Removal Of Placenta Research Articles

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls.

Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance. Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section. Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at least one prior cesarean section were included in the study. Following imaging features were evaluated: (1) gray scale covering intraplacental lacunae, disruption of uterovesical interface, myometrial thinning, loss of retroplacental clear space, and focal exophytic masses; and (2) color Doppler covering intraplacental lacunar flow, hypervascularity of uterine serosa–bladder wall interface, and perpendicular bridging vessels between placenta and myometrium. Study Design Present study is a prospective one in a tertiary care hospital. Results Of the 19 PAS cases, 18 were correctly diagnosed on ultrasonography (USG) and confirmed either by histopathological analysis of hysterectomy specimen or per-operatively due to difficulty in placental removal. PAS was correctly ruled out in 27 of 31 patients. The diagnostic accuracy of USG was 90%. The sensitivity, specificity, positive, and negative predictive values were 94.7, 87.1, 81.8, and 96.4%, respectively. Conclusion Ultrasound is indispensable for the evaluation of pregnant patients. It is an important tool for diagnosing PAS, thereby making the operating team more cautious and better equipped for difficult surgery and critical postoperative care. It can be relied upon as the sole modality to accurately rule out PAS in negative patients, thereby obviating unnecessary psychological stress among patients due to possible hysterectomy.

The consequences of fetal reduction for quintuplets after ICSI-ET

A 30-year-old primigravida who conceived following ICSI (Intra Cytoplasmic Sperm Injection) was admitted at 34 weeks of pregnancy with singleton fetus in breech presentation with Gestational diabetes and Gestational hypertension. To start with Quintuplets were diagnosed and she underwent fetal reduction of 3 foetuses at 14 weeks of pregnancy. Follow up USG revealed only one live fetus after one week. At LSCS (Lower Segment Caesarean Section) performed at 37 weeks, the placenta was found to be adherent and was manually removed. There was profuse bleeding after removal of placenta which was not controlled with uterine massage and uterotonics. Placental examination showed 3 fetus payraeceae. Intrauterine examination revealed an adherent fetus which was removed following which the haemorrhage stopped. In pregnancies following fetal reduction, postpartum haemorrhage can result due to retained fetus papyraceus and hence it is essential to make sure all papyraceae were removed.

THE EFFECTIVENESS OF MISOPROSTOL COMPARES TO OXYTOCIN IN MANAGEMENT OF RETAINED PLACENTA: AN EVIDENCE-BASED CASE REPORT

ABSTRACT
 Introduction: Retained placenta is one of major cause for postpartum haemorrhage. Various medication and routes of administration have been reported to increase spontaneous placenta delivery and prevent manual removal of placenta. Purpose of the study to compare the outcome between misoprostol and oxytocin in management of retained placenta.
 
 Method: literature searching was done in 4 databases (Pubmed, EbscoHost, Cochrane and Scopus) with specific keywords, continued with article selection and critical appraisal. 
 
 Result: 5 randomized controlled trial articles were found match to eligibility criteria. 3 of 5 studies found that spontaneous placental delivery occurred more in misoprostol group than oxytocin group. Based on 2 studies, the NNT value of misoprostol are 3 compare to oxytocin group. 2 other studies found that no significant differences of spontaneous delivery of placenta in misoprostol and oxytocin group. 2 studies found that misoprostol had shorter time for spontaneous placenta delivery. However, 2 other studies also found that misoprostol had longer time for spontaneous delivery. 1 study also found that Misoprostol group have less blood loss than oxytocin group.
 
 Conclusion: administration of misoprostol has better outcome in induce spontaneous placenta delivery, time needed for delivery and less blood loss volume compared to oxytocin.
 
 Keywords: misoprostol; oxytocin; prolonged third stage labour; retained placenta

Risk Factors for Postpartum Hemorrhage in a Thai-Myanmar Border Community Hospital: A Nested Case-Control Study.

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

Collection of umbilical cord blood and the risk of complications in postpartum women after natural labour in the context of the possibility of umbilical cord stem cells usage in clinical practice.

