Placental Hemorrhage Research Articles

Likelihood of Preterm Birth in Patients After Antenatal Corticosteroid Administration in Relation to Diagnosis and Confounding Risk Factors: A Retrospective Cohort Study.

Background: In the case of threatened preterm birth (PTB) before the 34th week of pregnancy, the application of antenatal corticosteroids (ACSs) for the maturation of the fetal lung is a standard procedure in perinatal medicine. Common diagnoses for ACS use in pregnancy are the preterm rupture of membranes (PPROMs), placental bleeding, premature labor, preeclampsia, oligohydramnios, amniotic infection syndrome (AIS), and cervical insufficiency. The aim of this study was to investigate whether the current diagnosis, which results in ACS, and the patient's risk factors influence the risk of PTB events. Methods: The data of all affected women were extracted, who were hospitalized in 2016 due to a threatening PTB and administered corticosteroids in the German federal state Rhineland-Palatinate (n = 1544), so the study was conducted as a retrospective cohort trial. Frequency analyses, Friedman tests, Chi square tests, logistic regressions, Spearman correlation, and moderation analysis were performed to determine the Odds ratio (OR) for PTB in ACS patients in relation to diagnosis and risk factors. Results: Only 60% of all patients with PTB risk delivered prematurely, whereby patients with different diagnoses differ in terms of the PTB risk; the highest risk could be found in AIS (OR = 16.12) or preeclampsia (OR = 5.46). For prior PTB, stillbirth, or abortion, there is a moderation effect (based on the confounders), while multiple pregnancies influence the PTB risk irrespective of diagnosis (OR = 6.45). In the whole collective, the OR for PTB was 6.6 in relation to all pregnant women in Germany. Conclusions: A higher risk of PTB could be found in patients with a diagnosis of AIS, preeclampsia, as well as in multiple pregnancies. Prior PTB, stillbirth, or abortion act as a relevant confounder.

Placental pathology of IVF-conceived dichorionic diamniotic twins after fresh embryo versus frozen-thawed transfer

IntroductionTo compare histopathological findings of placentas of dichorionic diamniotic twin pregnancies of in-vitro fertilization (IVF), conceived after fresh embryo transfer (ET) and frozen-thawed ET. MethodsThis retrospective study compared dichorionic diamniotic twin IVF pregnancies that resulted in livebirths during 2010-2022. The placental findings were classified according to definitions curated by the 2016 Amsterdam Placental Workshop Group Consensus Statement. A multivariate logistic analysis was constructed to estimate the odds ratios (OR) of placental histopathology abnormal findings, adjusted for maternal age, body mass index and nulliparity. ResultsThe mean gestational age at birth was lower following fresh ET pregnancies (n=236) than frozen-thawed ET pregnancies (n=122) (34.89 vs 35.77 weeks, p=0.003). For the fresh ET compared to the frozen-thawed ET group, rates were higher of preterm birth (69.5% vs. 55.7%, p=0.011), low birthweight (71.6% vs 57.4%, p<0.001) and very low birthweight (14.2% vs 9.0%, p value one sided=0.029). For the fresh ET compared with the frozen-thawed ET group, the rates were higher of maternal vascular lesions (20.3% vs. 11.5%, p=0.003), placental hemorrhage (12.7% vs. 7%, p=0.021), and villous lesions related to maternal vascular lesions (7.2% vs. 3.7%, p value one sided=0.04). A multivariate logistic analysis showed a higher risk of maternal or neonatal vascular lesions for twin pregnancies after fresh ET than frozen-thawed ET (adjusted OR=1.91, 95% CI 1.26-2.92, p=0.011). ConclusionsFollowing fresh ET compared to frozen-thawed ET, obstetrical and neonatal outcomes were worse, and the risk of maternal vascular lesions was greater.

