History Of Placenta Previa Research Articles

Assessment of Risk Factors Associated with Placenta Previa in a Tertiary Health Institution in Southeast Nigeria

Background: Placenta previa is a significant obstetric complication that can lead to adverse maternal and fetal outcomes. Understanding its risk factors is crucial for early diagnosis and management, particularly in healthcare settings in Nigeria. Objective: To assess the risk factors associated with placenta previa among pregnant women in a tertiary health institution in Southeast Nigeria. Materials and Methods: This prospective descriptive study was conducted over two years (January 2021 to December 2022) and included all pregnant women who delivered in the institution during this period. Data were collected using a structured, interviewer-administered questionnaire after obtaining informed consent from participants. Placenta previa was identified through abdominal ultrasonography, and all confirmed cases were managed according to the MacAfee regimen. Descriptive statistics and chi-square tests were used to analyze the data using SPSS version 26. Results: Out of the 8,766 deliveries recorded in the hospital during the period of this study, 94 (1.07%) were diagnosed with placenta previa. Significant associations were found between placenta previa and factors such as advanced maternal age (≥40 years, p=0.041), history of complications during previous pregnancies (p=0.039), previous cesarean section (p=0.009), history of placenta previa (p<0.001), multiple pregnancies (p=0.001), bleeding during pregnancy (p<0.001), and uterine surgeries apart from cesarean sections (p=0.001). Smoking history was also a significant risk factor (p<0.001). Conclusion: The study identified several risk factors for placenta previa, including advanced maternal age, previous cesarean section, history of placenta previa, multiple pregnancies, uterine surgeries, and smoking. These findings highlight the importance of targeted interventions and close monitoring of at-risk pregnant women to reduce complications.

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% .....

Incidence, risk factors and maternal outcomes of unsuspected placenta accreta spectrum disorders: a retrospective cohort study

BackgroundTo identify incidence and underlying risk factors for unsuspected placenta accreta spectrum (PAS) and compare the maternal outcomes between suspected and unsuspected cases in three large academic referral centers.MethodsA retrospective cohort study was conducted in three university-based tertiary referral centers from Jan 1st, 2013, to Dec 31st, 2022. All cases of PAS confirmed by pathology were included in the study. Unsuspected PAS cases were diagnosed at the time of delivery, while suspected cases served as the control group. Potential risk factors were compared between the two groups. Multivariable regression model was also performed to identify risk factors. Maternal outcomes were also evaluated.ResultsA total of 339 pathology-confirmed PAS cases were included in the study out of 415,470 deliveries, of which 35.4% (n = 120) were unsuspected cases. Unsuspected PAS cases were 7.9 times more likely to have a history of intrauterine adhesions (adjusted odds ratio [aOR] 7.93; 95% confidence interval [CI] 2.35–26.81), 7.0 times more likely to have a history of clinically confirmed PAS (aOR, 6.99; 95% CI 2.85–17.18), 6.3 times more likely to have a posterior placenta (aOR, 6.30; 95% CI 3.48–11.40), and 3.4 times more likely to have a history of placenta previa (aOR, 3.41; 95% CI 1.18–9.82). On the other hand, cases with gravidity > 3, placenta previa, and/or a history of previous cesarean delivery were more likely to be diagnosed antenatally (aOR 0.40, 0.19, 0.36; 95% CI 0.22–0.74, 0.09–0.40, 0.19–0.70). Although the suspected PAS group had a higher proportion of invasive cases and abdominal and pelvic organ injuries (74.4% vs. 25.8%, p < 0.001; 6.8% vs. 1.7%, p = 0.037), the maternal outcomes were more favorable in the sPAS group, with a lower median volume of 24-hour blood loss and blood product transfusion (estimated blood loss in 24 h, 1000 [800–2000] vs. 2000 [1400–2400], p < 0.001; RBC unit transfusion, 0 [0-800] vs. 800 [600–1000], p < 0.001; fresh-frozen plasma transfusion, 0 [0-450] vs. 600 [400–800], p < 0.001).ConclusionsOur findings indicate that 35% of patients with PAS were unsuspected prior to delivery. Factors associated with PAS being unsuspected prior to delivery include a history of intrauterine adhesions, a history of clinically confirmed PAS, a posterior placenta, and a history of placenta previa. Additionally, gravidity > 3, a history of previous cesarean delivery, and placenta previa increase the likelihood of antenatal diagnosis.