Comparison of changes in peripheral blood venous morphology and the frequency of select complications in patients who underwent umbilical cord blood collection during the third stage of labour by in the utero method compared to patients who did not undergo this procedure. Presentation of current therapeutic possibilities of cord blood stem cells. The study involved 248 patients who had a vaginal delivery and had umbilical cord blood taken by in utero method during the third stage of labour. The control group consisted of the first 400 patients who gave vaginal delivery starting in 2019. Each patient had a venous peripheral blood count taken before delivery and 18 hours after delivery. Changes in the results of laboratory tests and the occurrence of adverse outcomes, such as postpartum curettage, postpartum haemorrhage and manual removal of placenta, in the 3rd and 4th stage delivery periods, were analysed. In the blood donor group there were significantly lower haemoglobin (11.32 g/L vs 11.61 g/L, p = 0.004) and haematocrit (32.83% vs 33.82% p = 0.001) concentrations after delivery. Umbilical cord donors had a greater difference in haemoglobin (postpartum minus prepartum) (-1.4 g/L vs -0.9 g/L, p = 000), and haematocrit (-4.05% vs -2.5% , p = 0.000). The study group had a higher percentage of patients with postpartum anaemia (haemoglobin concentration < 10 g/L) (15.9% vs 10.64%, p = 0.05), but the result were borderline significant. The groups did not differ in terms of the percentage of postpartum curettage, PPH, manual removal of placenta, percentage of severe anaemia (Hb < 7g/L) or transfusion requirement. Collection of umbilical cord blood during the 3rd stage of labour using the in utero method is associated with a statistically significant increase of blood loss and a higher probability of postpartum anaemia. The observed changes are minor and may have little clinical significance in otherwise healthy patients.

A scoping review of maternal antibiotic prophylaxis in low- and middle-income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection.

Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. A scoping review comparing peripartum prophylactic antimicrobial use in low- and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourth-degree perineal tears. Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed. Of 1886 studies, 27 studies from 13 countries involving 43774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist. Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.

A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum.

IntroductionManagement options for women with placenta accreta spectrum (PAS) comprise termination of pregnancy before the viable gestational age, leaving the placenta in situ for subsequent reabsorption of the placenta or delayed hysterectomy, manual removal of placenta after vaginal delivery or during cesarean section, focal resection of the affected uterine wall, and peripartum hysterectomy. The aim of this observational study was to describe actual clinical management and outcomes in PAS in a large international cohort.Material and methodsData from women in 15 referral centers of the International Society of PAS (IS‐PAS) were analyzed and correlated with the clinical classification of the IS‐PAS: From Grade 1 (no PAS) to Grade 6 (invasion into pelvic organs other than the bladder). PAS was usually diagnosed antenatally and the operators performing ultrasound rated the likelihood of PAS on a Likert scale of 1 to 10.ResultsIn total, 442 women were registered in the database. No maternal deaths occurred. Mean blood loss was 2600 mL (range 150‐20 000 mL). Placenta previa was present in 375 (84.8%) women and there was a history of a previous cesarean in 329 (74.4%) women. The PAS likelihood score was strongly correlated with the PAS grade (P < .001). The mode of delivery in the majority of women (n = 252, 57.0%) was cesarean hysterectomy, with a repeat laparotomy in 20 (7.9%) due to complications. In 48 women (10.8%), the placenta was intentionally left in situ, of those, 20 (41.7%) had a delayed hysterectomy. In 26 women (5.9%), focal resection was performed. Termination of pregnancy was performed in 9 (2.0%), of whom 5 had fetal abnormalities. The placenta could be removed in 90 women (20.4%) at cesarean, and in 17 (3.9%) after vaginal delivery indicating mild or no PAS. In 34 women (7.7%) with an antenatal diagnosis of PAS, the placenta spontaneously separated (false positives). We found lower blood loss (P < .002) in 2018‐2019 compared with 2009‐2017, suggesting a positive learning curve.ConclusionsIn referral centers, the most common management for severe PAS was cesarean hysterectomy, followed by leaving the placenta in situ and focal resection. Prenatal diagnosis correlated with clinical PAS grade. No maternal deaths occurred.

The routine use of prophylactic Bakri balloon tamponade contributes to blood loss control in major placenta previa.

To verify the blood loss control effect of routine prophylactic Bakri balloon tamponade on major and minor placenta previa (PP). We conducted a retrospective cohort study of all singleton pregnancies that involved cesarean section (CS) for PP at our hospital. All participants were divided into Bakri balloon (underwent routine prophylactic use just after placenta removal) and non-balloon groups, and into major and minor PP groups. Clinical outcomes in major and minor PP were compared between balloon and non-balloon groups. The balloon and non-balloon groups contained 74 and 89 patients, respectively. There were 41 and 33 (balloon group) and 48 and 41 (non-balloon group) major and minor PP cases, respectively. Intraoperative and perioperative blood losses of major PP were significantly lower in the balloon group than the non-balloon group (1045ml versus 1553ml, P=0.016; and 1189ml versus 1810ml, P=0.006, respectively). The frequency of massive postpartum hemorrhage (>500ml) with major PP was lower in the balloon group than in the non-balloon group (2.4% versus 16.7%, P=0.027), but with no significant difference with minor PP. Routine prophylactic use of Bakri balloon tamponade during and after CS is effective in controlling blood loss in major PP.

