vs 18.8%, p = 0.032),placenta implantation (76.5% vs 31.3%, p = 0.015). We could also observe the significant difference in the amount of blood cell (2.80 ± 2.68vs.10.66 ± 11.97, p = 0.038) and blood plasma transfusion (280.00 ± 268.32 vs. 1033.33 ± 1098.20, p = 0.044) between group C and group D. The significant differences in the preoperative vaginal bleeding conditions (0% vs 75%, p = 0.009), the intraoperative application rates of vasopressors (0% vs. 58.3%, p = 0.044) and the postoperative ICU (intensive care unit) admission rates (0% vs. 58.3%, p = 0.044) were also kept.ConclusionsPTAAB occlusion could be useful in reducing the rate of post-operative uterine artery embolism and the amount of transfusion, and be useful in coping with patients with preoperative vaginal bleeding conditions, so as to reduce the rate of intraoperative applications of vasopressors and the postoperative ICU (intensive care unit) admission. In PPP patients with placenta implantation, central placenta previa and complete placenta previa, we advocate the utilization of prophylactic temporary abdominal aortic balloon placement.

Central Placenta Previa with Rh Negative Pregnancy with IUD

Central Placenta Previa with Rh Negative Pregnancy with IUD

Advancedsecondary Abdominal Pregnancy till Term: A Case Report

Introduction: Advanced abdominal pregnancy is a rare condition with high maternal &amp; fetal morbidity as well as mortality. Inadequate placentation, unusual implantation &amp;associated anomalies increase maternal &amp;fetal morbidity and mortality. Diagnosis &amp; management of advance abdominal pregnancy is always a challenge for obstetricians. Aims &amp; Objectives: Management of rare case of advanced secondary abdominal pregnancy. Material &amp; Methods: A 20yr young second gravida with full term gestation with history of previous L.S.C.S. with transverse lie &amp; low lying placenta refered to our institute for emergency LSCS. Her last USG at 34wks showing single live intrauterine fetus in transverse lie with placenta previa. We avoided per vaginal examination in v/o central placenta previa. Decision of emergency L.S.C.S. was taken. After opening abdomen we got many surprises, after all obstacles we came out with successful outcome. Happily closed the abdomen with expression of victory. Results: With skillful and patient handling we were able to manage such a rare case with successful outcome in terms of mother as well as fetus even with complete removal of placenta. Conclusion: Advanced secondary abdominal pregnancy are rarely diagnosed clinically. Use of timely ultra sonography, intraoperative recognition, surgical skill, ready access to blood products, patiently taking decision about status of placenta are the cornerstone of successful management. Dreadful surprises can change in a remarkable unforgettable victory.

Torsion of the gravid uterus: A rare cause of abdominal pain

Uterine torsion in pregnancy is a rare clinical entity with a non-specific clinical presentation. Here, we present a case of uterine torsion,which was diagnosed at laparotomy done for the lower segment cesarean section (LSCS) in a case of central placenta previa with thefetus in transverse lie. At 36.4 weeks period of gestation, the patient complained of severe left-sided abdominal pain which was notsuggestive of labor. This abdominal pain was refractory to analgesics. Emergency LSCS was done which confirmed uterine torsion aswell as anterior sacculation.

Lateral placentation and adverse perinatal outcomes

Lateral placentation may compromise placental perfusion, and we aimed to assess whether it impacts pregnancy outcomes. This single-center retrospective study included 1203 singleton pregnancies, categorized into two groups according to placental location. Women with lateral placenta had significantly higher risk of preterm birth <37 weeks (aOR 2.99) and <34 weeks (aOR 3.92), and gestational diabetes (aOR 2.72), compared to women with central placenta. Mean birth weight and small for gestational age (SGA) rates were similar between groups. Our findings suggest that lateral placenta may be associated with increased risk for preterm birth but not for SGA.