M‐SSD based on anchor proposal and ResNet101 backbone for placental haemorrhage MRI detection

AbstractMRI (magnetic resonance imaging) images can effectively show the placental haemorrhage area. In view of the special properties and real‐time detection requirements of placental haemorrhage MRI images, this paper has systematically improved the single‐shot multi‐box detector (SSD) target detection algorithm (M‐SSD). First, taking advantage of the particularity of the MRI image, the maximum stable extremum region (MSER) algorithm was used as the anchor proposal network which integrated the proposal information into the feature layer of SSD to avoid the hungry traversal of the original algorithm. Second, after the scale statistics of the placental haemorrhage area in MRI images, the bounding box matching the size of the placental haemorrhage area was redefined, in this way, the scale of the bounding box will have application pertinence, which can effectively improve the detection accuracy of the algorithm. Third, due to the small target property of the placental haemorrhage area in the MRI image, the VGG16 basic network in the original SSD was replaced by ResNet101, this made the algorithm have higher performance in small target detection. Finally, the Placental Haemorrhage MRI Detection Database (PHMD) has been built which is not only a base for this paper, but also for further research in this area.

CCR2-dependent placental migration of inflammatory monocytes suppresses abnormal pregnancies caused by Toxoplasma gondii infection.

Toxoplasma gondii (T. gondii) is a zoonotic protozoan parasite that causes congenital toxoplasmosis, including fetal death, abortion, stillbirth, morphological abnormalities, and premature birth. Primary T. gondii infection in pregnant women results in congenital toxoplasmosis. C-C chemokine receptor (CCR) 2 is reportedly a critical host defense factor against T. gondii infection. However, details of the role of CCR2 in the host immune response to T. gondii in congenital toxoplasmosis remain unclear. Here, we infected pregnant CCR2-deficient mice with T. gondii, resulting in stillbirth, embryonic resorption, fetal morphological abnormalities, and preterm delivery at significantly higher rates than those in pregnant wild-type (WT) mice. Consistent with the severity of abnormal pregnancy, a large area of placental hemorrhage and a large number of T. gondii infections around the hemorrhagic area were observed in the placentas of CCR2-deficient mice. In addition, the accumulation of inflammatory monocytes in the placenta was reduced in CCR2-deficient mice during infection. We further confirmed that the adoptive transfer of inflammatory monocytes collected from WT mice into T. gondii-infected pregnant CCR2-deficient mice effectively suppressed placental damage and abnormal pregnancy. Collectively, CCR2 contributes to pregnancy maintenance by regulating the migration of inflammatory monocytes into the placenta of T. gondii-infected pregnant mice.

Gestational age at birth in pregnancies with antenatal corticosteroid administration in relation to risk factors: a retrospective cohort study.

The aim was to investigate gestational age at birth of women after induction of fetal lung maturation (antenatal corticosteroids = ACS) because of imminent preterm birth (PTB), and to quantify incidence of late PTB (gestational age < 260 days) and extreme immaturity (gestational age < 196 days) in relation to several diagnoses (PPROM, placental bleeding, premature labor, preeclampsia, oligohydramnios, amniotic infection syndrome (AIS), cervical insufficiency) and risk factors (age > 35, history of preterm delivery, multifetal gestation, gestational diabetes, hypertension, nicotine abuse). The study was designed as a retrospective cohort trial, in which the data of all births taking place in 2016 in the German federal state Rhineland-Palatinate were evaluated. Frequency analyses, subgroup analysis (Chi-square tests and Friedman's tests), as well as multinomial logistic regressions and linear regressions were used to determine odds ratios (OR). In total, N = 1,544 patients were included who had been hospitalized due to an imminent PTB and had received ACS, of whom 52% had a late PTB and 8% a PTB with extreme immaturity. Regarding the gestational age at birth, there were only minor differences between the individual risk factors and diagnoses, only AIS patients showed a significantly lower gestational age (mean: 207 days). A significantly increased risk of PTB with extreme immaturity was found in patients with AIS (OR = 5.57) or placental bleeding (OR = 2.10). There is a need for further research in order to be able to apply therapeutic measures more accurately in relation to risk factors and diagnoses.