Treatment protocols and management of retained fetal membranes in cattle by rural practitioners in Belgium

Retained fetal membranes (RFM) is a frequent postpartum disorder in cattle causing considerable economic losses, and a common indication for antibiotic (AB) administration. There is controversy with regard to the treatment of RFM, and scientific recommendations are often in conflict with current legislation on AB use and practical routines in the field.The aim of this study was to assess the therapeutic approaches of RFM by Belgian rural veterinarians. A digital survey was sent to 468 Belgian veterinarians; 149 complete questionnaires (Wallonia: 78; Flanders: 71) were obtained. Survey questions captured socio-demographic characteristics, case definition, therapeutic approaches and treatment options for RFM. Questions on treatment were duplicated for dairy and beef cattle.When confronted with dairy cows suffering from RFM without fever, 35.6 % of vets do not treat with AB, while the majority administers AB, either intrauterine (47.6 %), systemically (10.7 %) or both (6.1 %). Dairy cows with RFM and fever receive a systemic (33.5 %), intrauterine (2.7 %) or combined (61.8 %) AB treatment. For a beef cow with RFM without fever, 21.5 % of vets prefer no AB treatment, while others prefer an intrauterine (24.2 %), systemic (24.8 %), combined (29.5 %) AB treatment. Beef cows with RFM and fever receive AB from the large majority of vets, by systemic (34.9 %) or combined (56.3 %) administration. In case of a parenteral treatment, benzylpenicillin, amoxicillin and ampicillin are by far the most frequently used molecules; only a minority of vets use cephalosporins. Manual placental removal is attempted by 93.9 % of the respondents.These results demonstrate that there is room for improvement when considering the treatment protocols of RFM. Many veterinarians use AB in RFM cows not presenting symptoms of general illness, or administer intrauterine AB in cows with or without clinical signs of illness. Concerning the molecules of choice, practical routines are largely in line with national AB recommendations. Beef cows suffering from RFM are treated more rigorously than dairy cows, regardless of their rectal temperature.

Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life.

To compare intramuscular oxytocin, Syntometrine® and carbetocin for prevention of postpartum haemorrhage after vaginal birth. Randomised double-blinded clinical trial. Six hospitals in England. A total of 5929 normotensive women having a singleton vaginal birth. Randomisation when birth was imminent. Primary: use of additional uterotonic agents. Secondary: weighed blood loss, transfusion, manual removal of placenta, adverse effects, quality of life. Participants receiving additional uterotonics: 368 (19.5%) oxytocin, 298 (15.6%) Syntometrine and 364 (19.1%) carbetocin. When pairwise comparisons were made: women receiving carbetocin were significantly more likely to receive additional uterotonics than those receiving Syntometrine (odds ratio [OR] 1.28, 95% CI 1.08-1.51, P=0.004); the difference between carbetocin and oxytocin was non-significant (P=0.78); Participants receiving Syntometrine were significantly less likely to receive additional uterotonics than those receiving oxytocin (OR 0.75, 95% CI 0.65-0.91, P=0.002). Non-inferiority between carbetocin and Syntometrine was not shown. Use of Syntometrine reduced non-drug PPH treatments compared with oxytocin (OR 0.64, 95% CI 0.42-0.97) but not carbetocin (P=0.64). Rates of PPH and blood transfusion were not different. Syntometrine was associated with an increase in maternal adverse effects and reduced ability of the mother to bond with her baby. Non-inferiority of carbetocin to Syntometrine was not shown. Carbetocin is not significantly different to oxytocin for use of additional uterotonics. Use of Syntometrine reduced use of additional uterotonics and need for non-drug PPH treatments compared with oxytocin. Increased maternal adverse effects are a disadvantage of Syntometrine. IM carbetocin does not reduce additional uterotonic use compared with IM Syntometrine or oxytocin.

Helpful viability of post calving tonic for the treatment of post calving complications in dairy animals.

