Risk Of Placenta Previa Research Articles

SUCCESSFUL CONCEPTION AND FIRST PREGNANCY IN A 28-YEAR-OLD WOMAN WITH CERVICAL UTERINE MYOMA AND TOTAL PLACENTA PREVIA: A CASE REPORT

Background: Placenta previa is a major pregnancy complication associated with life-threatening hemorrhage. Cervical Uterine Myomas, benign smooth muscle tumors, increase the risk of placenta previa by two to three times, contributing to adverse pregnancy outcomes such as infection, urinary retention, preterm labor, and bleeding. Understanding the interaction between Cervical Uterine Myomas and placenta previa is crucial for optimizing care in high-risk pregnancies and improving maternal and fetal outcomes. Case Description: A 28-year-old primigravida (G1P0A0) patient was diagnosed with a breech presentation, Cervical Uterine Myoma, and total placenta previa at Klungkung Regional Hospital. The patient had a regular menstrual cycle and no history of comorbid conditions. The patient's management includes hospitalization with strict bed rest, followed by a scheduled elective cesarean section (CS). Fluid therapy will be administered using Ringer's lactate, and preoperative prophylactic antibiotics will be provided. Discussion: Cervical Uterine Myoma, particularly cervical myomas, can significantly impact pregnancy outcomes, with a prevalence of 1.6% to 10.7%. These fibroids, particularly large ones, increase the risk of placenta previa, a condition where the placenta partially or completely covers the cervix. The combination presents significant risks for both the obstetrician and the patient, including urinary retention, myoma degeneration, preterm labor, obstructed labor, and postpartum hemorrhage. Careful surgical planning and management strategies are crucial. Conclusion: A 28-year-old primigravida with breech presentation, Cervical Uterine Myoma, and total placenta previa was admitted after three days of abdominal pain and scheduled for an elective cesarean section at 36 weeks. The cesarean successfully delivered a healthy male infant, and a 10 x 10 cm cervical myoma was identified without complications. Postoperatively, the patient had a normal recovery with well-healing surgical wounds and was discharged in stable condition with appropriate medications.

Artificial Sweetener and the Risk of Adverse Pregnancy Outcomes: A Mendelian Randomization Study.

The relationship between the intake of artificial sweetener (AS) and adverse pregnancy outcomes is under-researched, and existing studies yield inconsistent conclusions. A Mendelian randomization (MR) approach was employed to investigate the causal relationship between the intake of AS and adverse pregnancy outcomes. Instrumental variables related to the exposure phenotype were selected for analysis. The analysis was conducted using genome-wide association study summary data from public datasets. The inverse variance weighted, MR-Egger, weighted median, simple mode, and weighted mode methods were used to evaluate the causal relationship between exposure and outcomes. Sensitivity analysis and multivariable Mendelian randomization enrolling body mass index, type 2 diabetes mellitus, and fasting glucose were employed to further validate the consistency and robustness of the results. In univariable MR, the intake of AS added to tea was associated with an increased risk of ectopic pregnancy [OR = 1.821 (1.118-2.967), p = 0.016]. In multivariable MR adjusting for body mass index and type 2 diabetes mellitus, the intake of AS added to cereal was linked to a reduced risk of ectopic pregnancy [OR = 0.361 (0.145-0.895), p = 0.028] and premature rupture of membranes [OR = 0.116 (0.019-0.704), p = 0.019], while the intake of artificial sweetener added to coffee was associated with an increased risk of placenta previa [OR = 1.617 (1.042-2.510), p = 0.032]. No causal relationship was identified between the intake of artificial sweetener and other adverse pregnancy outcomes. The consumption of artificial sweetener during pregnancy warrants careful consideration.

Frequency of Placenta Previa among Women with Previous Cesarean-Section

Placenta Previa was defined as when the placenta was attached to the lower uterine segment, poses significant risks, including antepartum hemorrhage and maternal mortality. The incidence was rising, attributed partly to increased cesarean sections and advanced maternal age. Objective: To determine the frequency of placenta Previa among women with previous cesarean-sections. Methods: This cross sectional study was carried out at a Teaching Hospital of Sialkot, from June to December 2021. The sample size was 147 pregnant females. These pregnant females have a history of cesarean section. The non-probability Consecutive sampling technique was used, and data were analyzed by using SPSS version 25.0. Results: Among those, 16.3% had placenta Previa, which increased significantly in women with >2 previous cesarean sections to 26.4% (p = 0.003). Regarding parity, the increase in the risk of placenta Previa was not significant: 12.8% for parity < 3 and 20.3% for parity ≥ 3 (p = 0.087). However, in the stratified analysis by BMI, this became significant: 11.0% for normal-weight, 18.6% for overweight, and 66.7% for obese women (p = 0.001). There was no significant difference concerning age groups, p = 0.177. Such findings of the significant associations of placenta Previa with such factors as BMI and number of cesarean sections indicate that great attention to monitoring should be paid. Conclusion: Hence concluded that previous cesarean sections strongly correlate with placenta previa in subsequent pregnancies. Such findings underscore the need for rigorous monitoring and proactive measures, especially in cases of multiple cesarean deliveries, in the management of associated complications.

Trophectoderm grade is associated with the risk of placenta previa in frozen-thawed single-blastocyst transfer cycles.