A validation of placental pathology reports by ethnicity in New Zealand, through systematic analysis of histological slides

IntroductionReliability studies of placental examination have shown differing interobserver agreement for certain pathological features, a lack of uniform reporting criteria and variable experience among pathologists. In previous analyses we have shown that placental pathology differs by ethnicity. This validation study was performed to investigate whether bias related to ethnicity is a feature of placental pathology reporting in New Zealand (NZ). Methods199 of 1726 eligible perinatal death cases between 2008 and 2017 were selected at random for this audit-type study, including 51 cases from South Asian, Māori and NZ European ethnicity and 46 cases from Pacific mothers. Stored histology slides were blinded and re-examined by an experienced perinatal pathologist, and linked to the corresponding original pathology report. Interobserver agreement (overall, by ethnicity and by gestational age) was described by proportional differences and kappa coefficients. ResultsTotal interobserver agreement between original placental reporting and the validation review was 89.7 %, which differed by pathological feature. There was generally more underreporting than overreporting (3.6 % and 6.7 %, respectively). There was little disagreement by ethnicity (decidual vasculopathy [p = 0.03]), although there were more differences by gestational age (villous morphology [p < 0.01], chorioamnionitis [p = 0.03], high-grade villitis of unknown etiology [p < 0.01], and placental haemorrhage [p = 0.03]). DiscussionNo systematic bias in placental pathology reporting in NZ was identified by ethnicity or gestational age, as observed differences could be related to the underlying prevalence of pathology. We identified more underreporting than overreporting of pathology in the original reports, emphasizing the importance of placental investigation by specialised perinatal pathologists.

Tranexamic Acid and its Role in Total Knee Replacement

Abstract: Tranexamic acid is a synthetic lysine derivative that inhibits the lysine binding sites on plasminogen molecules in order to have an antifibrinolytic action. In patients with upper gastrointestinal bleeding, tranexamic acid was related to mortality decreases of 5 to 54% when compared to placebo. A 40% reduction was found by meta-analysis. Tranexamic acid therapy reduced mean menstrual blood loss in menstruating women with menorrhagia by 34 to 57.9% in comparison to placebo or control; the medication has also been successfully used to treat placental bleeding, postpartum hemorrhage, and cervix conization. In hemophiliac patients undergoing oral surgery, tranexamic acid considerably decreased mean blood losses, and it worked well as a mouthwash for dental patients taking oral anticoagulants. With the administration of the medication, blood loss was also decreased in patients having orthotopic liver transplantation or transurethral prostate surgery, and rebleeding rates were decreased in patients with traumatic hyphaema. Patients with hereditary angioneurotic edema have also claimed clinical improvement from tranexamic acid. The most frequent adverse reactions to tranexamic acid are nausea and diarrhea. Clinical trials have not shown that the medication increases the risk of thrombosis

P-152 Velocity of cytoplasmic movement in trophectodermal cells depends on the keratin cytoskeleton

