Introduction: Peripartum/postpartum hysterectomy is a rare but life-saving intervention for uncontrolled obstetric hemorrhage.Placenta accreta spectrum (PAS) and uterine atony are the most common indications; yet their clinical context and operative pathways may differ, particularly in centers where PAS is managed under urgent or emergent conditions.We evaluated indications, surgical management, and outcomes over a 10-year period and explored differences between uterine atony-related and PAS-related cases. Material and Methods:This retrospective, single-center study included women who underwent peripartum or postpartum hysterectomy for uncontrolled obstetric hemorrhage between January 2015 and June 2025.Cases were classified as uterine atony or PAS/placenta previa-related hemorrhage based on operative findings, clinical course, and pathology.Continuous variables were summarized as median [interquartile range (IQR)] and compared using the Mann-Whitney U test; categorical variables were compared using Fisher's exact test.Effect estimates with 95% confidence intervals (bootstrap for continuous variables) are provided in the tables; comparisons were exploratory.Results: Among 31,571 deliveries, 34 hemorrhage-related peripartum/postpartum hysterectomies were identified (incidence: 1.1 per 1,000 deliveries): 18 for uterine atony (52.9%) and 16 for PAS-related

OBJECTIVE: To describe the risk factors for emergency obstetric hysterectomy in patients treated in the Gynecology and Obstetrics Department of the "Nicolasa Cruz" National Hospital, Jalapa, from January 2019 to December 2023. METHOD: A retrospective, descriptive study was conducted. The sample consisted of 57 medical records of women who underwent emergency obstetric hysterectomy. A data collection form was used to record relevant information on risk factors, causes of the procedure, complications, and clinical outcomes. RESULTS: Women aged 29 to 32 were the most affected. Obstetric hemorrhage (30 cases) was the main cause, followed by uterine atony (15 cases). Postpartum hysterectomy was the most common, with uterine atony as the main risk factor. The most frequent complications were hemorrhagic shock and postoperative sepsis. The survival rate was 96% (55 cases) and mortality was 4% (2 cases). CONCLUSION: The findings highlight the importance of strengthening prenatal and perinatal care to identify risk factors early. Timely intervention and ongoing training of healthcare personnel in the management of obstetric emergencies can help reduce the need for emergency hysterectomies and their associated complications.

Placenta accreta spectrum (PAS) is a rare yet life-threatening obstetric complication. The primary risk factors include placenta previa and prior cesarean sections. However, high-quality epidemiological and clinical data on PAS remain scarce in China. This study aimed to comprehensively evaluate the clinical characteristics, pathological features, and radiological findings of PAS disorders in Chinese women, while quantifying the predictive value of key risk factors through receiver operating characteristic (ROC) curve analysis and assessing their impact on maternal-fetal outcomes. We conducted a retrospective study comparing clinicopathological and imaging data from 138 pathologically confirmed PAS patients and 276 age-matched controls at an academic women’s hospital in China. Statistical analyses included χ2 tests, logistic regression, and ROC curve evaluation. Magnetic resonance imaging (MRI) demonstrated higher sensitivity than sonography for PAS detection (97.6% vs 68.8%, P < .05). Univariate analysis identified gravidity, parity, prior CS, abortion history, current multiple pregnancy, and placenta previa as significant risk factors (P < .01). Multivariate analysis confirmed multivariate analysis confirmed that increased gravidity, increased parity, current multiple pregnancy, and placenta previa are independent risk factors (P < .05). ROC curve analysis identified placenta previa as the strongest predictor (area under the curve (AUC) = 0.871), followed by increased gravidity (AUC = 0.732) and increased parity (AUC = 0.722). PAS patients had significantly higher rates of postpartum hemorrhage, CS and hysterectomy (P < .001), and adverse neonatal outcomes (perinatal mortality, congenital anomalies, preterm birth, low birth weight, and asphyxia; P < .05). Subgroup analysis revealed grade 3A PAS was most prevalent (89.9%), while grades 3D/3E (2.2% each) showed higher cesarean rates, hysterectomy, newborn asphyxia, and congenital anomalies. Grade 3A was associated with more postpartum hemorrhage and fetal mortality. This study confirms MRI’s superior diagnostic accuracy for PAS (97.6% sensitivity). Placenta previa (AUC = 0.871) emerged as the strongest predictor, with increased gravidity and increased parity as key risk factors. PAS significantly increased maternal (89.9% hemorrhage rate) and neonatal complications, particularly in prevalent grade 3A cases, underscoring the need for early identification and multidisciplinary management in high-risk pregnancies.

