Placenta Previa Accreta Research Articles

Development of the utero-placental circulation in cesarean scar pregnancies: a case-control study

Cesarean scar pregnancies carry a high risk of pregnancy complications including placenta previa with antepartum hemorrhage, placenta accreta spectrum, and uterine rupture. To evaluate the development of utero-placental circulation in the first half of pregnancy in ongoing cesarean scar pregnancies and compare it with pregnancies implanted in the lower uterine segment above a previous cesarean delivery scar with no evidence of placenta accreta spectrum at delivery STUDY DESIGN: This was a retrospective case-control study conducted in 2 tertiary referral centers. The study group included 27 women who were diagnosed with a live cesarean scar pregnancy in the first trimester of pregnancy and who elected to conservative management. The control group included 27 women diagnosed with an anterior low-lying placenta or placenta previa at 19 to 22 weeks of gestation who had first and early second trimester ultrasound examinations. In both groups, the first ultrasound examination was carried out at 6 to 10 weeks to establish the pregnancy location, viability, and to confirm the gestational age. The utero-placental and intraplacental vasculatures were examined using color Doppler imaging and were described semiquantitatively using a score of 1 to 4. The remaining myometrial thickness was recorded in the study group, whereas the ultrasound features of a previous cesarean delivery scar including the presence of a niche were noted in the controls. Both the cesarean scar pregnancies and the controls had ultrasound examinations at 11 to 14 and 19 to 22 weeks of gestation. The mean color Doppler imaging vascularity score in the ultrasound examination at 6 to 10 weeks was significantly (P<.001) higher in the cesarean scar pregnancy group than in the controls. High vascularity scores of 3 and 4 were recorded in 20 of 27 (74%) cases of the cesarean scar pregnancy group. There was no vascularity score of 4, and only 3 of 27 (11%) controls had a vascularity score of 3. In 15 of the 27 (55.6%) cesarean scar pregnancies, the residual myometrial thickness was <2 mm. In the ultrasound examination at 11 to 14 weeks, there was no significant difference between the groups in the number of cases with an increased subplacental vascularity. However, 12 cesarean scar pregnancies (44%) presented with 1 or more placental lacunae whereas there was no case with lacunae in the controls. Of the 18 cesarean scar pregnancies that progressed into the third trimester, 10 of them were diagnosed with placenta previa accreta at birth, including 4 creta and 6 increta. In the 19 to 22 weeks ultrasound examination, 8 of the 10 placenta accreta spectrum patients presented with subplacental hypervascularity, out of which 6 showed placental lacunae. The vascular changes in the utero-placental and intervillous circulations in cesarean scar pregnancies are due to the loss of the normal uterine structure in the scar area and the development of placental tissue in proximity of large diameter arteries of the outer uterine wall. The intensity of these vascular changes, the development of placenta accreta spectrum, and the risk of uterine rupture are probably related to the residual myometrial thickness of the scar defect at the start of pregnancy. A better understanding of the pathophysiology of the utero-placental vascular changes associated with cesarean scar pregnancies should help in identifying those cases that may develop major complications. It will contribute to providing counseling for women about the risks associated with different management strategies.

Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface

The main histopathologic diagnostic criteria for the diagnosis of placenta accreta for more than 80 years has been the finding of a direct attachment of the villous tissue to the superficial myometrium or adjacent to myometrial fibers without interposing decidua. There have been very few detailed histopathologic studies in pregnancies complicated by placenta accreta spectrum disorders and our understanding of the pathophysiology of the condition remains limited. To prospectively evaluate the microscopic changes used in grading and to identify changes that might explain the abnormal placental tissue attachment. A total of 40 consecutive cesarean delivery hysterectomy specimens for placenta previa accreta at 32 to 37 weeks of gestation with at least 1 histologic slide showing deeply implanted villi were analyzed. Prenatal ultrasound examination included placental location, myometrial thickness, subplacental vascularity and lacunae. Macroscopic changes of the lower segment were recorded during surgery and areas of abnormal placental adherence were sampled for histology. In addition, 7 hysterectomy specimens with placenta in-situ from the Boyd Collection at 20.5 to 32.5 weeks were used as controls. All 40 patients had a history of at least 2 previous cesarean deliveries and presented with a mainly anterior placenta previa. Of note, 37 (92.5%) cases presented with increased subplacental vascularity, 31 (77.5%) cases with myometrial thinning and all with lacunae. Furthermore, 20 (50%) cases presented with subplacental hypervascularity, lacunae score of >3, and lacunae feeder vessels. Intraoperative findings included anterior lower segment wall increased vascularization in 36 (90.0%) cases and extended area of dehiscence in 18 (45.0%) cases. Immediate gross examination of hysterectomy specimens showed an abnormally attached areas involving up to 30% of the basal plate, starting at <2 cm from the dehiscence area in all cases. Histologic examination found deeply implanted villi in 86 (53.8%) samples with only 17 (10.6%) samples presenting with villous tissue reaching at least half the uterine wall thickness. There were no villi crossing the entire thickness of the uterine wall. There was microscopic evidence of myometrial scarification in all cases. Dense fibrinoid deposits, 0.5 to 2 mm thick, were found at the utero-placental interface in 119 (74.4%) of the 160 samples between the anchoring villi and the underlying uterine wall at the accreta areas and around all deeply implanted villi. In the control group, the Nitabuch stria and basal plate became discontinuous with advancing gestation and there was no evidence of fibrinoid deposition at these sites. Samples from accreta areas at delivery present with a thick fibrinoid deposition at the utero-placental interface on microscopic examination independently of deeply implanted villous tissue in the sample. These changes are associated with distortion of the Nitabuch membrane and might explain the loss of parts of the physiological site of detachment of the placenta from the uterine wall in placenta accreta spectrum. These findings indicate that accreta placentation is more than direct attachment of the villous tissue to the superficial myometrium and support the concept that accreta villous tissue is not truly invasive.

Conservative Management of Placenta Previa-Accreta in a First Trimester Missed Abortion.

The incidence of placenta accreta has been increasing along with the incidence of caesarean sections. There have only been a few case reports of placenta accreta diagnosed in the first trimester, and none in association with a missed abortion in a woman without risk factors. At a routine prenatal visit, a 33 year old G2P0101 at 12+6 weeks had an ultrasound demonstrating a fetus with a crown-rump length of 8+0 weeks, no fetal heart tones, a placenta previa, and a morbidly adherent placenta. The patient requested conservative management to help preserve her fertility. Imaging demonstrated an anterior placenta previa with extension of the placenta past the inner endometrium into the superficial myometrium wall and the myometrium adjacent to the superior surface of the bladder. Consultation with Maternal Fetal Medicine (MFM) at another institution similarly demonstrated a suspicion of vascular invasion of the uterine wall with no increased vascularity extending to the maternal bladder using color flow Doppler. The opinion from this second MFM team recommended expectant management with serial beta-hCG, ultrasounds, and serial physician visits as well. Her beta-hCG levels declined serially from 55262 to 4874 mIU/mL over eight weeks. Her serial ultrasounds showed involution of the placenta and reasborption of the fetus during that time. After nine weeks of conservative management, the patient underwent an uncomplicated suction dilation and curettage. Postoperatively, the patient did well and did not have any complications. A first trimester missed abortion with a placenta previa and accreta can be managed conservatively in the attempt to preserve future fertility.

Conservative Management of Placenta Previa-Accreta in a First Trimester Missed Abortion