Do obstetric and perinatal complications vary according to different blastocyst developmental parameters after frozen-thawed single-blastocyst transfer (SBT) cycles? Pregnancies following the transfer of a blastocyst with a grade C trophectoderm (TE) were associated with an increased risk of placenta previa compared to those with a blastocyst of grade A TE. Existing studies investigating the effect of blastocyst morphology grades on birth outcomes have mostly focused on fetal growth and have produced conflicting results, while the risk of obstetric complications has rarely been reported. Additionally, growing evidence has suggested that the appearance of TE cells could serve as the most important parameter for predicting implantation and live birth. Given that the TE ultimately develops into the placenta, it is plausible that this independent predictor may also impact placentation. This retrospective cohort study at a tertiary-care academic medical center included 6018 singleton deliveries after frozen-thawed SBT cycles between January 2017 and December 2021. Singleton pregnancies were grouped into two groups according to blastocyst developmental stage (Days 5 and 6), four groups according to embryo expansion (Stages 3, 4, 5, and 6), three groups according to inner cell mass (ICM) quality (A, B, and C), and three groups according to TE quality (A, B, and C). The main outcomes included pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, preterm premature rupture of membrane, placenta previa, placental abruption, placenta accreta, postpartum hemorrhage, preterm birth, low birth weight, small for gestational age, and birth defects. Multivariate logistic regressions were performed to evaluate the effect of blastocyst developmental stage, embryo expansion stage, ICM grade, and TE grade on measured outcomes adjusting for potential confounders. No association was found between blastocyst developmental stage and obstetric or perinatal outcomes both before and after adjusting for potential confounders, and similar results were found with regard to embryo expansion stage and ICM grade. Meanwhile, the incidence of placenta previa derived from a blastocyst with TE of grade C was higher compared with those derived from a blastocyst with TE of grade A (1.7%, 2.4%, and 4.0% for A, B, and C, respectively, P = 0.001 for all comparisons). After adjusting for potential covariates, TE grade C blastocysts had 2.81 times the likelihood of resulting in placenta previa compared to TE grade A blastocysts (adjusted odds ratio 2.81, 95% CI 1.11-7.09). No statistically significant differences were detected between any other measured outcomes and TE grades both before or after adjustment. The study is limited by its retrospective, single-center design. Additionally, although the sample size was relatively large for the study group, the sample size for certain subgroups was relatively small and lacked adequate power, particularly the ICM grade C group. Therefore, these results should be interpreted with caution. The study extends our knowledge of the potential downstream effect of TE grade on placental abnormalities. This study was supported by the National Key Research and Development Program of China (2023YFC2705500, 2023YFC2705501, 2023YFC2705505, 2019YFA0802604); National Natural Science Foundation of China (82130046, 82320108009, 82371660, 32300710); Shanghai leading talent program, Innovative research team of high-level local universities in Shanghai (SHSMU-ZLCX20210201, SHSMU-ZLCX20210200, SHSMU-ZLCX20180401), Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital Clinical Research Innovation Cultivation Fund Program (RJPY-DZX-003), Science and Technology Commission of Shanghai Municipality (23Y11901400), Shanghai's Top Priority Research Center Construction Project (2023ZZ02002), and Three-Year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.1-36). The authors have no conflicts of interest to declare. N/A.

Association between endometriosis and perinatal complications: a case-control study

BackgroundRecently, a history of endometriosis has been reported to be associated with several perinatal complications. However, it is unknown whether pre-pregnancy treatment for endometriosis reduces perinatal complications. In this study, we aimed to clarify the association between endometriosis and perinatal complications and investigate whether there is a significant difference in the incidence of placenta previa depending on the degree of surgical completion of endometriosis before pregnancy.MethodsThis case-control study included 2781 deliveries at the Hirosaki University Hospital between January 2008 and December 2019. The deliveries were divided into a case group with a history of endometriosis (n = 133) and a control group without endometriosis (n = 2648). Perinatal outcomes and complications were compared between the case and control groups using a t-test and Fisher’s exact test. Multiple logistic regression models were used to identify the risk factors for placenta previa. Additionally, we examined whether the degree of surgical completion of endometriosis before pregnancy was associated with the risk of placenta previa.ResultsPatients with a history of endometriosis had a significantly higher risk of placenta previa (crude odds ratio, 2.66; 95% confidence interval, 1.37‒4.83). Multiple logistic regression analysis showed that a history of endometriosis was a significant risk factor for placenta previa (adjusted odds ratio, 2.30; 95% confidence interval, 1.22‒4.32). In addition, among patients with revised American Society for Reproductive Medicine stage III–IV endometriosis, the incidence of placenta previa was significantly lower in patients who underwent complete surgery (3/51 patients, 5.9%) than in those who did not (3/9 patients, 33.3%) (p = 0.038).ConclusionsA history of endometriosis is an independent risk factor for placenta previa. Given the limitations of this study, further research is needed to determine the impact of endometriosis surgery on perinatal complications.

Untangling the independent effect of endometriosis, adenomyosis, and ART-related factors on maternal, placental, fetal, and neonatal adverse outcomes: results from a systematic review and meta-analysis.