Patient: Female, 28-year-oldFinal Diagnosis: Necrotizing fasciitisSymptoms: Septic shock and profuse foul-smelling woun dischargeClinical Procedure: —Specialty: Microbiology and Virology • Obstetrics and GynecologyObjective: Unusual clinical courseBackgroundNecrotizing soft tissue infections, known as NSTIs, are well known for being acute, aggressive, and rapidly progressive and can cause systemic sepsis, toxic shock syndrome, and multi-organ failure. Clinical presentation varies from tense edematous skin to blisters and necrosis. The correlation between necrotizing fasciitis and cesarean section has been reported to be 1.8 per 1000 women, but its pathogenesis is not fully understood.Case ReportWe present a case of a 28-year-old woman who underwent emergency cesarean section and presented 1 week later with septic shock and profuse foul-smelling wound discharge. IV antibiotic therapy began with meropenem, vancomycin, and clindamycin for suspected necrotizing fasciitis. Upon exploration, we found complete uterine dehiscence, necrotizing fasciitis of the anterior lower abdominal wall, and cutaneous fistulation. Emergency hysterectomy, extensive wound debridement, and vacuum-assisted closure (VAC) were performed. Tissue culture revealed methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis. Multiple VAC dressing changes and debridement of the abdominal wall were performed. The histopathology results confirmed a diagnosis of acute suppurative endometritis with bilateral acute salpingitis. The patient was discharged 22 days after exploratory laparotomy.ConclusionsEndomyometritis can lead to severe complications, including uterine dehiscence, with infection rapidly spreading along fascial planes and into subcutaneous tissue, ultimately resulting in necrotizing fasciitis, which is a rare but potentially fatal condition. Management in this case required extensive surgical debridement and emergency postpartum hysterectomy, in addition to broad-spectrum antimicrobial therapy. This case of an uncommon yet life-threatening complication strongly reinforces the critical importance of early diagnosis and prompt management of postpartum endometritis to reduce maternal morbidity and mortality.

BackgroundPregnancy-related sepsis contributes significantly to maternal mortality. While there is substantial information on postpartum hysterectomy, information on outcomes of hysterectomy as source control for puerperal sepsis is limited. Knowledge of the common causative organisms and their antimicrobial sensitivity may assist with targeted antibiotic therapy to improve patient outcomes. This study described the indications and outcomes of surgery in patients following hysterectomy as source control for puerperal sepsis.MethodsIn a retrospective study, we analysed the intra-operative and histological findings and the results of microbial culture and antibiotic sensitivity of women who underwent a hysterectomy for puerperal sepsis at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, from January 2019 to December 2019.ResultsTwenty-nine (88%) of the 33 women with hysterectomy for puerperal sepsis studied had a caesarean section (CS), 14 (48%) of whom had a CS performed for foetal distress. Eight of these 33 women (24%) had hypertensive-related disorders. The most common organisms cultured in the intra-abdominal fluid were Acinetobacter baumannii (n = 11, 26%), E. coli (n = 8, 19%), Klebsiella species (n = 6, 14%) and Enterococcus faecalis (n = 6, 14%) of a total of 42 organisms were identified from all sites. Puerperal sepsis was confirmed in 28 (85%) of the uterine histology samples, with a mortality rate of 6% in this study.ConclusionHysterectomy for puerperal sepsis was most frequently associated with CS, with hypertensive-related disorders the most common indication. Histological confirmation of sepsis is required, as the histological findings differed by 15% with surgical diagnosis.ContributionA. baumannii was the most common species isolated as the cause of infection.