Emergency Peripartum Hysterectomy and its Outcome in a Tertiary Care Hospital in Dhaka City, Bangladesh

Introduction: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. EPH is a challanging but life saving obstetric procedure performed when medical and surgical conservative measures fail to control postpartum haemorrhage .The present study aimed to review the peripartum hysterectomies and to compare the incidence, indications and outcome of EPH. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Dhaka, Bangladesh. Total 62 cases have taken, who had hysterectomy that was performed in Obstetric and gynaecology department of Addin Womens Medical College Hospital during the period between January 2020 and December 2022. Result: There were total of 36371 deliveries over the study period and EPH was performed in 62 cases making an incidence of 0.408. In this study 33.8% patients were between 35 to 39 years. Here 45.16% had their parity between 2nd and 3rd child. Here 61.2% had previous history of caesarean section, 24.19% had previous history of antepartum haemorrhage, 74.19% cases intrapartum operation had done. Among 62 cases of EPH 77.4% cases subtotal hysterectomy had done. Here, among 62 cases of caesarean section 35.48% had placenta accrete and 20.96% had history of placenta previa with haemorrhage and 12.9% had severe PPH due to atony of uterus. 22.5% cases had fetal outcome of still born but 32.25% baby born alive. In this study 51.6% cases patients develop haemorrhage as perioperative complication, 19.5% develop shock but 100% required blood transfusion among which 50% were in post operative period. Here 6 out of 62 cases had bladder injury, 5 patients needed relaparotomy due to haemoperitoneum caused by vaginal cuff bleeding. Mortality rate was 4.83%. Conclusion: Now a days the indication of EPH has changed from uterine atony to abnormal placentation. It is a most important obstetric surgery performed in life threatening haemorrhage. Involvement of an experienced obstetrician at an early stage of management and efforts should be taken to reduce morbidity and mortality. Sir Salimullah Med Coll J 2023; 31: 107-111

The association between placenta previa and the risk of breech presentation: A meta-analysis

Numerous observational studies have described that placenta previa can increase the risk of breech presentation. To date, no meta-analysis has been conducted to determine the association between placenta previa and increased risk of breech presentation. Therefore, we have done a meta-analysis based on epidemiologic evidence of the association between placenta previa and the risk of breech presentation. A literature search was done in key databases PubMed, Web of Science, Science Direct and Scopus to April 2020. The heterogeneity was evaluated by Q-test and I2 statistic. The publication bias was measured using the Begg’s and Egger’s tests. The results were presented by odds ratio (OR) estimate with its 95% confidence intervals (CI) using a random-effects model. The literature review involved 466 articles until April 2020 with 1,972,511 participants. There was a significant relation between placenta previa and the risk of breech presentation based on adjusted studies (OR = 1.93; 95% CI: 1.09, 2.76). To our knowledge, this was the first study that indicated placenta previa is a risk factor for breech presentation. Other studies are needed to identify which mothers with a history of placenta previa are at increased risk of breech presentation.

Risk Factor Analysis of the Incidence of Placenta Previa at RSUP Dr. Mohammad Hoesin Palembang in 2020–2021