The incidence of placenta accreta has been increasing along with the incidence of caesarean sections. There have only been a few case reports of placenta accreta diagnosed in the first trimester, and none in association with a missed abortion in a woman without risk factors. At a routine prenatal visit, a 33 year old G2P0101 at 12+6 weeks had an ultrasound demonstrating a fetus with a crown-rump length of 8+0 weeks, no fetal heart tones, a placenta previa, and a morbidly adherent placenta. The patient requested conservative management to help preserve her fertility. Imaging demonstrated an anterior placenta previa with extension of the placenta past the inner endometrium into the superficial myometrium wall and the myometrium adjacent to the superior surface of the bladder. Consultation with Maternal Fetal Medicine (MFM) at another institution similarly demonstrated a suspicion of vascular invasion of the uterine wall with no increased vascularity extending to the maternal bladder using color flow Doppler. The opinion from this second MFM team recommended expectant management with serial beta-hCG, ultrasounds, and serial physician visits as well. Her beta-hCG levels declined serially from 55262 to 4874 mIU/mL over eight weeks. Her serial ultrasounds showed involution of the placenta and reasborption of the fetus during that time. After nine weeks of conservative management, the patient underwent an uncomplicated suction dilation and curettage. Postoperatively, the patient did well and did not have any complications. A first trimester missed abortion with a placenta previa and accreta can be managed conservatively in the attempt to preserve future fertility.

A novel low uterine segment sandwich technique (Caliskan's technique) for the management of post-cesarean hemorrhage due to placenta previa accreta

Objective:Placenta previa (PP) and placenta accreta spectrum (PAS) disorders are major causes of postpartum hemorrhage (PPH). There is a variety of surgical management options with inexplicit reported success rates. Uterine sandwich is a combination of uterine compression sutures and intrauterine balloon placement to achieve hemostasis. The aim of this study was to present our experience of seven women managed with a novel “lower uterine sandwich” technique to control post-cesarean hemorrhage due to PP accreta.Materials and Methods:Seven pregnant women diagnosed as having PP totalis accreta underwent a post-cesarean procedure combining bilateral ligation of the uterine artery, utero-ovarian artery, and internal iliac artery, Pereira compression sutures implemented on the uterine isthmus, Foley catheter placement into the lower uterine segment, and transvaginal cervical cerclage application, namely “Caliskan’s uterine sandwich technique”.Results:All women included in this study had placental invasion abnormalities of varying degrees. Postoperative diffusion magnetic resonance imaging assessment revealed a completely normal and preserved uterine blood supply. All women menstruated regularly in their postoperative follow-up period and two women conceived again and delivered uneventfully. None of the patients experienced morbid complications nor required hysterectomy.Conclusion:This novel procedure appears to be a plausible fertility and organ-preserving option in cases of intractable PPH, particularly in lower uterine segment bleeding. This uterine sandwich technique may allow physicians to manage massive hemorrhage due to PAS conservatively by preserving the uterus and its functions without major complications.

Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals.

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

The effect prophylactic internal iliac artery balloon occlusion in patients with placenta previa or placental accreta spectrum: a systematic review and meta\u2010analysis

BackgroundPlacenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS).MethodsIn this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2).ResultsIn the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P < 0.05).ConclusionThe results of this study show that the use of prophylactic internal iliac artery balloon occlusion in patients with placenta previa or Placenta accreta spectrum has benefits such as reduced intraoperative blood loss, reduced hysterectomy and increased gestation (weeks), which can be considered by midwives and obstetricians.

Role of Color Doppler Ultrasound in Antenatal Diagnosis of Placenta Accreta in Patients with Previous Cesarean Scar

Morbidly adherent placenta is asignificant cause of maternal morbidity , mortality and massive obstetric hemorrhage. It is defined as an abnormal placental adherence either in whole or in part of the placenta to the underlying uterine wall. It is a potentially life threatening condition responsible for 7-10% of maternal mortality.Is to evaluate the accuracy of Color Doppler Ultrasonography in antenatal diagnosis of placenta previa accreta in patients with previous cesarean sections. The study included 60 pregnant females after 28 week of gestation from obstetrics and gynecology department of Banha University hospital during a period from (1st of December 2018 to 30th November 2019) with suspected history and ultrasonographic findings of placenta accreta. Gray-scale B-mode transabdominal sonography and Color Doppler Ultrasound scans were done. The overall accuracy of diffuse or focal lacunar flow was 73.3%, vascular lakes with turbulent flow 70%, Hypervascularity of serosa bladder interface 62% and markedly dilated vessel over peripheral sub-placental zone 71% in doppler ultrasound. Color Doppler does not appear to improve the accuracy of Gray-Scale so, it is suggested to use both Gray scale ultrasound and Color Doppler in all cases of placenta previa with previous C.S to find out features that suggest presence of placenta accreta

First trimester serum PAPP-A is associated with placenta accreta: a retrospective study.

Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies by a retrospective cohort analysis. A total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of BMI and age matched, healthy pregnant controls. PAPP-A multiples of the median (MoM) were acquired from laboratory data files in 1 January 2017-30 September 2019. The probable maternal serum biochemical predictor of placenta accreta was analyzed by using multiple logistic regression analysis. PAPP-A MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.009 < 0.05, p < 0.001). Serum PAPP-A was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, age, smoking, and previous cesarean section history (OR: 3.51; 95% CI: 1.77-6.94; p = 0.0003 < 0.05). In addition, smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) and previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) were also significantly associated with placenta accreta. Increased first trimester serum PAPP-A was significantly positively associated with placenta accreta, suggesting that the potential role of PAPP-A in identifying pregnancies at high risk for placenta accreta. Smoking and previous cesarean section history may be the risk factors for accreta in placenta previa patients.

Uterine Artery Doppler and Placental Morphological Features as Predictors of Peripartum Complications in Placenta Previa and Placenta Previa Accreta

Background: Placenta accreta is becoming an increasingly common complication of pregnancy. Placenta accreta originates from abnormal trophoblast invasion. Objective: to assess if uterine artery Doppler and Placental Morphological Features could be predictors of maternal and fetal outcome in pregnancies complicated with placenta previa and placenta previa accreta. Subjects and methods: This study included 80 pregnant women of which they were divided into 3 groups. The first group included 40 pregnant women of normal pregnancies, 2nd one included 20 pregnant women with placenta previa and the 3rd one included 20 pregnant women with suspected placenta previa accreta by ultrasound. Abdominal ultrasound and uterine artery Doppler were done in a week before delivery. Results: There was a direct relationship between presence of lacunae especially high grade, placental vascularity (abnormal) and the mean values of uterine artery PI, RI and presence of peripartum maternal and fetal complications. Conclusion: the gray scale and color Doppler ultrasound have a high diagnostic value in the diagnosis by certain placental morphological features, Including loss of retro-placetal clear zone, thinning of myometrial thickness, Intraplacental lacunae, Intraplacental vascularity and exophytic mass into bladder space. Ultrasound is helpful and non-invasive tool in prediction of maternal and fetal outcome. High grade of placental lacunae and abnormal placental vascularity were highly associated with maternal and fetal complications. Uterine artery Doppler PI and RI is also useful in prediction of maternal complications and fetal complications of placenta previa and placenta previa accreta.

Minimizing abdominal incision for transverse uterine fundal incision by aspiration of amniotic fluid and reduction of uterine size.

Transverse uterine fundal incision (TUFI) was developed to avoid catastrophic hemorrhage associated with cesarean section of the placenta previa-accreta. Abdominal incisions extend as far as the upper abdomen in patients in the third trimester of pregnancy and require general anesthesia. Instead, we tried to aspirate amniotic fluid (AF) to reduce the uterine size. TUFI was performed in 19 of our patients in the third trimester in whom placenta previa accreta could not be ruled out between June 2012 and August 2016. After the lower abdominal vertical incision, we attempted to exteriorize the uterine fundus. If this was impossible, we inserted an 18-gauge spinal needle into the amniotic space. We aspirated AF until the uterine fundus could be exteriorized. We exteriorized the uterine fundus without extending the incision to the upper abdomen by aspirating 250-670 mL of AF in 12 patients who were between the 33rd and 37th week of pregnancy, and TUFI was performed under spinal anesthesia. AF aspiration was not required in four patients who were in the 30th or 31st week of pregnancy and in two patients with oligohydramnios in the 35th week of pregnancy. In one case, the trial was canceled due to hemorrhagic AF aspiration. No serious complications were observed in mothers or neonates. TUFI could be made by abdominal incision to the left of the umbilicus under spinal anesthesia without anesthesia by reducing the uterine size through AF aspiration, even for patients in the third trimester of pregnancy.