Placenta accreta spectrum (PAS) refers to a group of abnormal placental attachments in which the placenta adheres too deeply to the uterine wall, with varying degrees of invasion classified as accreta, increta, or percreta. Increased rates of uterine surgeries, advanced maternal age, and cesarean deliveries have all contributed to an increase in the incidence of PAS. Complications associated with PAS can lead to severe intrapartum or postpartum hemorrhage, hysterectomy, and significant maternal morbidity, making early diagnosis and management crucial for improving outcomes. Understanding the epidemiology and risk factors of PAS is crucial for developing early detection protocols and preventive strategies. Localized data, particularly from Bahrain, can inform targeted care approaches and optimize resource allocation, ultimately leading to improved clinical guidelines, enhanced patient education, and better healthcare outcomes for affected women. There are growing concerns about the impact of PAS on maternal health and healthcare resources in Bahrain, similar to trends observed in other regions. To improve patient education and management strategies, it is essential to comprehend the regional patterns, characteristics, and outcomes associated with PAS. However, the absence of comprehensive data specific to Bahrain hinders effective clinical decision-making and policy development. Addressing this gap is imperative for advancing maternal healthcare in the region.

Background: Morbidly adherent placenta is a serious obstetric conditions in which placenta abnormally attached to uterus and cannot be separated easily. It is associated with high maternal and fetal complication especially in settings with increasing caesarean section rate and poor antenatal care. Objective: To determine the frequency of feto-maternal outcomes in pregnant women with morbidly adherent placenta. Study Design: Cross sectional study. Duration and Place of Study: This study was carried out from April 2024 to October 2024 in Department of Obstetrics and Gynaecology, Lady Reading Hospital, Peshawar. Methodology: A total of 87 pregnant women aged 18–40 years with diagnosis of morbidly adherent placenta on ultrasonography were included. Patients were followed till delivery and immediate postpartum period. Mean and standard deviation were calculated for numerical variables, while frequencies and percentages were calculated for categorical variables using Statistical Package for Social Sciences version 23. Results: Mean age was 31.62 ± 4.96 years and mean gestational age was 34.74 ± 2.39 weeks. Neonatal intensive care unit admission was seen in 34(39.1%) cases. Fetal growth restriction was observed in 20(23.0%) cases, while intrauterine fetal demise was noted in 3(3.4%) cases. Postpartum haemorrhage occurred in 40(46.0%) women. Hysterectomy was performed in 62(71.3%) patients. Conclusion: Morbidly adherent placenta is associated with high maternal and fetal morbidity. Postpartum haemorrhage and hysterectomy were most common maternal complications.

Placenta accreta spectrum (PAS) involves abnormal placental attachment and can lead to severe complications such as postpartum hemorrhage and hysterectomy. Ultrasound is the main tool used to screen for PAS due to its non-invasive nature and convenience, although its accuracy depends on the skill of the operator. Magnetic Resonance Imaging has emerged as a supplementary tool, especially for complex cases or posterior placentas, providing more accurate anatomical detail and enabling the invasion depth and location to be assessed. This review summarizes recent advances in prenatal imaging for PAS, aiming to improve diagnostic accuracy and guide future research.