Women with endometriosis may constitute a group at a particularly increased risk of pregnancy-related complications. Furthermore, women selected for assisted reproductive technology (ART) are exposed to additional endocrinological and embryological factors that have been associated with adverse pregnancy outcomes. This study aimed to investigate the independent effect of endometriosis, adenomyosis, and various ART-related factors on adverse maternal, placental, fetal, and neonatal outcomes. Published randomized controlled trials, cohort studies, and case-control studies were considered eligible. PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus were systematically searched up to 1 March 2024. This systematic review and meta-analysis was performed in line with the PRISMA and the MOOSE reporting guidelines. To thoroughly investigate the association between endometriosis/adenomyosis and adverse pregnancy outcomes, sub-analyses were conducted, whenever possible, according to: the method of conception (i.e. ART and non-ART conception), the endometriosis stage/phenotype, the coexistence of endometriosis and adenomyosis, any pre-pregnancy surgical treatment of endometriosis, and the form of adenomyosis. The odds ratio (OR) with 95% CI was used as effect measure. The quality of evidence was assessed using the GRADE approach. We showed a higher risk of placenta previa in women with endometriosis compared to controls (34 studies, OR 2.84; 95% CI: 2.47, 3.26; I2 = 83%, moderate quality). The association was observed regardless of the method of conception and was particularly strong in the most severe forms of endometriosis (i.e. rASRM stage III-IV endometriosis and deep endometriosis (DE)) (OR 6.61; 95% CI: 2.08, 20.98; I2 = 66% and OR 14.54; 95% CI: 3.67, 57.67; I2 = 54%, respectively). We also showed an association, regardless of the method of conception, between endometriosis and: (i) preterm birth (PTB) (43 studies, OR 1.43; 95% CI: 1.32, 1.56; I2 = 89%, low quality) and (ii) cesarean section (29 studies, OR 1.52; 95% CI: 1.41, 1.63; I2 = 93%, low quality). The most severe forms of endometriosis were strongly associated with PTB. Two outcomes were associated with adenomyosis both in the main analysis and in the sub-analysis that included only ART pregnancies: (i) miscarriage (14 studies, OR 1.83; 95% CI: 1.53, 2.18; I2 = 72%, low quality) and (ii) pre-eclampsia (7 studies, OR 1.70; 95% CI: 1.16, 2.48; I2 = 77%, low quality). Regarding ART-related factors, the following associations were observed in the main analysis and confirmed in all sub-analyses conducted by pooling only risk estimates adjusted for covariates: (i) blastocyst stage embryo transfer (ET) and monozygotic twinning (28 studies, OR 2.05; 95% CI, 1.72, 2.45; I2 = 72%, low quality), (ii) frozen embryo transfer (FET) and (reduced risk of) small for gestational age (21 studies, OR 0.59; 95% CI, 0.57, 0.61; P < 0.00001; I2 = 17%, very low quality) and (increased risk of) large for gestational age (16 studies, OR 1.70; 95% CI, 1.60, 1.80; P < 0.00001; I2 = 55%, very low quality), (iii) artificial cycle (AC)-FET and pre-eclampsia (12 studies, OR 2.14; 95% CI: 1.91-2.39; I2 = 9%, low quality), PTB (21 studies, OR 1.24; 95% CI 1.15, 1.34; P < 0.0001; I2 = 50%, low quality), cesarean section (15 studies, OR 1.59; 95% CI 1.49, 1.70; P < 0.00001; I2 = 67%, very low quality) and post-partum hemorrhage (6 studies, OR 2.43; 95% CI 2.11, 2.81; P < 0.00001; I2 = 15%, very low quality). Severe endometriosis (i.e. rASRM stage III-IV endometriosis, DE) constitutes a considerable risk factor for placenta previa and PTB. Herein, we recommend against superimposing on this condition other exposure factors that have a strong association with the same obstetric adverse outcome or with different outcomes which, if coexisting, could determine the onset of an ominous obstetric syndrome. Specifically, we strongly discourage the use of AC regimens for FET in ovulatory women with rASRM stage III-IV endometriosis or DE. We also recommend single ET at the blastocyst stage in this high-risk population. CRD42023401428.

P-718 Risk of placenta previa in assisted reproduction: population study with sibling analyses from the committee of Nordic ART and safety