Placenta previa is a placenta that lies at the bottom of the uterus, above or very close to the internal cervical ostium. The exact cause of placenta previa is still unknown, but several factors have been associated with an increased risk of placenta previa. This study aims to determine the relationship between maternal age, parity, distance between pregnancies, history of placenta previa, history of cesarean delivery, history of curettage, assisted reproductive technology, multiple pregnancies, and fetal gender on the incidence of placenta previa at RSUP Dr. Mohammad Hoesin Palembang in 2020-2021. This study is an observational analytic study with a case control design. This study used secondary data from medical records of obstetric patients at RSUP Dr. Mohammad Hoesin Palembang in 2020-2021 that met the inclusion criteria and exclusion criteria. The study sample amounted to 100 people consisting of 50 cases and 50 controls. The results of bivariate analysis using the chi-square test and the fisher exact alternative test showed that maternal age (p=0.010), parity (p=0.038), history of cesarean delivery (p=0.000), and history of curettage (p=0.001) had a significant relationship with the incidence of placenta previa. Distance between pregnancies (p=0.204), history of placenta previa (p=0.242), and fetal sex (p=0.162) did not have a significant relationship with the incidence of placenta previa. The results of multivariate analysis using binary logistic regression test showed that the most influential risk factors for the incidence of placenta previa were history of cesarean delivery (OR=54.751) and history of curettage (OR=20.204). It can be concluded that a history of cesarean delivery and a history of curettage are the most influential risk factors for the incidence of placenta previa.

Risk Factors and Pregnancy Outcome in Women with a History of Cesarean Section Complicated by Placenta Accreta

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA). Methods: This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta. Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21% vs. 231/869,26.58%) was significantly increased in the PA group (P &lt; 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00–3520.00) g vs. 2920.00 (2530.00–3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly (P &lt; 0.05). Weight (odds ratio (OR) = 1.03, 95% confidence interval (CI): 1.01–1.05)), parity (OR = 1.18, 95%CI: 1.03–1.34), number of miscarriages (OR = 1.31, 95%CI: 1.17–1.47), number of previous cesarean sections (OR = 2.57, 95%CI: 2.02–3.26), history of premature rupture of membrane (OR = 1.61, 95%CI: 1.32–1.96), previous cesarean-section transverse incisions (OR = 1.38, 95%CI: 1.12–1.69), history of placenta previa (OR = 2.44,95%CI: 1.50–3.96), and the combination of prenatal hemorrhage (OR = 9.95,95%CI: 8.42–11.75) and placenta previa (OR = 91.74, 95%CI: 74.11–113.56) were all independent risk factors for PA. Conclusion: There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Knowledge of reproductive age women regarding placenta previa in Mosul City, Iraq

Objective: To assess knowledge about placenta previa among women of reproductive age in our community. Methodology: This descriptive cross-sectional study was done in Department of obstetrics and gynecology, Mosul Teaching Hospitals. Data were collected by interviewing 208 women of reproductive age. A detailed questionnaire was used and consisted of demographic characteristics and knowledge of women toward signs and symptoms, risk factor, diagnosis and management of placenta previa. Results: More than half of study sample (62.02%) had age between 15-26 years, most of them were housewives and had secondary education. There was statistically significant correlation between knowledge of women and socio-demographics, level education and women had history of placenta previa (p&lt;0.05). Conclusion: Women participants at Mosul city had poor knowledge level about placenta previa.

A COMBINED ULTRASOUND AND CLINICAL SCORING MODEL FOR THE PREDICTION OF PERIPARTUM COMPLICATIONS IN PREGNANCIES COMPLICATED BY PLACENTA PREVIA

Introduction: Patients with placenta previa are at an increased risk of uncontrolled hemorrhage. Various clinical and ultrasound parameters can predict the risk of bleeding in these patients. Hence, the objective of our study is to develop a combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa. Methods: Fifty singleton pregnant women with placenta previa who underwent cesarean delivery in our hospital were included in the study. We collected clinical and ultrasound data prospectively, and the score was given to each parameter, and total score correlated with the occurrence of peripartum complications. Clinical parameters included age, parity, history of dilatation and evacuation, previous cesarean delivery, history of placenta previa, antepartum hemorrhage, and ultrasound parameters included type of previa, no. of lacunae in placenta, uteroplacental hypervascularity. The peripartum complications noted were the need for blood transfusion, uterine artery ligation, and cesarean hysterectomy. Results: According to the composite scoring done, uterine artery ligation was needed in more than 50% of patients at a score of 9–10. It increased to 100% as the score increased to ≥11. At a score of ≥12, hysterectomy was needed in around 75% of patients, and 100% of patients needed a blood transfusion. Univariate analysis using the Pearson Chi-square test was also done to know whether individual parameters and peripartum complications were significantly related that is p&lt;0.05 with one another. Conclusion: The scoring system may serve to predict peripartum complications in pregnancies complicated by placenta previa.