Obstetric patient blood management (PBM) strategies were used at Corniche Hospital in 2018, initially focusing on minimizing bleeding, with other clinical strategies implemented incrementally. This study assesses program outcomes in patients with major obstetric hemorrhage of 2000 mL or greater. A retrospective study of 353 women admitted to The Corniche Hospital between 2018 and 2023 who experienced major obstetric hemorrhage of 2000 mL or greater. The primary outcome measure was units of red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused. Secondary outcomes included pretransfusion hemoglobin in patients with no active bleeding, hemoglobin levels 3 weeks postdischarge, anemia predelivery, blood product-acquisition cost savings, mortality, composite morbidity (transfusion reaction, acute lung injury, thrombosis, sepsis, postpartum hysterectomy), hospital and high-dependency unit length of stay, and all-cause emergency readmissions within 28 days. Comparing baseline (2018) with the final year (2023), the mean units of RBCs, FFP, and platelets transfused per admission decreased from 4.18 to 0.67 ( P -trend <.001), resulting in blood acquisition savings of US$ 175,705. Over the same period the percentage of women anemic predelivery decreased from 40.3% to 23.8% ( P -trend = 0.015) and the mean pretransfusion hemoglobin level in nonactively bleeding patients decreased from 7.54 g/dL to 6.35 g/dL ( P -trend < .001). The mean hemoglobin rise 3 weeks postdischarge increased from 2.41 g/dL in 2018 to 4.26 g/dL in 2023. There were no changes in adjusted composite morbidity, hospital, or high-dependency unit length of stay. In women with a major obstetric hemorrhage of 2000 mL or greater, the implementation of an obstetric PBM program was associated with reduced blood product utilization, reduced costs, reduced anemia, and increased hemoglobin rise postdischarge.

Bleeding before (antepartum) and after (postpartum) delivery remains a major contributor to perinatal mortality and maternal morbidity worldwide. Placenta accreta is a cause of maternal morbidity and mortality, recently becoming the most common reason for emergency postpartum hysterectomy. A 35-year-old woman weighing 55 kg, height 151 cm, G3P1101Ab000 at a gestational age of 34-36 weeks, with a history of antepartum bleeding and suspicion of placenta accreta from the ultrasound, is scheduled for pregnancy termination via cesarean section. Before the surgery, a transarterial balloon catheter is inserted, and the estimated blood loss during the operation is around 10,000 ml. In this patient, the choice of general anesthesia is made considering the history of third-trimester bleeding, a high probability index score of 51% for accreta, and the plan for hysterectomy, leading to an anticipated prolonged operation time. Additionally, the risk of significant bleeding during the surgery prompts the selection of general anesthesia for hemodynamic management, and the placement of a catheter balloon is done to anticipate massive bleeding. To obtain a more comprehensive comparison and understanding of estimated blood loss, a comparison with other cases involving catheter balloon procedures before or after surgery is needed.