Abstract Study question Which treatment methods and causes of infertility contribute to the increased risk of placenta previa in assisted reproductive technology (ART)? Summary answer Risk was increased across all treatment methods and causes of infertility, but most strongly following fresh blastocyst transfer (fresh-BT) and in women with endometriosis. What is known already A higher risk of placenta previa after ART is well established. Recent studies indicate risk differences according to type of embryo transfer, with particularly high risk seen after fresh-BT. Underlying mechanisms are poorly understood, and maternal factors such as cause of infertility might contribute. Within-mother analyses, where each woman serves as her own control (i.e., sibling design), help disentangle treatment contributions from maternal confounders that are constant between pregnancies. Study design, size, duration The Committee of Nordic ART and Safety (CoNARTaS) cohort consists of linked nationwide data from health registries in four Nordic countries. Data on ART were from Medical Birth Registries (MBRs) and ART quality registries, and data on placenta previa were from MBRs and hospital discharge/specialist health care registries. We included singleton and multiple births after natural conception (NC, n = 5 614 512) and ART (n = 139 694) in Denmark (1994-2014), Finland (1990-2014), Norway (1988-2015) and Sweden (1988-2015). Participants/materials, setting, methods All women who gave their first birth during the study period, at ages 20-45 years, were included, and contributed ≤4 births at 22-44 gestational weeks. We used multilevel logistic regression to compare risk of placenta previa after ART vs NC, both at the population level and within mothers, adjusting for year, maternal age, parity and country. We categorized ART-conception according to embryo cryopreservation, culture duration, and by cause of infertility (any ART method). Main results and the role of chance Population level risk of placenta previa was higher for ART (any method) vs NC (adjusted odds ratio [aOR] 4.16, 95% confidence interval [CI] 3.96-4.37). Controlling for constant maternal factors, the association attenuated, but risk remained higher for ART vs NC (within mothers aOR 2.64, 95% CI 2.31-3.02). Compared to NC, pregnancies from fresh embryos had a higher risk increase (population level aOR 4.69, 95% CI 4.41-4.98; within mothers aOR 3.31, 95% CI 2.81-3.91) than from frozen embryos (population level aOR 2.71, 95% CI 2.35-3.13; within mothers aOR 1.59, 95% CI 1.19-2.13). Further categorization by culture duration showed highest risk increase after fresh-BT (population level aOR 11.51, 95% CI 9.75-13.57; within mothers aOR 7.80, 95% CI 4.59-13.27), and lowest risk increase after frozen cleavage stage embryo transfer (population level aOR 2.33, 95% CI 1.93-2.80; within mothers aOR 1.20, 95% CI 0.83-1.75). Similar results were found across sensitivity analyses, including restriction to singletons. Compared to NC, risk was higher across all causes of infertility, where women with endometriosis and ART-conception had the highest risk increase (aOR 9.35, 95% CI 8.50-10.29), and women with polycystic ovary syndrome who conceived by ART had the lowest risk increase (aOR 1.52, 95% CI 1.12-2.09). Limitations, reasons for caution Analyses within mothers require that women have several births, hence, results might not apply to women with a single birth. Missing data on ART method or cause of infertility made within-mother analyses by cause of infertility unfeasible. We lacked data on extent of placenta previa (low-lying placenta vs placenta previa). Wider implications of the findings Type of embryo transfer and underlying maternal factors, particularly fresh-BT and endometriosis, respectively, both contribute to the increased risk of placenta previa in ART-conceived pregnancies. Identifying the responsible mechanisms might provide opportunities for prevention. Choice of transfer type should incorporate risk of placenta previa as well as other adverse outcomes. Trial registration number NA

O-092 Prevalence of multiple gestation births and perinatal outcomes in pregnancies secondary to clomiphene citrate treatment: a nationwide cohort study

Abstract Study question Is the incidence of multiple gestation births higher in pregnancies obtained after clomiphene citrate (CC) treatment compared to spontaneous pregnancies? Summary answer The rate of multiple gestation births in pregnancies obtained after CC treatment is significantly increased compared to spontaneous pregnancies. What is known already CC is a selective estrogen modulator frequently used to induce ovulation in infertile women. Data regarding the prevalence of multiple gestation births and adverse perinatal outcomes after CC are contradicting and based on meta-analysis of small sample size studies. Multiple gestations are frequently associated with complications such as preeclampsia, premature labor, and growth restriction, which contribute to higher mortality and morbidity rates. Study design, size, duration Using the French National Health Data System (SNDS) spanning 2013 to 2019, we conducted a nationwide cohort study including all pregnancies lasting more than 22 weeks of gestation, in women aged between 18-43 years. Participants/materials, setting, methods For each women, the first pregnancy during study was included. Women with the dispensing of IVF/ICSI treatment and/or gonadotrophins were excluded. Pregnancies exposed to CC (during the period [-60days,-11days] before the beginning of the pregnancy) were 1:10 matched to unexposed pregnancies. Pregnancies exposed to CC between 12 to 2months or less than 11 days before the beginning of the pregnancy were excluded to mitigate misclassification bias. The primary outcome was the multiple gestation birth rate. Main results and the role of chance Of 3,173,013 pregnancies, 32,010 (10 ‰) occurred in women exposed to clomiphene. The multiple pregnancy rate was significantly higher in pregnant women exposed with CC compared to matched controls (odd ratio 4.1, 95% CI [3.9-4.3]) such as twin pregnancies (OR 4.1, 95% CI [3.9-4.3]) and triple or more pregnancies (OR 5.1, 95% CI [3.8-7.2]). Women exposed to CC presented significantly more adverse obstetrical and perinatal outcomes, including stillbirths, premature delivery threats, premature rupture of membranes, gestational diabetes, placenta previa, gravid hypertension, pre-eclampsia, preterm birth, small for gestational age (SGA), C-section rate, and major birth defect rate. After stratification on multiple pregnancy and adjustment on confounders (history of psychiatric disease, diabetes, arterial hypertension, obesity and embryo reduction during pregnancy), women exposed to CC had a significantly higher risk of stillbirth, gestational diabetes, placenta previa, pre-eclampsia, preterm delivery and SGA in case of singleton pregnancies. Additionally, in the case of multiple pregnancies, they had a higher risk of placenta previa, preterm delivery, and SGA compared to non-exposed women. Limitations, reasons for caution The use of filled prescriptions as a measure of drug exposure could be subject to bias such as misclassification bias, although we attempt to mitigate it. Wider implications of the findings Clomiphene use is strongly associated with multiple gestation births and with adverse obstetrical and perinatal outcomes even in singleton pregnancies. These findings should provide awareness of practitioners and patients about its use. It underscore the importance of attentively monitoring follicular growth during the treatment process to avoid multiple pregnancies. Trial registration number NA

P-288 How do pregnancy complications, intrapartum, and neonatal risks differ in bicornuate and didelphys uteri. A population-based study