Plasenta previa ve plasenta akreta birlikteliğinin kısa dönem maternal morbiditeye etkileri

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p&lt;0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p&lt;0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone.

Management of Placenta accreta and its complications in cases of previous cesarean section with placenta previa anterior at Al-Hussein University Hospital

Background: Every year, 140 000 women are estimated to die of postpartum hemorrhage. Placenta accreta has since become a statistically relevant etiology for maternal morbidity and mortality. There has been a 10-fold increase in the occurrence of placenta accreta since 1970, due to the rising rate of cesarean delivery. Objective: This work aims to determine the occurrence and complications of placenta accreta in instances of prior cesarean sections with placenta previa anterior and outcome of management of these complications at Al Hussein University Hospital. Patients and Methods: The study is a prospective cohort study including all cases admitted to Al Hussein university Hospital diagnosed as placenta previa anterior plus one or more previous cesarean sections during the period from January 2020 to June 2020. The number of cases was 64 cases. 40 cases (63%) of them were found as placenta previa accreta. Results: Our findings indicate that the occurrence, risk factors and feto-maternal outcomes of the treatment of patients with placenta accreta at Al Hussein University Maternity Hospital are similar to those of preceding literature. Conclusion: Placenta previa accreta for the diagnosis, particularly anterior placenta accreta, the sensitivity and specificity of color imagery by Doppler was high since abnormal uteroplacental invasion can be identified with a high degree of trust.

VP46.34: Placenta previa accreta and short cervix: a case report

To describe a case of a patient with a placenta previa accreta with a history of preterm delivery and a short cervix. Placenta accreta is an obstetric entity that has been increasing.The coexistence of this finding, adding to the short cervix and a localisation of the placenta previa in a patient with a history of preterm delivery, confronts us with various debates, regarding what is the ideal moment of termination of pregnancy and the alternatives management. This is a 23-year-old patient with a history of 2 previous Caesarean sections. Those who enter the emergency department with profuse, non-painful vaginal bleeding undergo emergency obstetric ultrasound, evidencing a previous, total, occlusive placenta with ultrasound signs suggestive of placental accretions and a length of the cervix of 19mm. The patient is hospitalised and treatment with hydroxyprogesterone caproate, due to the history of 2 preterm labour, with clinical improvement, progressive bleeding reduction and hemodynamic stability. A Medical Board is held and it is considered to continue management with weekly progesterone caproate, with the goal of bringing the pregnancy to week 34 to reduce the impact of prematurity. Placental accretion represents a challenge for obstetric management and the coexistence of a history of preterm delivery and short cervix implies the integration of preventive management of preterm delivery and the organisation of a multidisciplinary equipment. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Combined Uterine Artery Ligation, Segmental Myometrial Resection and Intrauterine Balloon to Control Bleeding from Placenta Previa Accreta during Caesarean Section

Background: Morbidity attached placenta (MAP) remain a major surgical problem for obstetricians due to severe hemorrhage and its incidence had been continually increased due to increased rate of cesarean deliveries. Aim of the work: To evaluate the safety and efficacy of a conservative intervention for management of placenta accreta.Patients and methods: Forty-eight, pregnant females with a confirmed diagnosis of placenta previa accreta had been scheduled for elective cesarean delivery had been included. All females had been screened by full history taking, clinical examination, ultrasound and lab investigations. Blood loss, operative time, need for transfusion and need for other surgical interventions represented the main outcome and other complications were documented.RESULTS: The blood loss (ml) ranged between 850 to 1300 ml; the mean values were 1082.29±105.89 ml. The operative time ranged between 60 to 130 minutes; the mean values were 87.92±19.35 minutes. There was significant decrease of post-partum hemoglobin when compared to corresponding pre-partum values (9.29±0.76 vs 10.71±0.54 mg/dl respectively). Four patients [8.3%] need ICU admission, and nine patients [18.75%] need blood transfusion. However, no patients need further surgical intervention or developed DIC. In addition, no mortality had been reported in the current work. Conclusion: Combined uterine artery ligation, partial segmental myometrial resection and intrauterine balloon as a conservative treatment modality or placenta previa accreta is safe and effective