Objectives:Aimless use of anti-microbials for the treatment of uterine diseases has driven the rise of safe strains. Subsequently, within the current consider, the viability of post calving tonic (PCT) was assessed in vivo for the treatment of post calving complications in dairy cattle.Materials and Methods:The placentas of 10 chosen post-calved dairy animals with a history of postpartum complications primarily held placentas were drenched with PCT 250 ml twice a day for 2 successive days. The evaluation parameters, viz., time taken for removal of lochia, placenta, involution of the uterus and estrus come back time, body condition score, and milk yield have been analyzed to assess the efficacy of PCT in post calved dairy bovines.Results:The results depicted that following the administration of PCT, the mean time taken for expulsion of uterine discharge (lochia), placenta, time taken for the involution of the uterus, and estrus come back time was 86 and 10 h, 30 and 36 days, respectively. Additionally, the administration of PCT 250 ml twice daily for 2 consecutive days to the post-calved dairy cows caused a significant increase (p < 0.05) in milk yield.Conclusion:It was apparent that PCT encourages the unconstrained removal of held placenta through its ecbolic movement and advances uterine discharge exercises. In addition, PCT supplementation caused augmentation of milk yield in post calved dairy cows.

Availability, utilization and quality of emergency obstetric care services in Sousse, Tunisia.

Introductionemergency obstetric care (EmOC) is a high-impact priority intervention strongly recommended for improving maternal health outcomes. The objectives of this study were to assess the availability, utilization, and quality of emergency obstetric care services in the Governorate of Sousse (Tunisia).Methodsa cross-sectional study was conducted among public health facilities which performed deliveries in Sousse in 2017. Data were collected by consulting clinical records and registers and interviewing staff using WHO EmOC tools. Emergency obstetric care (EmOC) indicators were calculated.Resultsonly the University maternity Unit functioned as full comprehensive EmOC facility. No other public facility provided all the 7 Basic EmOC signal functions 3 months prior to the survey. The unperformed signal functions were: administration of parenteral antibiotics, manual removal of placenta and assisted vaginal delivery. The number of EmOC facilities was 0.72 per 500,000 inhabitants. The met need for EmOC was 89.5%. The proportion of caesarean section was 24.2%. The direct obstetric case fatality rate was 0.159% and intrapartum and very early neonatal death rate was 0.65%.Conclusionraising maternity facilities to a minimum level of basic EmOC status would be a major contributing step towards maternal mortality reduction.

Spontaneous Separation Versus Manual Removal of Placenta During Elective Cesarean Section Regarding Blood Loss

Background: Cesarean section (CS) rates have increased; this is especially concerning in developing countries. The mode of placental delivery contributes to morbidity associated with CS, and determines blood loss during CS. Objective: The aim of the work was to compare spontaneous placental delivery with cord traction and manual removal of placenta as regards amount of blood loss during elective cesarean section. Patients and Methods: This prospective Cohort study included a total of 48 Women prepared for elective cesarean section, attending at Zagazig University Hospitals and Zagazig General Hospital. This study was conducted between April 2019 to October 2019. The included subjects were divided into two groups (24 each) regarding methods of placental delivery. Group A; placenta was allowed to be separated spontaneously and removed by gentle cord traction. Group B; placenta was removed manually by the surgeon’s hand introduced into the uterine cavity and cleavage plane was created between the placenta and decidua basalis following which the placenta was grasped and removed. With the use of oxytocin by intravenous infusion 20 units after delivery of the baby in both groups. Results: Blood loss in spontaneous placental separation group was (881.67 ± 74.54) ml, but in manual placental separation group was (962.79 ± 116.11) ml, (p < 0.01).The preoperative hemoglobin (g/dl) in spontaneous separation group was (11.3 ± 1.07) and in manual separation group was (11.63 ± 1.11), postoperative hemoglobin in spontaneous separation group was (10.3 ± 0.83) and in manual separation group was (9.42 ± 0.74). Conclusion: Manual removal of placenta only seems to be superior in saving the time taken to extract out placenta. Manual removal of placenta adds to the post-operative complications in form of greater blood loss and infections.