Abstract Study question Are there differences between didelphys and bicornuate uteri regarding obstetrical and neonatal outcomes based on an analysis of a population database? Summary answer Didelphys uteri present higher risks of preeclampsia, preterm delivery, PPROM, and cesarean delivery; while bicornuate uteri present higher risks of placenta previa, and placental abruption. What is known already Didelphys and bicornuate uteri are similar congenital anomalies with duplication of the uterine corpus. It is thought that both defects are similar when it comes to pregnancy complications, with increased risks of preterm delivery (PTD), malpresentation, and cesarean delivery, when compared to women without uterine anomalies. The didelphys uterus has two cervixes and a double vagina while the bicornuate uterus has one cervix and a single vagina. This minor difference may or may not alter the risks of pregnancy complications in these groups. However, obstetric and perinatal outcomes for didelphys and bicornuate uteri have never been directly compared. Study design, size, duration This retrospective population-based cohort study utilized data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusively. There were 3,846,342 births between 2010 and 2014, 1146 women with didelphys uteri and 6327 women with bicornuate uteri were included in the database and the study. Women were included only once per pregnancy. Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and is comprised of hospitalizations throughout the USA. It provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of Americans. Multivariate logistic regression was conducted to explore associations between bicornuate uteri and delivery outcomes while controlling for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance No significant difference was seen between the groups in regard to age, income, medical insurance plan, rates of obesity, illicit drug use, chronic hypertension, diabetes, thyroid disease, HIV, tobacco smoking during pregnancy, previous cesareans, pregnancy from IVF, and multiple gestations (P &amp;gt; 0.05). The only difference was in racial distribution, which was controlled for in the subsequent analysis (p &amp;lt; 0.05).In comparison to pregnant women with bicornuate uteri, patients with didelphys uteri were more likely to experience preeclampsia (aOR 1.38 95%CI: 1.05-1.80 P = 0.020), preterm premature rupture of membranes (PPROM) (aOR 1.76 95%CI1.32-2.34 P = 0.000), preterm delivery (aOR 1.39 95% CI1.18-1.64P=0.000), and higher chances of cesarean delivery (aOR 1.41 95% CI1.20-1.64 P = 0.000), after controlling for confounding demographics. Additionally, women with didelphys uteri have less risks of developing placenta previa (aOR 0.26 95%CI: 0.08-0.84 P = 0.024) and Abruptio placenta (aOR 0.52 95%CI 0.31-0.87 P = 0.013). No significant difference was seen between the groups regarding pregnancy induced hypertension, eclampsia, gestational diabetes, chorioamnionitis, operative vaginal delivery, hysterectomy, post-partum hemorrhage, wound complications, blood transfusion, maternal death, maternal infection, venous thromboembolism, pulmonary embolism or DIC (P &amp;gt; 0.05). Moreover, there was no significant difference between the two groups when comparing neonatal outcomes, including small for gestational age fetuses and intrauterine fetal demise (P &amp;gt; 0.05). Limitations, reasons for caution The limitation of our study are related to its retrospective nature and use of administrative database, which relies on the accuracy, and consistency of the individual coding the data, and the masking of undetected bias. Wider implications of the findings The present study demonstrates that women with bicornuate and didelphys uteri have certain differences when it comes to pregnancy, and intrapartum complications, including rates of preeclampsia, placenta previa, placental abruption, cesarean section, PPROM, and preterm delivery. These findings emphasize the importance of individualized perinatal care in these two cases. Trial registration number not applicable

Endometriosis and risk of adverse pregnancy outcomes: a retrospective multicenter cohort study

To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction. Multicenter retrospective cohort study. A total of 103 French maternity units. Deliveries by 368,935 women (377,338 infants) from 1999 through 2016. Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) MAIN OUTCOMES MEASURES: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates. Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups. Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis.

Complications of placenta previa: A retrospective observational study at tertiary care hospital

: Placenta previa (PP) is condition where the placenta is inserted completely or partially into the lower uterine segment, at or after 28 weeks of gestation. Maternal and fetal risks are antepartum haemorrhage (APH), postpartum haemorrhage (PPH), abnormal adherence of placenta, low birth weight (LBW), intra uterine growth restriction (IUGR), preterm births and congenital malformations. The purpose of this study was to determine the proportion of placenta previa, the demographics of patients, types- severity, complications and the feto-maternal outcome in patients of placenta previa.: After due permission of Institutional Review Board, this retrospective observational study was carried out at tertiary care teaching hospital from July 2020 to November 2022.Proportion of pregnancies with placenta previa was 0.3%. Majority 44(91.7%) patients were registered, 38(79.2%) of patients were in age group of 21-30 years, 38(79.1%) patients were multigravida, 41 (85.4%) had major degree of placenta previa, 29(60.4%) patients admitted after 37 weeks of gestation and 47(97.9%) of patients were delivered by caesarean section. Majority of patients, 20 (41.7%) had mild anemia. Major complications were bleeding episodes during antenatal period/APH in 23 (47.9%) and PPH in 22 (45.8%) patients. Maternal mortality occurred in 1 (2.1%) patient. All babies were live at time of birth and 44(91.7%) babies were alive at the time of discharge and neonatal death occurred in 4 (8.3%) preterm babies (28-33 week gestation). Majority of patients were multigravida. No patient was severely anaemic. Majority of patients were delivered by CS. APH and PPH were major complications. About two third of patients required blood transfusion in ante/intra/post-natal period. Obstetric hysterectomy was required in about one tenth of patients. Majority of babies were alive at the time of discharge due to higher number of registered patients who took regular antenatal care, hospital delivery and good NICU facilities. Once diagnosed, placenta previa and morbidly adherent placenta should be managed at tertiary care centre with multidisciplinary approach so as to lessen the feto-maternal morbidity and mortality. Prevention is better than cure. Multiparity increases the risk of placenta previa. Hence, family planning with an aim to reduce unwanted pregnancies and abortions will help to reduce the chances placenta previa. CS increases the risk of development of placenta previa. Efforts should be made to reduce the primary caesarean section rate as it poses more risk of placenta previa, morbidly adherent placenta and its related complications in subsequent gestations.