Maternal predictive factors for preterm birth: A case-control study in Southern Iran.

BACKGROUND:Preterm birth (PTB) is one of the most important factors that increase the risk of chronic diseases and postpartum death in infants. The aim of this study was to determine the maternal factors that affect the birth of preterm infants in the city of Bandar Abbas.MATERIALS AND METHODS:This is a case–control study that was performed on 400 preterm infants. Sampling was done by a simple method, and information was gathered by interviewing the mothers and their medical records. Data were collected by SPSS software version 16. To compare risk factors in the two groups, conditional logistic regression was used, and P < 0.05 was considered statistically significant.RESULTS:Results showed that factors such as type of delivery (odds ratio [OR] = 3.584, 95% confidence interval [CI]: 1.981–6.485), preeclampsia (OR = 2.688, 95% CI: 1.164–6.207), history of PTB (OR = 4.171, 95% CI: 1.483–11.728), premature rupture of membranes (OR = 3.273, 95% CI: 1.745–6.137), care during prenatal (OR = 0.334, 95% CI: 0.159–0.701), placental abruption (OR = 3.209, 95% CI: 1.209–8.519), placenta previa (OR = 9.333, 95% CI: 2.086–41.770), and cervical insufficiency (OR = 11, 95% CI: 1.381–87.641) were independent risk factors of preterm infant birth.CONCLUSIONS:The PTB risk is higher for women with cervical insufficiency, history of placenta previa, and history of preterm. Early recognition and management of these high-risk conditions among pregnant women may lead to a reduction in PTB rates.

VP46.25: The natural history of placenta previa: from first trimester to delivery

VP46.25: The natural history of placenta previa: from first trimester to delivery

Effect of previous placenta previa on outcome of next pregnancy: a 10-year retrospective cohort study

BackgroundTo determine the effects of previous placenta previa on the maternal and neonatal outcomes of the next pregnancy.MethodsThis 10-year retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2009 and 2018. We retrospectively analyzed the effects of a previous singleton pregnancy in women with and without placenta previa on the outcomes of the subsequent pregnancy. To control for confounders, we used multiple logistic regression models.ResultsA total of 57,251 women with singleton pregnancies gave birth during the 10-year study period. Among them, 6070 women had two consecutive births. For the first pregnancy, 1603 women delivered by cesarean delivery and 4467 by vaginal delivery. Among women with a history of cesarean delivery, placenta previa was an independent risk factor for hemorrhage (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [CI]: 1.1–4.62), placenta accreta spectrum (PAS) disorders (aOR: 4.11, 95% CI: 1.68–10.06), and placenta previa (aOR: 6.24, 95% CI: 2.85–13.67) during the subsequent pregnancy. Puerperal infection, blood transfusion, and perinatal outcomes did not significantly differ between women with a history of placenta previa and women without this history. Among women with a history of vaginal delivery, placenta previa increased the risk of PAS disorders (aOR: 5.71, 95% CI: 1.81–18.03) and placenta previa (aOR: 4.14, 95% CI: 1.07–16.04) during the subsequent pregnancy. There was no significant difference between the two groups in terms of hemorrhage, blood transfusion, puerperal infection, and perinatal outcomes.ConclusionsWomen with a history of placenta previa are at risk for adverse outcomes such as postpartum hemorrhage, PAS disorders, and placenta previa in the subsequent pregnancy.