Abstract Disclosure: E. Ahsan: None. F.F. Foo: None. C. Lesniak: None. M. Akula: None. K. Hu: None. R. Ong: None. K. Chalasani: None. J. Cheng: None. S. Holland: None. Introduction: Postpartum pituitary necrosis, commonly known as Sheehan syndrome (SS), is the term used to describe the necrosis of anterior pituitary gland cells that occurs after significant postpartum bleeding, hypovolemia, and shock. This typically occurs after delivery, during which the mother suffers significant blood loss. The pituitary gland fails to produce hormones due to this blood loss. Depending on the degree of tissue damage, SS can have an acute or chronic course, and patients may present with a wide range of clinical symptoms at diagnosis. Acute SS is associated with postpartum pituitary infarction, which can result in hypotension, shock, hypoglycemia, hyponatremia, headache, vision disturbances, unconsciousness, and an inability to lactate. We present a rare case of SS where the patient experienced hypertension instead of classic hypotension due to postpartum preeclampsia. Clinical Case: A 40-year-old female with no significant medical history presented to the hospital for scheduled induction of labor for polyhydramnios and underwent vacuum-assisted vaginal delivery and postpartum hysterectomy due to severe postpartum hemorrhage secondary to DIC. The postpartum course was also complicated by preeclampsia with severe features. Patients developed features like excessive fatigue, hypoglycemia, hyponatremia, hypothyroidism, polyuria, and failure of lactation, which were consistent with panhypopituitarism secondary to Sheehan syndrome. However, the patient was hypertensive to 145/91 before steroids were given. Labs were significant for serum sodium 116 mmol/L (135-145 mmol/L), FSH &amp;lt;0.7 mIU/mL (Follicular Phase: 2.5-10.2, Mid-cycle Peak: 3.1-17.7, Luteal Phase: 1.5-9.1, Postmenopausal: 23.0-116.3), LH &amp;lt;0.2 mIU/m (Follicular Phase: 1.9-12.5, Mid-Cycle Peak: 8.7-76.3, Luteal Phase: 0.5-16.9, Postmenopausal: 10.0-54.7), Prolactin: 2.4 ng/mL (Non-pregnant: 3.0-30.0, Pregnant: 10.0-209.0, Postmenopausal: 2.0-20.0), PM Cortisol on admission: 1.10 ug/dL (3.44-16.76 ug/dL), plasma ACTH 7 pg/mL( 6 - 50 pg/mL), TSH 0.430 uIU/mL (0.550 - 4.780 uIU/mL), FT4 0.59 ng/dL - 1.76 ng/dL). MRI of the brain pituitary showed- A 1.5 cm region of hypoenhancement and an additional 2 mm focus of hypoenhancement in the sella, findings represent evolving pituitary necrosis. The patient received 24 units of blood transfusion and hormone replacement therapy, followed by outpatient endocrinology follow-up. Clinical lessons: Although considerable blood loss causes hypotension in patients with SS, additional postpartum medical issues can sometimes result in atypical presentations. In our patient, postpartum preeclampsia caused hypertension. Identifying the atypical symptoms of SS is just as vital as identifying its typical features to prevent potentially fatal consequences. Presentation: 6/2/2024

Increasing availability of immediate postpartum long-acting reversible contraception (LARC) has added contraceptive alternatives to bilateral tubal ligation (BTL) in the immediate postpartum period. The resultant access to long-term contraception has provided patients with improved control over the timing of pregnancies. Our objective is to evaluate changes in the utilization of immediate postpartum contraceptive methods over a 10-year period and its association with interpregnancy interval (IPI). Retrospective cohort study of 36,445 patients delivered at a single academic hospital center from 2012 to 2020. Deliveries <23 weeks gestation and patients who underwent a cesarean hysterectomy or postpartum hysterectomy for obstetric indications were excluded. The primary outcome was the utilization of postpartum BTL, intrauterine devices, contraceptive implants, and Depo-Provera over the study time period. The secondary outcomes were IPI and interdelivery interval (IDI). Outcomes were compared using appropriate tests of trend. We adjusted for significant covariates as assessed in baseline characteristics. A total of 35,281 patients were included in our study. Groups were different in baseline characteristics including age, race/ethnicity, parity, BMI, insurance status, comorbidity risk, and attendance at postpartum exam. Over the study period, there was a significant difference in utilization of Depo-Provera, LARC, intrauterine device (IUD), and implant (p < 0.001). There was a significant increase in IPI (p < 0.001) and IDI (p < 0.001). We observed a significant increase in utilization of immediate postpartum LARC over the study period which corresponded to a significant increase in IPI and IDI. Our findings emphasize the importance of the availability of immediate postpartum contraception as well as its effectiveness in improving family planning options for reproductive-aged patients. We found significantly increased IPI and IDI associated with increased utilization of long-acting reversible contraceptives immediately postpartum. Our findings emphasize the importance of providers offering these options to patients as well as being comfortable initiating immediate postpartum contraception. · Immediate postpartum LARC access has increased over the past 10 years.. · Access to more methods of contraception allows patients more options for family planning.. · Increased utilization of LARC led to increased IPI and IDI..