Abstract Study question Can dysfunction of the keratin cytoskeleton, known to severely hinder postimplantation development of mammalian embryos, be detected by analysis of cytoplasmic movement in trophectodermal cells? Summary answer Depletion of keratins increases cytoplasmic movement in trophectodermal cells in extent depending on the developmental stage and on the location of the trophectodermal cells (mural/polar). What is known already Recent literature data indicate that keratins, intermediate filament proteins, are key regulators of trophectoderm function in mouse and human embryos. Keratin knockouts display trophoblast fragility, placental bleeding, and lethality after implantation. However, depletion of keratin 8 (Krt8) and keratin 18 (Krt18), which are most abundant in preimplantation embryos, does not lead to severe phenotype up to the blastocyst stage at least in mice and cattle, so can easily remain unnoticed. However, it affects the biomechanical properties of the trophectoderm. Analysis of cytoplasmic movement allows for biomechanical assessment of the trophectoderm in a non-invasive way. Study design, size, duration We analyzed 188 mouse embryos (66 control, 60 with Krt8 depletion, and 62 with Krt18 depletion) to quantitatively assess changes in the velocity of cytoplasmic movement caused by a knockdown of Krt8 and Krt18. Additionally, we correlated the velocity of cytoplasmic movement in trophectodermal cells (n = 70 embryos) with the ability to form outgrowths. Appropriate statistical tests were used to determine the statistical significance of the obtained results. A value of p &amp;lt; 0.05 was considered statistically significant. Participants/materials, setting, methods Zygotes were injected with Krt8 and Krt18 siRNAs or with scrambled siRNAs used as a negative control. The efficiency of the knockdown was tested on mRNA and protein levels. The embryos were cultured for 3 or 4 days and the velocity of cytoplasmic movement in polar and mural trophectoderm cells was measured. Additionally, we correlated the cytoplasmic movement velocity in trophectodermal cells in E3.5 embryos with their ability to implant in vitro (i.e., form outgrowths). Main results and the role of chance Our research showed that the velocity of cytoplasmic movement of trophectodermal cells varies depending on the embryo's developmental stage. Namely, the velocity of cytoplasmic movement was higher in E3.5 blastocysts than in E4.5 blastocysts. In addition, the velocity of cytoplasmic movement was higher in polar (8.45 ± 2.64 nm/s in E3.5 and 6.79 ± 1.96 nm/s in E4.5 control embryos) than in mural (6.30 ± 2.30 nm/s in E3.5 and 4.98 ± 1.89 nm/s in E4.5 control embryos) trophectodermal cells. Noteworthy, the depletion of Krt8 and Krt18 increased the velocity of cytoplasmic movement both in the mural and polar trophectodermal cells. However, it appears that changes caused by the depletion of these keratins depend on the embryo's developmental stage. For example, the depletion of Krt18 increased the velocity of cytoplasmic movement in mural trophectodermal cells in E3.5 embryos (9.61 ± 3.80 nm/s), while the depletion of Krt8 - in E4.5 embryos (6.65 ± 2.35 nm/s). In addition, data from our preliminary experiments with in vitro implantation suggested that embryos characterized by the higher cytoplasmic movement velocity were unable to form an outgrowth. The above data suggest that the velocity of cytoplasmic movement depends on the keratin cytoskeleton and probably can be used to predict an embryo’s ability to implant. Limitations, reasons for caution We used mouse embryos, a well-established model of early mammalian embryo development. However, analogous experiments should be repeated on other mammalian species, including humans, if we wish to pursue the possibility that cytoplasmic velocity in trophectodermal cells is an embryo quality marker. Wider implications of the findings Our data indicate that cytoplasmic velocity in trophectodermal cells may be a valuable tool in embryo quality assessment, as it reflects the functionality of the keratin cytoskeleton in embryos as well as correlates with the embryos’ ability to implant. Trial registration number not applicable

UTERINE SCAR IS A RISK FACTOR FOR PLACENTA PREVIA. A CASE CONTROL STUDY

OBJECTIVE: Uterine scar is a risk factor for placenta previa. A case control studyMATERIAL AND METHODS: The study was conducted in Gynae A Unit of Khyber Teaching HospitalPeshawar from June 2021 to November 2021. Sample size 81 was used according to Kelsey samplingformula. Patients were divided into 2 groups. Group A includes 27 patients with placenta previa ascases and group B includes 54 patients admitted as control. An informed consent was taken from thepatients. Secondary risk factors like age, parity, miscarriages, uterine curettage, smoking, history ofmyomectomy, previous cesarean sections and previous history of placenta previa were also evaluated.Other causes of antepartum hemorrhage like placental abruption and bleeding due to local causes andunclassified APH were excluded from the study.RESULTS: A total of 2467 patients were delivered during the study period. Among them 27 presentedas cases of placenta previa and 54 were taken as control with case to control ratio of 1:2. Most commonrisk factor leading to placenta previa was advanced maternal age &gt; 35 years (OR= 5.2, P-value 0.001)followed by previous cesarean section (OR= 2.96, P-value 0.026), history of curettage (OR= 2.29, Pvalue0.095) and history of miscarriage (OR= 2.21 P-value 0.005).CONCLUSION: Uterine scar is a risk factor for placenta previa.