Effect of the delivery way and number of parity in the subsequent incidence of placenta previa

Aim: To appraise the impact of previous birth type and the number of deliveries on placenta previa incidence and the extent of intrapartum massive hemorrhage.Materials: Placenta previa complications among healthy singleton subsequent pregnancies following previous pregnancies without placenta previa history were classified according to their birth types and previous numbers of parity. Subgroups of subsequent pregnancies with massive hemorrhage and placental adhesion anomalies were compared.Result: One, two, three or more previous cesarean births triggered a significant increase in the rate of massive hemorrhage when compared to subgroups of previous vaginal births (31.5% versus 50.9%, p = .02; 32.7% versus 69.0%, p = .001; and 42.9% versus 81.9%, p = .035, respectively). The rate of placental adhesion anomalies in all subgroups of previous cesarean births were statistically higher than subgroups of previous vaginal births (12.4 versus 32.7%, p = .003; 10.2% versus 52.2%, p = .001; and 9.5% versus 63.6%, p = .001, respectively). Urogenital complications in women with one previous cesarean birth were higher than those of the vaginal birth group (9.1 versus 0%, p = .004).Conclusion: Previous cesarean births are more frequently associated with increased massive hemorrhage and placental adhesion anomalies in subsequent pregnancies with placenta previa when compared to previous vaginal births.

731: The risk of abnormal placentation and hemorrhage in subsequent pregnancy following primary elective caesarean delivery

China has the highest caesarean rate in the world largely driven by the overuse of elective caesarean delivery (CD). With termination of the one child policy in 2015, more women are now having a second pregnancy. We aimed to evaluate the relationship between mode of first delivery with subsequent placenta previa, placenta accreta/increta and significant postpartum hemorrhage (PPH). This retrospective cohort study included women with 2 consecutive singleton deliveries between 2007-2017 at our institution if the women were nulliparous and delivered at term at the time of first delivery. The first pregnancy delivery mode was classified as (1) vaginal delivery, (2) antepartum CD without labor, or (3) intrapartum CD after onset of labor. Within these 3 groups, rates of placenta previa, placenta accreta/increta and PPH at the time of the second delivery were compared. Significant PPH was defined as hemorrhage requiring blood transfusion. Logistic regression was used to adjust for maternal characteristics, gestational week, obstetric complications, previous pregnancy loss, history of placenta previa, and the time interval between the two pregnancies. RESULTS: A total of 8 208 women were analyzed. Most first deliveries were vaginal (n=5210, 63.5%), followed by antepartum CD (n=2432, 29.6%) and intrapartum CD (n=566, 6.9%). The incidence of placenta previa in subsequent deliveries differed by previous delivery mode: vaginal, 0.9%; antepartum CD, 2.0%; intrapartum CD,1.6% (P<0.001). Similar differences were also observed with respect to placenta accreta/increta (0.5% vs 1.5% vs 0.9%, P<0.001) and PPH (0.6% vs 1.2% vs 0.4%, P=0.017). Compared to the previous vaginal delivery group, the antepartum CD group had increased risks of placenta previa (aORs 2.02, 95% CI 1.35-3.05), placenta accreta/increta (aOR 2.52; 95% CI 1.53-4.14) and PPH ( aOR 1.78, 95%CI 1.14-2.98) in subsequent pregnancies. However, previous intrapartum CD was not significantly associated with increased risks of these complications. Previous antepartum CD was associated with 2-fold increased risks of placenta previa, placenta accreta/increta and significant PPH in the second delivery compared to women with a prior vaginal delivery. The increased risks of subsequent abnormal placentation following primary antepartum CD may be important for counseling concerning non-medically indicated elective caesarean.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