Management of Placenta Previa with Accreta: A Case Series in Public Tertiary Care Hospital

Placenta previa with accreta is a rare cause of major obstetric hemorrhage resulting in maternal morbidity and mortality. A case series of 08 patients of placenta previa with accreta presented at Abbasi Shaheed hospital Gynecology unit 1 from January 2018 to December 2018. Seven (07) patients were delivered by Caesarean Section and one vaginally. In 05 patients placenta was left in situ and injection methotrexate was given. Removal of placenta during Lower Segment Caesarean Section (LSCS) and bilateral internal iliac artery ligation was done in 02 cases. Febrile illness occurred in 02 patients. One patient required laparotomy on fifteenth postoperative day due to uterine scar dehiscence. Two cases required obstetrical hysterectomy due to torrential hemorrhage. Conservative management in women with placenta previa with accreta has proven to be successful in carefully selected cases at tertiary care hospital with multi-disciplinary team.

A randomized clinical trial to compare the effectiveness of two different doses of intravenous Nitroglycerine for manual removal of placenta

Introduction: After the birth of the baby if the placenta is not expulsed within 30 minutes of the delivery, it is termed as retained placenta. The incidence of retained placenta is 2% of deliveries world-wide and is an important cause for maternal mortality and morbidity. Nitroglycerine (NTG) is an organic nitrate that relaxes smooth muscles and produces a generalized vasodilatation. As it relaxes the smooth muscle, it is also used as a uterine relaxant for manual placental removal. Aims and Objectives: To know the efficacy and safety of intravenous NTG in manual removal of placenta and to know the hemodynamic effects during the procedure. Materials and Methods: Total number of patients included in this study were 40. Patients were divided in two groups, each group having 20 patients each. Group 1 patients were administered with 100 microgm of NTG and group 2 patients with 150 microgm of NTG. Clinical parameters and complications were studied and compared between the two groups. Placenta was observed for separation and graded as easily separated, separated with assistance, difficult to separate, failed to separate. The clinical parameters like hypotension, tachycardia, headache after awakening, palpitation after awakening were compared between the two groups. Results: In group 1, we observed that placenta was easily separatedin 12 patients (60%), separated with assistance in 3 patients (15%), difficult to separate in 3 patients (15%) and in 2 patients (10%) placenta was not separated. In group 2, we observed that, placenta was easily separated in 14 patients (70%), separated with assistance in 2 patients (10%), difficult to separate in 2 patients (10%) and in 2 patients (10%) placenta was not separated. Conclusion: Intravenous NTG is an effective and safe method for manual removal of placenta with a dose of 100 microgram. Keywords: Intravenous, Nitroglycerinr, Retained placenta.

Advancedsecondary Abdominal Pregnancy till Term: A Case Report

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

Placenta accreta spectrum disorders\u2014experience of management in a German tertiary perinatal centre

PurposePlacenta accreta spectrum (PAS) disorders can cause major intrapartum haemorrhage. The optimal management approach is not yet defined. We analysed available cases from a tertiary perinatal centre to compare the outcome of different individual management strategies.MethodsA monocentric retrospective analysis was performed in patients with clinically confirmed diagnosis of PAS between 07/2012 and 12/2019. Electronic patient and ultrasound databases were examined for perinatal findings, peripartum morbidity including blood loss and management approaches such as (1) vaginal delivery and curettage, (2) caesarean section with placental removal versus left in situ and (3) planned, immediate or delayed hysterectomy.Results46 cases were identified with an incidence of 2.49 per 1000 births. Median diagnosis of placenta accreta (56%), increta (39%) or percreta (4%) was made in 35 weeks of gestation. Prenatal detection rate was 33% for all cases and 78% for placenta increta. 33% showed an association with placenta praevia, 41% with previous caesarean section and 52% with previous curettage. Caesarean section rate was 65% and hysterectomy rate 39%. In 9% of the cases, the placenta primarily remained in situ. 54% of patients required blood transfusion. Blood loss did not differ between cases with versus without prenatal diagnosis (p = 0.327). In known cases, an attempt to remove the placenta did not show impact on blood loss (p = 0.417).ConclusionPAS should be managed in an optimal setting and with a well-coordinated team. Experience with different approaches should be proven in prospective multicentre studies to prepare recommendations for expected and unexpected need for management.

Complications of the third stage of labor in in vitro fertilization pregnancies: an additional expression of abnormal placentation?