Combined Internal Iliac Artery Ligation, Transverse B-Lynch Suture and Intrauterine Balloon to Control Bleeding from Placenta Accreta during Caesarean Delivery

Introduction and aim: Placenta praevia and accreta are associated with high morbidity and mortality. Bleeding is the sole etiology of both morbidity and mortality. Thus, anti-bleeding measures are mandatory and research continues to search for ideal prophylactic measure. This work was designed to assess the efficacy of bilateral internal iliac artery ligation followed by Transverse B-Lynch compression suturing and intrauterine balloon tamponade as a conservative methods to control placental site bleeding due to placenta praevia accreta.&#x0D; Methodology: The study included 24 pregnant females with placenta praevia accreta who were scheduled for elective cesarean section. All participants were subject to history taking, clinical evaluation and laboratory investigations. Ultrasound examination was carried out for assessment of: Estimated fetal weight, confirmation of gestational age, confirm diagnosis of placenta previa accreta and level of the placental edge in lower uterine segment. Deliveries were scheduled to take place between 36-37 weeks of gestation. The primary outcome was the amount of intra-operative blood loss.&#x0D; Results: Blood loss ranged between 249.29 and 560.43 ml, and there was statistically significant decrease of hematocrit percent and platelets after surgery when compared to corresponding values before surgery. All females need blood transfusion. However, none of them need further surgical intervention or intensive care unit admission.&#x0D; Conclusion: Prophylactic bilateral internal iliac artery ligations before extraction of placenta accreta followed by transverse B Lynch suture and intrauterine balloon tamponade seemed to be an effective and safe technique to reduce intrapartum and postpartum complications, and to avoid emergent peripartum hysterectomy.

Differential Effects of Intrauterine Balloon Tamponade Indications on Postpartum Hemorrhage Outcomes.

ObjectiveTo determine whether the indication of intrauterine balloon tamponade (IUBT) was associated with postpartum hemorrhage (PPH) outcomes.MethodsPatients with PPH who underwent IUBT between January 2013 and November 2021 were included in a cohort study. PPH outcomes in patients who had IUBT for indications of uterine atony were compared to those who had IUBT for indications of placental site bleeding. PPH outcomes included uterine artery embolization (UAE) or hysterectomy after IUBT, estimated blood loss (EBL) after balloon placement, and blood transfusion. Statistical analysis was performed using multivariate logistic regression.ResultsIUBT was performed on 603 cases, with 121 (20.1%) undergoing it for placental site bleeding and 482 (79.9%) for uterine atony. In general, IUBT was a reliable treatment for PPH, but the specific efficacy varied depending on the indication for placement. After controlling for confounding variables, compared to the indication of uterine atony, the indication of placental site bleeding increased the risk of transfusion of ≥4 units of PRBCs (aOR 2.47, 95%CI 1.32–3.98), EBL ≥ 300 ml after IUBT (aOR 3.78, 95%CI 2.22–5.33), and UAE or hysterectomy (aOR 2.52, 95%CI 1.20–6.01), respectively. Other factors associated with adverse PPH outcomes were lower antenatal hemoglobin, higher IUBT volume, longer duration of IUBT and larger shock index values.ConclusionsIUBT was less effective in treating PPH patients with indications of placental site bleeding than with indications of uterine atony. Follow-up monitoring of PPH patients with placental site bleeding should be intensified.

Maternal and child-health outcomes in different endometrial preparation methods for frozen-thawed embryo transfer: a retrospective study