The Relation Of Placenta Previa With History Of Previous Cesarean Section And Miscarriages

Background and objectives: The factors that increase the risk of placenta previa in subsequent pregnancies include past miscarriages and the scar from a previous cesarean operation. This study aimed to determine whether a history of cesarean section or miscarriage was related to placenta previa at Sulaimani Maternity Teaching Hospital. Methods: At the Sulaimani Maternity Teaching Hospital, this case-control study was conducted between the 11th of September 2021 to the 31st of June.2022. A total of 100 women provided information, which was divided into two groups: Group A, which included 50 pregnant women with gestational ages between 30 and 40 weeks and confirmed placenta previa, and Group B, which included 50 pregnant women randomly selected with pregnancy lengths of 30 to 40 weeks and the placenta was in its usual location. Detailed history was taken from each woman, through this the relationship of placenta previa with previous cesarean section and miscarriages was studied. Results: The results of this study revealed that prior cesarean sections were previously performed in 74% of cases of placenta previa, compared to 46% of controls (p value = 0.004). In addition; there was no correlation between placenta previa and prior miscarriages (p value= 1.000), and a highly significant correlation was seen between the rise in previous cesarean deliveries and the presence of accreta (p value = 0.003). Conclusion: The likelihood of placenta previa in subsequent pregnancies is dramatically increased in this study by past cesarean deliveries; previous miscarriages have no significant impact on placenta previa development.

Maternal age and adverse pregnancy outcomes among Meitei women of Manipur, Northeast India: A cross-sectional study.

The study examines the outcomes of pregnancies conceived at advanced maternal age (AMA) and maternal complications after childbirth among Meitei women of Northeast India. A total of 760 women participants were included in this study and compared among women aged ≥35 years, with a reference group of women aged 20-34 years. Data on obstetric characteristics were collected after obtaining consent. The data were compared using chi-square analysis, and the results were adjusted using a logistic regression model. Decision trees were developed to predict the potential variables associated with preterm delivery and postpartum complication. In the study, 18.95% of AMA women experienced one or more adverse pregnancy outcomes (APOs). Women with AMA are at significantly increased risk of placenta previa (adjusted odds ratio [AOR] = 4.89, 95% confidence interval [CI]: 2.78-8.57), induction of labor (AOR = 3.69, 95%CI: 2.48-5.50), and caesarean section (AOR = 3.42, 95%CI: 2.28-5.12). Moreover, AMA women have a 1.86-2.76 AOR for developing gestational diabetes, pregnancy-induced hypertension, urinary tract infections, preterm delivery, and postpartum complications. Decision tree analysis revealed that AMA and urban residence independently predict preterm delivery and postpartum complications. The study's findings confirm the adverse impact of AMA on pregnancy outcomes and postpartum complications. Such issues should be addressed, and counseling on the risk of AMA should be provided, particularly for those in the high-risk group. Further prospective studies are needed to understand other potential risk factors of APOs and the impact of AMA complications to prevent the associated burden.

Increased risk of placenta previa and preterm birth in pregnant women with endometriosis/adenomyosis: A propensity-score matching analysis of a nationwide perinatal database in Japan.

We aimed to investigate the associations of endometriosis and adenomyosis with pregnancy complications by using a large-scale Japanese database. We retrospectively analyzed 145 590 singleton pregnancies from the Japan Perinatal Registry Network Database. Pregnant women registered as having endometriosis or adenomyosis were designated as the case group (EA), whereas the control group (non-EA) was selected using propensity-score matching adjusted for variables such as age, parity, BMI, smoking history, and the use of assisted reproductive technology. The main outcomes included placental malposition, preterm birth, and hypertensive disorders of pregnancy (HDP). In total, 1203 patients from both the EA and non-EA groups were matched and evaluated. The EA group showed significantly higher rates of placenta previa (odds ratio [OR], 3.01; 95% confidence interval [CI], 1.84-4.92), low-lying placenta (OR, 2.02; 95% CI, 1.06-3.86), and preterm birth (OR, 1.44; 95% CI, 1.13-1.84) than the non-EA group. However, no significant difference was observed in the incidence of HDP (OR, 1.22; 95% CI, 0.90-1.66). The use of propensity-score matching to analyze a nationwide perinatal database in Japan clarified that EA was associated with increased pregnancy complications, specifically placental malposition, including placenta previa and low-lying placenta, and preterm birth, but not with HDP.