To develop and validate a nomogram model that combines radiomics features, clinical factors, and coagulation function indexes (CFI) to predict intraoperative blood loss (IBL) during cesarean sections, and to explore its application in optimizing perioperative management and reducing maternal morbidity. In this retrospective consecutive series study, a total of 346 patients who underwent magnetic resonance imaging (156 for training and 68 for internal test, center 1; 122 for external test, center 2) were included. IBL+ was defined as more than 1000mL estimated blood loss during cesarean sections. The prediction models of IBL were developed based on machine-learning algorithms using CFI, radiomics features, and clinical factors. ROC analysis was performed to evaluate the performance for IBL diagnosis. The support vector machine model incorporating all three modalities achieved an AUC of 0.873 (95% CI 0.769-0.941) and a sensitivity of 1.000 (95% CI 0.846-1.000) in the internal test set, with an AUC of 0.806 (95% CI 0.725-0.872) and a sensitivity of 0.873 (95% CI 0.799-0.922) in the external test set. It was also scored significantly higher than the CFI model (P = 0.035) on the internal test set, and both the CFI (P = 0.002) and radiomics-CFI models (P = 0.007) on the external test set. Additionally, the nomogram constructed based on three modalities achieved an internal testing set AUC of 0.960 (95% CI 0.806-0.999) and an external testing set AUC of 0.869 (95% CI 0.684-0.967) in the pregnant population without a pernicious placenta previa. It is noteworthy that the AUC of the proposed model did not show a statistically significant improvement compared to the Clinical-CFI model in both internal (P = 0.115) and external test sets (P = 0.533). The proposed model demonstrated good performance in predicting intraoperative blood loss (IBL), exhibiting high sensitivity and robust generalizability, with potential applicability to other surgeries such as vaginal delivery and postpartum hysterectomy. However, the performance of the proposed model was not statistically significantly better than that of the Clinical-CFI model.

In Croatia, the model of obstetrics-midwifery management of childbirth in maternity hospitals is still in effect, and this is how > 99% of Croatian women give birth. However, in my view, midwives are still not sufficiently educated for completely independent work notwithstanding their university education. The Law on Midwifery defined the role of the midwife in home birth without, however, setting out other organisational-communication and professional provisions. Then it began with sporadic midwifery home births of a few per year, which grew quite rapidly, especially with the impact of the Covid-19 virus pandemic, to about 100 out of a total of about 38,000 births that are performed annually in the Republic of Croatia in maternity hospitals. Since the start of planned home births many bad perinatal outcomes have been recorded in hospital maternity wards who have admitted women after such deliveries. These include puerperal sepsis, protracted labour of several days, neglected protracted labour with perinatal asphyxia and aspiration of meconium amniotic fluid and resuscitation of the newborn (who later developed cerebral palsy), severe postpartum haemorrhage with obstetric shock and postpartum hysterectomy, episiotomy infection, and stillbirth at term pregnancy. Therefore, planned home birth in Croatia should now be regarded as an unsafe birth in extraordinary circumstances and the person who takes charge of it must be professionally prepared, educated and have numerous social skills. Most Croatian gynaecologists and obstetricians give support to midwives in their efforts to be professional and independent when at work, including the controlled and legal implementation of the planned home birth. We unreservedly support self-aware midwives to maintain their profession as highly ethical and professional as possible above the wishes of non-professionals who call for autonomy, so that we do not have to discuss such problems of malpractice of Croatian midwifery in the 21st century.