The purpose of this study was to analyse the obstetric outcome after frozen embryo transfer depending on the protocol used. The endometrial preparation during frozen embryo transfer (FET) was performed in the natural cycle (NC) with timing based on monitoring of the naturally occurring luteinizing hormone (LH) peak or in human chorionic gonadotropin (hCG)-triggered modified natural cycles (MNC), artificial cycle (AC) with hormone replacement therapy cycle and cycle with ovulation induction (OI). A retrospective cohort study was conducted between 2018 and 2020. Pregnancy, perinatal complications and neonatal outcomes were compared among patients treated during AC or MNC or OI protocols. After adjusting for the effect of gravidity, parity, pre-pregnancy body mass index (BMI) and number of miscarriages, the AC group had higher but not significantly different rates of gestational hypertension, preeclampsia and intrahepatic cholestasis of pregnancy (ICP) than women in OI and MNC groups. Significant differences were observed in the rates of placental adherence (15.30% in AC vs. 9.24% in MNC, p = 0.004) and postpartum haemorrhage (PPH) (24.33% in AC vs. 13.07% in OI, p = 0.003, 24.33% in AC vs. 16.24% in MNC, p = 0.002) among the three groups. In singletons, significant differences were observed in the rates of placental adherence (14.09% in AC vs. 8.57% in MNC, p = 0.002), AC and MNC groups had higher risk of PPH compared with OI group (18.36% in AC vs. 12.38% in MNC, p = 0.042 and 7.69% in OI vs. 18.36% in AC, p = 0.013). Neonatal outcomes were similar among the three groups except risk of small for date infants (0.35% in AC vs. 1.44% in MNC, p = 0.008). These findings are important in view of increasing use of frozen cycles and new policy of freeze-all cycles in in vitro fertilization (IVF). The results suggest a link between the absence of corpus luteum and adverse obstetric outcomes.

Stillbirth after COVID-19 in Unvaccinated Mothers Can Result from SARS-CoV-2 Placentitis, Placental Insufficiency, and Hypoxic Ischemic Fetal Demise, Not Direct Fetal Infection: Potential Role of Maternal Vaccination in Pregnancy.

Stillbirth is a recently recognized complication of COVID-19 in pregnant women. Other congenitally transmitted infections from viruses, bacteria and parasites can cause stillbirth by infecting fetal organs following transplacental transmission of the agent from the maternal bloodstream. However, recent research on pregnant women with COVID-19 having stillbirths indicates that there is another mechanism of stillbirth that can occur in placentas infected with SARS-CoV-2. In these cases, viral infection of the placenta results in SARS-CoV-2 placentitis, a combination of concurrent destructive findings that include increased fibrin deposition which typically reaches the level of massive perivillous fibrin deposition, chronic histiocytic intervillositis and trophoblast necrosis. These three pathological lesions, in some cases together with placental hemorrhage, thrombohematomas and villitis, result in severe and diffuse placental parenchymal destruction. This pathology can involve greater than one-half of the placental volume, averaging 77% in the largest study of 68 cases, effectively rendering the placenta incapable of performing its function of oxygenating the fetus. This destructive placental process can lead to stillbirth and neonatal death via malperfusion and placental insufficiency which is independent of fetal infection. Fetal autopsies show no evidence that direct infection of fetal organs is contributory. Because all mothers examined have been unvaccinated, maternal vaccination may prevent viremia and consequent placental infection.

Transabdominal amnioinfusion: An evaluation of its adverse events

ObjectiveTransabdominal amnioinfusion is beneficial in oligohydramnios, which has high fetal mortality and does not improve with observation alone. However, there are few reports on the maternal adverse events of transabdominal amnioinfusion. This study aimed to evaluate the adverse events of amniocentesis with transabdominal amnioinfusion. Study designThis study is a retrospective cohort study at a single tertiary perinatal center in Japan. A total of 313 procedures in 126 patients who underwent amniocentesis for transabdominal amnioinfusion at our tertiary perinatal institution were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE). Adverse events were retrospectively examined using a 5-grade evaluation based on the CTCAE. Procedurally, a 21–23-G percutaneous transhepatic cholangiography drainage (PTCD) needle was advanced under ultrasound guidance into the amniotic fluid cavity with a gravity-fed infusion of warm saline solution. ResultsNo maternal deaths were recorded. Only two maternal/fetal adverse events occurred, and grade 4 fetal adverse events requiring pregnancy termination were observed in seven cases. Fetal death occurred in five cases, all with severe oligohydramnios and premature rupture of the membranes. No placental abruption or bleeding occurred before or after delivery. ConclusionAdverse events during transabdominal amnioinfusion were successfully analyzed using CTCAE. We also provided new terminology for evaluating adverse events during amnioinfusion. Our results may encourage obstetricians to perform amnioinfusion in difficult situations, with less concern for severe maternal or fetal adverse events.