Placental height, together with the distance from the short side of the placental edge to the internal cervical os, provides an accurate assessment of bleeding risk for placenta previa

Placental height, together with the distance from the short side of the placental edge to the internal cervical os, provides an accurate assessment of bleeding risk for placenta previa

Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies

BackgroundAt present, there are several studies on abortion history and perinatal outcomes, but there is no unified conclusion whether the history of abortion and different types of abortion are related to perinatal complications of subsequent pregnancy. We aim to study the impact of different types of abortion history on perinatal outcomes of singleton pregnancies.MethodsThis was a retrospective study from a maternity and infant hospital in Shanghai, China from 2016 to 2020. Pregnant women who gave birth to live singleton infant were included (n = 75,773). We classified abortion into spontaneous abortion (SAB) and induced abortion (IA). We compared the perinatal outcomes of singleton pregnancies with different abortion histories and used Logistic regression analysis to evaluate the associations between pre-pregnancy abortion history with perinatal outcomes.ResultsWe observed that pregnant women with a history of abortion were more likely to have a premature delivery (0.99% VS 0.45%), gestational diabetes mellitus (GDM) (13.40% VS 10.29%), placenta abnormality (8.16% VS 5.06%), placenta previa (5.65% VS 3.75%), placenta accreta (0.18% VS 0.04%), and placenta adhesion (2.79% VS 1.03%) than those who obtained singleton pregnancies without a history of abortion. When confounding factors were adjusted, differences in placenta abnormality still existed (excluding placenta abruption). The odds ratios and 95% confidence interval of placenta previa, placenta accreta, and placenta adhesion in pregnant women with only SAB history, only IA history, and both abortion history were 1.294(1.174–1.427), 1.272(1.159–1.396), and 1.390(1.188–1.625), 2.688(1.344–5.374), 2.549(1.268–5.125), and 5.041(2.232–11.386), 2.170(1.872–2.515), 2.028(1.738–2.366), and 3.580(2.917–4.395), respectively.ConclusionsOur research showed that pregnant women who have a history of abortion before pregnancy were more likely to have premature birth, GDM, placenta previa, placenta accreta, and placenta adhesion. After adjusting for confounding factors, we found that the history of SAB, IA, and both SAB and IA history were related to the increased risk of placenta previa, placenta accreta, and placenta adhesion.

Adenomyosis and obstetric complications: A retrospective case–control study

ObjectiveAdenomyosis is a uterine pathology affecting an increasing number of women of childbearing age. Its diagnosis is based upon histology or imaging [ultrasound or magnetic resonance imaging (MRI)]. Several studies have investigated the impact of adenomyosis on obstetric complications, with its diagnosis based on clinical symptoms, ultrasound or composite criteria. The aim of this study was to identify potential obstetric complications related to adenomyosis in women with an MRI-confirmed diagnosis. MethodsA single centre retrospective case–control study was undertaken in pregnant patients with an MRI-confirmed diagnosis of adenomyosis between January 2013 and December 2017 at the University Hospitals of Strasbourg. Controls were matched in a 4:1 ratio for age, parity and body mass index. Multivariate analysis was performed to identify obstetric complications. ResultsIn total, 291 women with an MRI-confirmed diagnosis of adenomyosis were identified during the study period. Of these, 89 patients achieved pregnancy after 24 weeks of gestation. The mean age of patients was 30.8 years. The adenomyosis group and the control group were comparable for matching criteria. Adenomyosis was found to be associated with increased risk of caesarean section [odds ratio (OR) 1.1, 95 % confidence interval (CI) 1.0–1.2; p = 0.03], intrauterine growth restriction (OR 1.3, 95 % CI 1.1–1.4; p < 0.001), postpartum haemorrhage (OR 1.2, 95 % CI 1.1– 1.4; p < 0.01), pre-eclampsia (OR 1.3, 95 % CI 1.0–1.6; p = 0.004) and previous spontaneous miscarriage (OR 2.09, 95 % CI 1.36–3.33; p < 0.001). Premature rupture of membranes, preterm delivery, severe intrauterine growth restriction and the risk of placenta praevia were not significantly higher in the adenomyosis group compared with the control group on multivariate analysis. ConclusionThis study demonstrates increased risk of several obstetric complications (caesarean section, intrauterine growth restriction, postpartum haemorrhage, pre-eclampsia, history of spontaneous miscarriage) in women with adenomyosis. To the authors’ knowledge, this is the first study to use MRI as the sole criterion for diagnosis. These results could be complemented by larger-scale prospective studies in order to manage these patients more effectively during pregnancy.

Risk factors for placenta previa among pregnant women of Kyiv, Ukraine: a retrospective cohort study

Placenta previa is a significant obstetric problem with elevated morbidity and mortality rates for both mother and fetus. The risks associated with placenta previa underscore the necessity for comprehensive treatment and timely intervention to mitigate adverse outcomes. Purpose - to conduct a retrospective analysis of the impact of obstetric-gynecological factors on the prediction of placenta previa occurrence and its influence on perinatal outcomes. Materials and methods. A retrospective cohort study was conducted on cases of placenta previa between 2018 and 2022. The study included 22491 deliveries, of which 65 (0.29%) cases were registered as placenta previa. Data from delivery records of 374 patients without placenta previa were used for comparison. The following variables were evaluated for all patients: maternal age, characteristics of the menstrual cycle, gravidity, parity, history of cesarean sections, gestational age at delivery, method of delivery, blood loss during delivery, length of postpartum hospitalization, birth weight, gender of the newborn, Apgar scores at 1 and 5 minutes. Gynecological intervention histories, including curettage/hysteroscopy, laparoscopy, and cervical treatment, as well as obstetric pathologies, such as cesarean section, ectopic pregnancy, instrumental abortions, missed pregnancies, and assisted reproductive technologies in the last pregnancy, were examined. Results. Multifactorial analysis revealed four significant risk factors. The risk of placenta previa was found to increase with advanced maternal age (p&lt;0.001), OR=1.14 (95% CI 1.07-1.20), and the presence of previous cesarean sections (p&lt;0.001), OR=5.51 (95% CI 2.73-11.1), while a history of previous deliveries reduced the risk (p&lt;0.001), OR=0.24 (95% CI 0.15-0.40). Instrumental abortions increased the risk of placenta previa (p=0.001), OR=2.14 (95% CI 1.20-3.81). Newborns in the placenta previa group had lower Apgar scores at 1 and 5 minutes and lower birth weight. Conclusions. The obtained results emphasize the importance of considering risk factors in assessing placenta previa occurrence during antenatal monitoring and can contribute to improving obstetric and perinatal care for women. However, the morphological and functional basis of placenta previa remains unknown and requires further study. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interests was declared by the authors.