THROMBOPHILIA AND ABNORMAL LOCATION OF PLACENTA

The aim of the study was to search for a connection between the abnormal location of placenta and the presence of genetic and acquired forms of thrombophilia. Materials and methods. A total of 132 women with the aggravated obstetrical history were examined: Group 1 – 42 patients with the history of placenta previa; Group 2 – 60 pregnant women diagnosed with placenta previa in the current pregnancy; Group 3 – 30 pregnant women with the history of placenta previa and the same abnormality in the current pregnancy. The control group included 120 women with no abnormalities in their obstetric history and with normal location of placenta during the current pregnancy. All patients were assessed for the antiphospholipid antibodies using an enzyme immunoassay. The presence of genetic forms of thrombophilia was tested (with polymerase chain reaction and three pairs of oligonucleotide primers) for the following mutations: the C677T mutation in the 5,10-methylenetetrafolate reductase gene, the prothrombin mutation in the G20210A gene, mutations in the Leiden factor V gene, polymorphism 675 4G/5G in the gene of the inhibitor of plasminogen activator type 1, polymorphism 455G/A in the fibrinogen gene. Results. The thrombophilia spectrum in patients with placenta previa during the current pregnancy and those with abnormal placenta location in the past did not significantly differ from each other. However, in patients with both abnormal placental locations in the past and the present pregnancy, there was a greater occurrence of both genetic and acquired forms of thrombophilia. In the control group, much fewer cases of either genetic or acquired thrombophilia were found. Conclusion. The obtained results suggest a connection between thrombophilia and the abnormal location of placenta. Women with the abnormal placenta location either in the past or during the current pregnancy should be routinely tested for the genetic markers of thrombophilia and for hemostasis abnormalities.

Frequency and causes of emergency hysterectomy along with vaginal delivery and caesarean section in Hamadan, Iran.

BackgroundEmergency hysterectomy (peripartum) is a high-risk surgery that almost always is done in the treatment or prevention of severe and life-threatening bleeding that occurs after vaginal delivery or caesarean.ObjectiveTo compare the frequency and causes of emergency hysterectomy along with the vaginal delivery and caesarean section (CS).MethodsThe cross-sectional research was conducted on patients who underwent a peripartum hysterectomy from 2005 to 2015 at Fatemieh Hospital in Hamadan City, Iran. Data collection tools included a questionnaire about demographic features and factors associated with hysterectomy surgery. Data were analyzed using SPSS version 21 and by descriptive statistics, chi-square, paired t-test, and one-way analysis of variance (ANOVA).ResultsThe mean age of women was 33.4±5.09 years. In recent years, 37 cases of hysterectomy were reported, with the peak occurring in 2015. The highest prevalence of hysterectomy was associated with 28 (77.8%) women with a third pregnancy and second parity, while 32 cases (86.5) were related to those with no history of vaginal delivery, 15 (45.5%) were related to repeated CS and second repeated CS; 28 cases (75.7%) to those with no history of placenta previa; 21 cases (56.8) to the majority with the anterior placenta;, 33 cases (97.1%) to those with no over-distance of uterine; and 36 cases (97.3%) to those without a history of uterine myoma. Among 37 cases who had hysterectomy, placenta accreta was observed in 27 cases (77.1%), with placenta increta in three (8.1%) and placental attachment, including percreta, were seen in seven cases (18.9 %).ConclusionThe rate of hysterectomy in multiparous women (in their third or fourth pregnancy) was higher. The greatest cause of hysterectomy was related to attached placenta including accreta, uterus atony, a history of CS, multipara, and repeated CS. Therefore, due to the increase in the number of CSs in recent years, planning should be taken into account in order to encourage pregnant women for vaginal delivery.

Placenta previa, anemia, care in antenatal, employment score: Development of a scoring system to predict low birth weight in underserved area in Indonesia