Гистероскопическая картина патологии полости матки в позднем послеродовом периоде

Various obstetric and gynecological disorders, such as placental retention, dysfunctional bleeding and endometrial polyps can cause postpartum uterine bleeding. Placental remnants and arteriovenous malformations are often found in uterine bleeding in the late postpartum period. Optimal treatment based on a correct differential diagnosis is necessary. Differential diagnosis of the placental bed made with an ultrasound examination is essential. An ultrasound examination and determination of the chorionic gonadotropin level are the basic steps in the diagnostic. In the absence of massive bleeding, hemodynamic stability of the patient with suspected placental polyp, it is advisable to conduct hysteroscopy for therapeutic and diagnostic purposes. The article presents the advantages of hysteroscopy in this type of pathology and describes a clinical case of a patient with placental remnants.

Management of PPH (Placental Site Bleeding) by a Direct Haemostatic Suture in True PPH during Caesarean section: A New Approach

This study includes 20 cases of PPH seen during Caesarean section by a single surgeon Dr. Sadhna Mathur during the last 11 years where this hemostatic suture was used to control PPH from placental site in uterine cavity, after the medical measures failed to control the bleeding from placental site (uterine cavity). The bleeding point was localized and a haemostatic suture in the overlying uterine musculature was applied. It was found to be completely effective hence it is being shared through this paper

Urological complications in obstetrics

Urinary tract injury is a rare but severe complication during abdominal delivery. Over the past quarter of the last century, the frequency of abdominal delivery in Russia has more than tripled due to the increase in the number of pregnant women at high risk for the development of maternal and perinatal complications. Intraoperative diagnosis of urinary tract injuries allows timely treatment with better postoperative outcomes. Given the high percentage of caesarean sections in many countries, the risk of the above complications remains high. Risk factors for urinary tract injury during cesarean section are an increase in womens average age and body mass index, high parity, the presence of adhesions, prior cesarean section, emergency cesarean section, and cesarean section in the second stage of labor. This article discusses several clinical cases on the development of urological complications in obstetrics and gynecology. Due to modern progress in the field of operative obstetrics, vesicouterine fistulas caused by obstetric causes may not occur as often as in the last century. Nevertheless, even despite this, one should not forget about elementary preventive measures in operative delivery, especially in such obstetric situations as placental ingrowth, bleeding, hematoma, and parametria.

Comparison of Postoperative Pulmonary Outcomes in Patients Undergoing Cesarean Section under General and Spinal Anesthesia: A Single-Center Audit.

Introduction:Regional anesthesia (RA), i.e., spinal or epidural anesthesia when performed for lower segment cesarean section (LSCS) provides excellent surgical conditions, avoiding manipulation of the maternal airway, maternal satisfaction, and good postoperative analgesia. However, in situations like fetal distress (fetal heart rate abnormalities), obstetric indications (abruption of placenta, antenatal placental bleeding, cord prolapse), maternal refusal for RA, contraindications to neuraxial anesthesia (anticoagulation, coagulopathy), and at times failed RA general anesthesia (GA) is administered. Several studies have demonstrated greater mortality and morbidity when LSCS is done under GA when compared to neuraxial block.Methods:After necessary approval, we retrospectively reviewed data over a period of 1 year (January 1, 2020–December 31, 2020) of LSCS under GA versus RA. The aim was to compare immediate postoperative complications, postoperative pulmonary complications up to 4 weeks from the time of elective and emergency LSCS under either RA or GA.Results:Of the 753 patients who underwent LSCS in one calendar year, there were 272 (36.12%) elective and 481 (63.87%) emergency LSCS. The number of elective LSCS under neuraxial block was 219 (29.09%) and under GA were 53 (7.03%). Emergency LSCS done under neuraxial block were 268 (35.59%) and under GA were 213 (28.28%). There were no adverse pulmonary complications at the end of 4 weeks in either group.Conclusion:RA provides maternal satisfaction and excellent perioperative analgesia in LSCS. Safe GA can be achieved with proper airway planning, if case is attended by at least two anesthesiologist with adequate preoperative fasting, and postoperative monitoring.

“Does the use of gestation-specific centiles for cervical length change the management of pregnancies at risk of recurrent spontaneous preterm birth?”