The World Health Organization (WHO) is concerned about the risks faced by mothers dur-ing pregnancy and childbirth in India, especially the high rate of emergency postpartum hys-terectomies.In low-and middle-income countries, around 21 million pregnancies occur among adolescents aged 15-19 annually, with half of them unintended, resulting in approximately 12 million births.To address these issues, a groundbreaking solution has been proposeda wearable belt integrated with AI and IoT technologies.This innovative system continuously monitors vital health parameters of expectant mothers, analyzes the data, and transmits it to ThingSpeak, an IOT-based cloud platform.The development includes machine learning models for fetal heart classification and identifying various risks during pregnancy, providing crucial insights into the wellbeing of both mother and child.The proposed system uses sensors like accelerometers and pulse sensors to track the baby's movements and heart rate.This helps overcome accuracy issues of traditional monitors for fetal movement, challenges pregnant women face with in-person monitoring, and limitations in monitoring duration with devices like ultrasonic Doppler imaging.This approach, focusing on the entire pregnancy journey, supports the goal of achieving Sustainable Development Goals (SDGs) for maternal and newborn health.The new technology not only addresses current problems but also lays the foundation for a comprehensive and data-driven strategy to improve the health of both mothers and newborns.This contributes to global efforts for a healthier and more sustainable future.

Objective: To find out the frequency of placenta previa and maternal and fetal outcomes in cases of placenta previa in our population. Methods: All women with an age range from 18-40 years diagnosed with placenta previa based on ultrasound were recruited with the study. Data including patient age, parity, previous normal deliveries, previous caesarian sections, grade of the placenta previa and history of previous pregnancies was recorded. Maternal complications including post-partum haemorrhage, hysterectomy and death were also recorded. Fetal complications including low APGAR score at five minutes, low birth weight and death were also recorded. Results: The age group between 26-35 years seems to have the highest incidence of placenta previa (62.58%). Post-partum haemorrhage was seen in 57 (38.77%) patients. Post-partum haemorrhage was strongly associated with the grade of placenta previa. Emergency obstetric hysterectomy was done in 7 (4.76%) patients. Two (1.36%) patients died of complications. Out of 147, 38 (25.85%) had low APGAR scores, 52 (35.37%) had low birth weight and 12 (8.16%) died of various complications. Conclusion: Placenta previa has become a very common condition which may be attributable to higher rates of caesarians. It may lead to increased morbidity and mortality of the mother and the baby if not diagnosed and managed properly. These cases should be managed by experienced multidisciplinary teams in a tertiary care centre to minimize the rate of complications. Keywords: APGAR score, Intrauterine growth retardation,Neonatal, Placenta previa, Postpartum haemorrhage

To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH). A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight. The histologically-based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34-8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38-24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08-10.31, P = 0.036), urgent/emergency C-section (OR: 24.15, 95% CI: 2.60-223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48-16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05-12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32-11.02, P = 0.013). In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.

Introduction Placenta accreta is an important factor responsible for maternal morbidity and mortality and is commonly associated with emergent postpartum hysterectomy. The precise prenatal diagnosis of affected pregnancies allows optimal obstetric management. Ultrasonography (USG) and magnetic resonance imaging (MRI) are the only diagnostic modalities available for the prenatal diagnosis of placenta accreta. Objective This study aims to evaluate the accuracy of USG and MRI in diagnosing adherent placenta. Methods Thirty females with placenta previa or a history of previous cesarean sections were evaluated with USG at 28-30 weeks, followed by MRI. The findings of USG and MRI were compared with the intra-operative findings (gold standard) as determined at surgery and by pathological examination. Results Abnormal bridging vessel (n = 24; 80%) was the most common finding seen on USG, whereas abnormal bulge (n = 22; 73.3%) and heterogenous placenta (n = 21; 70%) were the most common findings seen on MRI. The sensitivity of USG and MRI was in the range of 86.7%-92.9% and 92.9%-100%, respectively, in diagnosing three types of adherent placenta. The positive predictive values (PPV) of USG and MRI were in the range of 86.7%-86.7%and93.8%-100%, respectively, in diagnosing three types of adherent placenta. The accuracy of USG and MRI was in the range of 86.7%-96.7% and 96.7%-100%, respectively, in diagnosing three types of adherent placenta. Conclusion MRI helps to accurately classify placental invasion according to depth, as can be seen from the results of the present study, where the MRI technique was more accurate in diagnosing three types of adherent placenta.

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.

Clinical Risk Factors for Placenta Accreta or Placenta Percreta: A Case-Control Study