To assess the correlation between invitro fertilization (IVF) and complications of the third stage of labor. Retrospective cohort of vaginal deliveries from November 2008 to January 2020. Maternal and obstetric outcomes of singleton deliveries were compared between IVF and non-IVF pregnancies. University hospital. Women with live singleton vaginal deliveries at >24 weeks of gestation. Invitro fertilization-attained pregnancies (compared with spontaneous ones). Complications of the third stage of labor, defined as manual placental removal (either entire removal due to nonseparation or exploration of the uterine cavity due to suspected retained products of conception). Overall, 1,264 IVF pregnancies and 34,166 non-IVF pregnancies were included. Deliveries in the IVF group were characterized by an older maternal age, lower parity, higher rate of diabetes and hypertensive disorders, higher rate of placental abnormalities, earlier gestational age, higher rate of labor induction, chorioamnionitis, and instrumental delivery. Complications of the third stage of labor occurred in 5.9% of IVF deliveries and in 2.8% of controls, and blood transfusion was more prevalent in IVF deliveries. The rate of complications of the third stage were higher in both fresh and frozen transfer cycles as compared with spontaneous pregnancies (5.8%, 8.8%, and 2.8%, respectively), although no difference was noted between fresh and frozen transfers. Invitro fertilization was associated independently with complications of the third stage of labor after adjustment for potential confounders. Invitro fertilization is associated independently with an increased risk of complications of the third stage of labor.

Intrauterine bacterial growth in elective and non-elective caesarean sections

We assessed intrauterine bacterial growth for elective and non-elective caesarean sections (CSs). Aerobic uterine cultures were obtained from the uterine cavity immediately following placental removal from 1376 patients who underwent CS in one center during one year. About 13.8% (115/832) of elective CS were positive vs. 55.9% (304/544) of non-elective CS (p < .001). Of non-elective CSs, 28.6% (56/196) of those without ruptured membranes (ROM) were positive vs. 71.3% (248/348) with ROM (p < .001). Mean birth weight and 1-minute Apgar scores were significantly lower in women with positive cultures, elective and non-elective, than negative cultures. A higher percentage of women with positive uterine cultures presented with postpartum endometritis (p < .05). Intrauterine bacteria in elective CSs demonstrate that the uterine cavity is not sterile. Non-elective CS, particularly after membrane rupture, is a significant risk factor for positive uterine culture. Positive uterine culture is associated with lower birth weight, lower one-minute Apgar score and postpartum endometritis. Impact statement What is already known on this subject? Postpartum endometritis is a leading cause of postpartum febrile morbidity. Caesarean sections, in particular non-elective cesareans, are an important risk factor for the development of postpartum endometritis. Controversy exists concerning the sterility of the placenta and uterus. The diagnosis of endometritis is based mainly on clinical findings and does not necessitate bacterial isolation from the uterine cavity. Positive culture at caesarean section has been associated with positive postoperative culture and yet, currently, professional organisations do not recommend the routine sampling of intrauterine cultures during caesarean section. What do the results of this study add? Since positive uterine culture rate was higher in non-elective CSs and associated with lower birth weight and 1-minute Apgar score and postoperative endometritis, obtaining uterine culture in those cases might be of clinical value. What are the implications of these findings for clinical practice and/or further research? Obtaining routine intrauterine cultures during non-elective caesarean sections might be useful for detecting significant pathogens and tailoring antibiotic treatment in postpartum endometritis. Further studies are necessary in order to determine the impact of obtaining intrauterine cultures during caesarean sections, particularly non-elective cesareans.

Typha capensis (Rohrb.) N.E.Br. (Typhaceae): morphology, medicinal uses, biological and chemical properties

Typha capensis (Rohrb.) N.E.Br. is a robust, monoecious, perennial marshy herb that belongs to the family Typhaceae. The current research aims to provide a comprehensive analysis of the biological and chemical properties, botany and medicinal uses of T. capensis. Comparative analysis of literature showed that T. capensis is a medicinal plant that has multiple benefits such as food for humans, feeds for animals and medicines to treat various diseases. All the parts including the leaves, seeds, rhizomes and pollen can be used in making decoction to improve male potency and libido, cures genital problems, boosts circulation, enhance female fertility, strengthens uterine contraction in childbirth and facilitates placenta removal. It is also used for the treatment of dysmenorrhea, diarrhoea and dysentery venereal diseases. The plant contains several flavones and phenolic compounds which have been reported to possess anti-inflammatory activity. Scientific studies have shown that T. capensis has a broad range of biological activities such as antibacterial, antioxidants, fertility-promoting effect and apoptosis effect. T. capensis should be subjected to comprehensive phytochemical, pharmacological and toxicological assessments projected at assessing its efficacy and safety as herbal medicine.