Background: Early intervention of low birth weight (LBW) should reduce maternal and fetal morbidity. In underserved areas, with inadequacy of health technologies, it was very important to develop a simple scoring system based on the LBW risk factors. Aims and Objective: The aim of this study is to develop a scoring system to predict LBW in underserved area. Materials and Methods: This case–control study enrolled total of women with a singleton LBW in Padang Sidempuan General Hospital. For every case, the subsequent woman who delivered a baby weighing ≥2500 g acted as control. All data were by Chi-square or Fisher’s exact test. Significant variables were taken to be analyzed in backward stepwise binary regression. Then, receiver operating characteristic curve was developed to determine cutoff point and diagnostic value. This was done by SPSS (Statistical Product and Service Solutions, Chicago, IL, USA) 22.0 with 95% confidence interval significant value. Results: This study involved 62 LBW and 62 normal birth weight newborns. Among all variables, only four variables were found to be significant, such as employment, antenatal care, history of anemia in pregnancy, and history of placenta previa in pregnancy. The placenta previa, anemia, care in antenatal, employment (PACE) score was obtained as score for employment was +1, antenatal care was −2, history of anemia in pregnancy was +2, and history of placenta previa was +3. The cutoff point was determined as 0, where a positive score will predict fetal with LBW and total score ≤0 (negative) will predict fetal with normal weight. This model had sensitivity of 88.7%, specificity of 66.1%, and area under curve 0.844 (P < 0.001). Conclusion: Positive total score of PACE could be a promising predictor for LBW in underserved area.

A combined ultrasound and clinical scoring model for the prediction of peripartum complications in pregnancies complicated by placenta previa

ObjectivesTo generate a combined ultrasound and clinical model predictive for peripartum complications in pregnancies complicated by placenta previa. Study designThis study included 110 singleton pregnant women with placenta previa delivered by cesarean section (CS) from July 2011 to November 2013. We prospectively collected ultrasound and clinical data before CS and observed the occurrence of blood transfusion, uterine artery embolization and cesarean hysterectomy. We formulated a scoring model including type of previa (0: partials, 2: totalis), lacunae (0: none, 1: 1–3, 2: 4–6, 3: whole), uteroplacental hypervascularity (0: normal, 1: moderate, 2: severe), multiparity (0: no, 1: yes), history of CS (0: none, 1: once, 2: ≥ twice) and history of placenta previa (0: no, 1: yes) to predict the risk of peripartum complications. ResultsIn our study population, the risk of perioperative transfusion, uterine artery embolization, and cesarean hysterectomy were 26.4, 1.8 and 6.4%, respectively. The type of previa, lacunae, uteroplacental hypervascularity, parity, history of CS, and history of placenta previa were associated with complications in univariable analysis. However, no factor was independently predictive for any complication in exact logistic regression analysis. Using the scoring model, we found that total score significantly correlated with perioperative transfusion, cesarean hysterectomy and composite complication (p<0.0001, Cochrane Armitage test). Notably, all patients with total score ≥7 needed cesarean hysterectomy. When total score was ≥6, three fourths of patients needed blood transfusion. ConclusionsThis combined scoring model may provide useful information for prediction of peripartum complications in women with placenta previa.

Prenatal and Perinatal Complications: Is It the Link Between Race and SES and Childhood Sleep Disordered Breathing?

Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones. Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort. Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES. These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood.

Acretismo diagnóstico prenatal mediante ultrasonido y resonancia magnética y su correlación histopatológica en Barranquilla (Colombia)

Introducción: el acretismo y percretismo se asocian con antecedentes de placentas previas y cesáreas anteriores, las cuales se han incrementado en nuestro medio. Por este motivo, su detección anteparto es fundamental en el propósito de disminuir el riesgo de morbimortalidad materna.Objetivo: evaluar la utilidad del ultrasonido (US) y la resonancia magnética (RM) en el diagnóstico prenatal de este trastorno adherencial placentario.Metodología: el presente es un estudio de cohorte prospectivo que incluyó a once mujeres en tercer trimestre de embarazo con antecedentes de placenta previa y cesárea anterior, a las cuales se les practicó US transabdominal y transvaginal, Doppler color y resonancia magnética, buscando signos de acretismo, los cuales fueron comparados con los hallazgos durante el parto y la histopatología.Resultados: el ultrasonido mostró una sensibilidad de 70% (IC95% 35,4-91,9). En contraste, el Doppler color y la resonancia magnética evidenciaron una sensibilidad de 90% (IC 95% 54,1-99,5).Conclusión: en pacientes con placenta previa y cesárea anterior, el US y el Doppler color surgen como una herramienta útil en la detección de acretismo placentario; sin embargo, se requieren mayores estudios para confirmar su validez diagnóstica.