First trimester serum PIGF is associated with placenta accreta

ObjectivesIn this retrospective study, we investigated whether first trimester serum placental growth factor (PIGF) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies. MethodsIn 1 January 2017–30 September 2019, a total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of age and BMI-matched, healthy pregnant controls. PIGF multiples of the median (MoM) were acquired from laboratory data files. The predictor of placenta accreta was analyzed by using multiple logistic regression analysis. ResultsPIGF MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.0098 < 0.01, p = 0.0002 < 0.01). Serum PIGF was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, and age (OR: 4.83; 95% CI: 1.91–12.24；p = 0.0009 < 0.01). In addition, previous cesarean section history (OR: 2.75; 95% CI: 1.23–6.17; p = 0.014 < 0.05) and smoking (OR: 9.17; 95% CI: 1.69–49.62; p = 0.010 < 0.05) were also significantly associated with placenta accreta. ConclusionIncreased first trimester serum PIGF was significantly positively associated with placenta accreta, suggesting that the potential role of PIGF in identifying pregnancies at high risk for placenta accreta. Previous cesarean section history and smoking may be the risk factors for accreta in placenta previa patients.

Nėštumų ir gimdymų baigtys po pagalbinio apvaisinimo

Santrauka. Tyrimo tikslas. įvertinti moterų, pastojusių po pagalbinių apvaisinimo budų (PAB), neštumo, gimdymo eigą ir rezultatus bei išanalizuoti naujagimių baigtis. Tyrimo medžiaga ir metodai. 2016–2018 m. laikotarpiu retrospektyviai tirtos 427 pacientės, gimdžiusios Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (toliau – Kauno klinikos), suskirstytos į tiriamąją (n=215) bei kontrolinę (n=212) grupes. Tiriamoji grupė – tai moterys pastojusios po PAB, kontrolinė grupė – tai atsitiktinai atrinktos savaime pastojusios moterys. Analizuoti neštumo, gimdymo eigos ir naujagimių buklės duomenys remiantis gimdymo registro, gimdymo knygų ir ligos istorijomis. Rezultatai. Daugiavaisiai neštumai PAB grupeje sudarė 37,7 proc., o kontrolinėje grupėje – 10,4 proc., p&lt;0,001. Neštumo komplikacijų: preeklampsijos (lengvos, sunkios), neščiųjų hipertenzijos, neščiųjų diabeto dažnis tarp grupių reikšmingai nesiskyrė, p&gt;0,05. Placentos patologijos (įaugusi placenta ir placentos pirmeiga) dažnesnėsPAB grupėje, atitinkamai – p=0,012 ir p=0,004. Priešlaikinio vaisiaus dangalų plyšimo dažnis tarp grupių nesiskyrė. Vaisiaus ydų dažniai abiejose grupėse nesiskyrė, p=0,302. Cezario pjūvio operacijų (CPO) dažnis didesnis PAB grupėje ir siekia 49,8 proc., p=0,016. Placentos atšokos dažnis grupėse nesiskyrė. Apgar balų vidurkis 1 ir 5 min. grupėse nesiskyrė, p1&lt;0,994 ir p5&lt;0,484, tačiau PAB grupėje buvo didesnis neišnešiotų naujagimių, p=0,015, vaisiaus augimo sulėtejimo (VAS), p=0,005 bei mažesnis stambių vaisių dažnis, p=0,005. Išvados. Svarbiausios su PAB susijusios komplikacijos yra daugiavaisiai neštumai, CPO, su placenta susijusios patologijos, priešlaikinis gimdymas, vaisiaus augimo sulėtėjimas.