Magnetic Resonance Imaging-Based Radiomics Nomogram to Predict Intraoperative Hemorrhage of Placenta Previa.

Placenta previa (PP) is associated with intraoperative and postpartum hemorrhage, increased maternal morbidity and mortality. We aimed to develop a magnetic resonance imaging (MRI)-based nomogram to preoperative prediction of intraoperative hemorrhage (IPH) for PP. A total of 125 PP pregnant women were divided into a training set (n = 80) and a validation set (n = 45). An MRI-based model was built for the classification of patients into IPH and non-IPH groups in a training set and a validation set. Multivariate nomograms were built according to radiomics features. Receiver operating characteristic (ROC) curve was used to assess the model. Predictive accuracy of nomogram were assessed by calibration plots and decision curve analysis. In multivariate analysis, placenta position, placenta thickness, cervical blood sinus, and placental signals in the cervix were significantly independent predictors for IPH (all ps < 0.05). The MRI-based nomogram showed favorable discrimination between IPH and non-IPH groups. The calibration curve showed good agreement between the estimated and the actual probability of IPH. Decision curve analysis also showed a high clinical benefit across a wide range of probability thresholds. Area under the ROC curve was 0.918 (95% confidence interval [CI]: 0.857-0.979) in the training set and 0.866 (95% CI: 0.748-0.985) in the validation set by the combination of four MRI features. The MRI-based nomograms might be a useful tool for the preoperative prediction of IPH outcomes for PP. Our study enables obstetricians to perform adequate preoperative evaluation to reduce blood loss and cesarean hysterectomy. · MRI is an important method for preoperative assessment of the risk of placenta previa.. · MRI-based nomogram can assess the risk of intraoperative bleeding of placenta previa.. · MRI is helpful for more comprehensive evaluation of placenta previa and adequate preoperative preparation..

P-269 trophectoderm grade is associated with the risk of placenta previa in frozen-thawed single blastocyst transfer cycles

Abstract Study question Dose obstetric and perinatal complications differ among different blastocyst developmental parameters after frozen-thawed single blastocyst transfer (SBT) cycles? Summary answer Blastocysts with grade C trophectoderm (TE) were associated with an increased risk of placenta previa compared to those with grade A TE. What is known already Existing studies investigating the effect of blastocyst morphology grades on birth outcomes have mostly focused on fetal growth and have produced conflicting results, while the risk of obstetric complications has rarely been reported. Additionally, growing evidence have suggested that the appearance of TE cells could serve as the most important parameter for predicting implantation and live birth. Given that the TE ultimately develops into the placenta, it is plausible that this independent predictor may also impact placentation. Study design, size, duration This was a retrospective cohort study conducted at a single tertiary-care academic reproductive center. A total of 6168 patients who underwent frozen-thawed SBT and resulted in singleton delivery beyond 20 weeks of gestation between January 2017 and December 2021 were analyzed. Participants/materials, setting, methods Main outcomes included placenta previa, placental abruption, placenta accreta, pregnancy-induced hypertension (PIH), preeclampsia, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Multivariate logistic regressions were performed to evaluate the effect of blastocyst developmental stage (day 5 and 6), embryo expansion stage (stages 3, 4, 5 and 6), inner cell mass (ICM) grade (A, B and C), and TE grade (A, B and C) on measured outcomes adjusting for potential confounders. Main results and the role of chance The overall rates of placenta previa, placental abruption, placenta accreta, PIH, preeclampsia, PTB, LBW and SGA was 2.8% (n = 173), 0.4% (n = 26), 1.3% (n = 83), 5.3% (n = 328), 4.3% (n = 267), 6.8% (n = 417), 3.7% (n = 230), and 2.8% (n = 172), respectively. Specifically, the incidence of placenta previa derived from blastocyst with TE of grade C was higher compared with those derived from blastocyst with TE of grade A (1.8%, 2.5% and 3.9% for A, B and C, respectively, P = 0.003 for all comparisons). No such differences were observed for any other outcomes. After adjusting for potential covariates (maternal age, maternal BMI, maternal education, duration of infertility, gravidity, parity, previous caesarean section, infertility diagnosis, IVF or ICSI, previous embryo transfer, and type of endometrial preparation), TE grade C blastocyst had 2.58 times the likelihood of resulting in the risk of placenta previa compared to TE grade A blastocysts (adjusted odds ratio [AOR] 2.58, 95% confidence interval [CI] 1.05-6.31). No statistically significant associations were detected between any other measured outcomes and blastocyst developmental parameters. Furthermore, when restricted to pregnancies above 28 gestational weeks, the risk of placenta previa remained significantly higher with TE of grade C (AOR 2.56, 95% CI 1.05-6.27) than with TE of grade A. Limitations, reasons for caution The retrospective design, lack of controlling for residual confounding factors, and inter-observer variability limited this study. Wider implications of the findings The study extends our knowledge of the potential downstream effect of TE grade on placental abnormalities. Trial registration number not applicable