IntroductionPreterm birth is the leading cause of neonatal morbidity and mortality. Spontaneous Preterm Birth (sPTB) has many and varied causes but is known to be strongly associated with a short or shortening cervix in the midtrimester of pregnancy. The strongest risk factor for sPTB is a previous sPTB.In women with a history of sPTB, we can offer surveillance and treatments which have been proven to reduce the risk of sPTB, such as cervical cerclage and vaginal progesterone supplementation. Alongside other indications, we currently use 25 mm or shorter as a “trigger threshold” for offering cervical cerclage treatment in the Preterm Birth Prevention Clinic at The National Maternity Hospital. AimTo determine if using gestation-specific centiles instead of a 25 mm cut-off for cervical length changes the antenatal management of women at high risk of sPTB. MethodThis was a retrospective chart review of all women attending the preterm birth clinic over the 2-year period 2018–2020 in a large tertiary referral unit in Dublin, Ireland. Demographic details, obstetric history, preterm birth risk factors and preventative treatments offered were collected and analysed. Cervical lengths were measured with ultrasound using a standardised protocol and all performed or supervised by 2 experienced sonographers. ResultsA total of 200 patients with known risk factors for sPTB attended the Preterm Birth Surveillance Clinic at the National Maternity Hospital during the study period. Of these, 36/200 (18%) went on to deliver again prior to 37 weeks despite attending the clinic +/- receiving interventions & this group are the focus of this paper. The indications for surveillance in this group that had a recurrent sPTB included recurrent second-trimester pregnancy losses/preterm delivery < 34 weeks (26/36 (72%)), cervical trauma (including treatment of CIN) (12/36 (33%)), congenital abnormalities (1/36 (2.8%)), uterine anomaly (1/36 (2.8%)) and placental bleeding (1/36 (2.8%)). There was one smoker in this series. Funnelling was observed in 3/36 cases (8.3%). Of the 36 patients, an additional 15 would have received a cerclage had gestation-specific centiles, i.e., <5th centile, been used and an additional 10/36 (28%) would have been offered progesterone therapy. ConclusionIn those at high risk of preterm birth, the use of gestation-specific centiles for cervical length increases the proportion of patients that would be eligible for cervical cerclage. It is unclear whether this would change clinical outcome.

Impact of Fusarium-Derived Mycoestrogens on Female Reproduction: A Systematic Review.

Contamination of the world’s food supply and animal feed with mycotoxins is a growing concern as global temperatures rise and promote the growth of fungus. Zearalenone (ZEN), an estrogenic mycotoxin produced by Fusarium fungi, is a common contaminant of cereal grains and has also been detected at lower levels in meat, milk, and spices. ZEN’s synthetic derivative, zeranol, is used as a growth promoter in United States (US) and Canadian beef production. Experimental research suggests that ZEN and zeranol disrupt the endocrine and reproductive systems, leading to infertility, polycystic ovarian syndrome-like phenotypes, pregnancy loss, and low birth weight. With widespread human dietary exposure and growing experimental evidence of endocrine-disrupting properties, a comprehensive review of the impact of ZEN, zeranol, and their metabolites on the female reproductive system is warranted. The objective of this systematic review was to summarize the in vitro, in vivo, and epidemiological literature and evaluate the potential impact of ZEN, zeranol, and their metabolites (commonly referred to as mycoestrogens) on female reproductive outcomes. We conducted a systematic review (PROSPERO registration CRD42020166469) of the literature (2000–2020) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources were primary literature published in English obtained from searching PubMed, Web of Science, and Scopus. The ToxR tool was applied to assess risk of bias. In vitro and in vivo studies (n = 104) were identified and, overall, evidence consistently supported adverse effects of mycoestrogens on physiological processes, organs, and tissues associated with female reproduction. In non-pregnant animals, mycoestrogens alter follicular profiles in the ovary, disrupt estrus cycling, and increase myometrium thickness. Furthermore, during pregnancy, mycoestrogen exposure contributes to placental hemorrhage, stillbirth, and impaired fetal growth. No epidemiological studies fitting the inclusion criteria were identified.