Biomarkers of abnormally invasive placenta

IntroductionAbnormally invasive placenta (AIP, aka placenta accreta spectrum; PAS) is an increasingly common pregnancy pathology, which, despite significant morbidity risk to the mother, is often undiagnosed prior to delivery. We tested several potential biomarkers in plasma from PAS mothers to determine whether any were sufficiently robust for a formal, diagnostic accuracy study. MethodsWe examined hyperglycosylated hCG (h-hCG), decorin and IL-8, based on biological plausibility and literature indications that they might be altered in PAS. These analytes were assayed by ELISA in maternal plasma from five groups, comprising (1) normal term controls, (2) placenta previa controls, and cases of (3) placenta increta/percreta without placenta previa, (4) placenta previa increta/percreta and (5) placenta previa accreta. ResultsThere were no differences in h-hCG, ß-hCG or the h-hCG/ß-hCG ratio between the groups. Mean decorin levels were increased in previa controls (Group 2) compared to the other groups, but there was substantial overlap between the individual values. While an initial multiplex assay showed a greater value for IL-8 in the placenta previa increta/percreta group (Group 4) compared to placenta previa controls (Group 2), the subsequent validation ELISA for IL-8 showed no differences between the groups. DiscussionWe conclude that the absence of differences and the extent of overlap between cases and controls does not justify further assessment of these biomarkers.

Hubungan Skor Plasenta Akreta Indeks (PAI) dengan Kejadian Plasenta Akreta pada pasien bersalin di bagian kebidanan RSUP.dr.M.Djamil Padang

Objective: To determine the relationship between PAI scores and the incidence of placenta accreta in placenta previa accreta suspects who gave birth at RSUP M. Djamil Padang. Method: This study is an analytical study using a cross-sectional study design with a sample of all patients with placenta previa totalis suspected accreta who gave birth in the obstetrics department of RSUP M. Djamil Padang during the period January 1, 2017 - April 30, 2018. The data were taken from the patient's medical records that included age, parity status, labor history, and PAI score from ultrasound examination results. The relationship between PAI scores and the incidence of placenta accreta was analyzed using an independent T-test with a significant degree of &lt;0.05. The research results are presented in tabular form. Results: During the study period, 30 patients with placenta previa suspected of accreta at RSUP M. Djamil Padang. It is known that cases of placenta accreta were more common in multiparous (57.7%), suspected accreta (57.7%), had a history of SC (65.2%), and the mean age of patients with accreta was 34.7 ± 3.5 years. Furthermore, it can be concluded that the mean PAI score in patients with placenta accreta is higher than non-accreta, and there is a significant relationship between PAI scores and cases of placenta accreta (p&gt; 0.05).Conclusion: The mean PAI score in patients with placenta accreta is higher than without accreta and there is a significant relationship between PAI scores and cases of placenta accreta.Keywords: Placenta Accreta, PAI Score

Hubungan Skor Plasenta Akreta Indeks (PAI) dengan Kejadian Plasenta Akreta pada pasien bersalin di bagian kebidanan RSUP.dr.M.Djamil Padang

Objective : To determine the relationship between PAI scores and the incidence of placenta accreta in placenta previa accreta suspects who gave birth at RSUP M. Djamil Padang. Method : This study is an analytical study using a cross-sectional study design with a sample of all patients with placenta previa totalis suspected accreta who gave birth in the obstetrics department of RSUP M. Djamil Padang during the period January 1, 2017 - April 30, 2018. The data were taken from the patient's medical records that included age, parity status, labor history, and PAI score from ultrasound examination results. The relationship between PAI scores and the incidence of placenta accreta was analyzed using an independent T-test with a significant degree of &lt;0.05. The research results are presented in tabular form. Results : During the study period, 30 patients with placenta previa suspected of accreta at RSUP M. Djamil Padang. It is known that cases of placenta accreta were more common in multiparous (57.7%), suspected accreta (57.7%), had a history of SC (65.2%), and the mean age of patients with accreta was 34.7 ± 3.5 years. Furthermore, it can be concluded that the mean PAI score in patients with placenta accreta is higher than non-accreta, and there is a significant relationship between PAI scores and cases of placenta accreta (p&gt; 0.05). Conclusion : The mean PAI score in patients with placenta accreta is higher than without accreta and there is a significant relationship between PAI scores and cases of placenta accreta. Keywords: Placenta Accreta, PAI Score