Placenta Previa Totalis Research Articles

Autologous Blood Donation and Transfusion in Patients with Placental Malposition: A Single-Institution Pilot Study and Systematic Literature Review.

Autologous blood donation for placental malposition is common in Japan, but no studies have scientifically evaluated its usefulness. The purpose of this study was to evaluate the necessity for autologous blood donation for placental malposition. A retrospective study was conducted of patients who underwent autologous blood donation for placental malposition at Kindai University Hospital from 2012 to 2022. The primary outcome was the proportion of patients who were able to avoid allogeneic blood transfusion by autologous blood transfusion; secondary outcomes were autologous blood disposal rate, allogeneic blood transfusion rate, and complications of autologous blood donation and allogeneic blood transfusion. A systematic review of studies on autologous blood transfusion for placental malposition was conducted on PubMed. Fifty-two patients (total placenta previa 16; marginal placenta previa 20; low-lying placenta 16) were included. Eight (15%) had complications at the time of autologous blood donation, including non-reassuring fetal heart rate, but no sequelae. Allogeneic blood transfusion was avoided by autologous blood transfusion in only five cases (9.6%). Autologous blood was discarded in nine cases (17%), seven of which had a low-lying placenta positioned normally at delivery. Allogeneic blood transfusion was performed in eight cases (15%) with no complications. In the systematic review, seven articles that met the inclusion criteria were selected for further evaluation. The results showed that there were no publications that scientifically demonstrated the benefit of autologous blood transfusion. The results of this study indicate that autologous blood donation for placental malposition has little benefit.

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.

Diagnostic accuracy of magnetic resonance imaging to predict peripartum hysterectomy and neonatal mortality in total placenta previa: A retrospective cohort study

ObjectivesTo assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa. Study DesignThis retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis. ResultsReduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm3; OR: 0.993, 95 % CI: 0.990–0.995 and OR: 1.007, 95 % CI: 1.005–1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 − 0.88 and OR: 1.7, 95 % CI: 1.4 − 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2–250, p = 0.001). ConclusionsPlacental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.

Development of a machine learning approach for prediction of red blood cell transfusion in patients undergoing Cesarean section at a single institution

Despite recent advances in surgical techniques and perinatal management in obstetrics for reducing intraoperative bleeding, blood transfusion may occur during a cesarean section (CS). This study aims to identify machine learning models with an optimal diagnostic performance for intraoperative transfusion prediction in parturients undergoing a CS. Additionally, to address model performance degradation due to data imbalance, this study further investigated the variation in predictive model performance depending on the ratio of event to non-event data (1:1, 1:2, 1:3, and 1:4 model datasets and raw data).The area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUPRC) were evaluated to compare the predictive accuracy of different machine learning algorithms, including XGBoost, K-nearest neighbor, decision tree, support vector machine, multilayer perceptron, logistic regression, random forest, and deep neural network. We compared the predictive performance of eight prediction algorithms that were applied to five types of datasets. The intraoperative transfusion in maternal CS was 7.2% (1020/14,254). XGBoost showed the highest AUROC (0.8257) and AUPRC (0.4825) among the models. The most significant predictors for transfusion in maternal CS as per machine learning models were placenta previa totalis, haemoglobin, placenta previa partialis, and platelets. In all eight prediction algorithms, the change in predictive performance based on the AUROC and AUPRC according to the resampling ratio was insignificant. The XGBoost algorithm exhibited optimal performance for predicting intraoperative transfusion. Data balancing techniques employed to alter the event data composition ratio of the training data failed to improve the performance of the prediction model.

Prothrombin Complex Concentrate as a Key Adjunct in Massive Hemorrhage Management in Placenta Accreta Spectrum Disorder: A Case Report

Placenta accreta spectrum disorder (PASD) is a severe obstetric complication associated with significant hemorrhage risk. This report highlights the successful use of prothrombin complex concentrate (PCC) as part of a multidisciplinary approach to managing a case of massive hemorrhage in PASD. A 36-year-old woman, G3P2002, at 33 weeks gestation, diagnosed with placenta previa totalis and suspected PASD, underwent a planned cesarean hysterectomy. The surgery was complicated by 5200 mL hemorrhage due to placental invasion and bladder injury. Hemodynamic instability was managed with massive transfusion protocol activation, including PCC, tranexamic acid, and packed red blood cells. Intra-abdominal packing was performed for hemostasis, and the bladder injury was repaired. Continued PCC administration in the ICU, along with other supportive measures, resulted in hemorrhage control and stabilization. The patient was successfully extubated and discharged after a second surgery to remove packing. This case emphasizes the vital role of PCC in the multidisciplinary management of massive hemorrhage in PASD. Early recognition of PASD risk factors and prompt intervention, including PCC administration, are crucial for optimal maternal outcomes.

Predictive value of cervical length in placenta previa totalis: a single-center experience

Aims: In our study, we aimed to scientifically assess the utility of measuring cervical length in predicting the risk of postpartum hemorrhage and the necessity for emergency preterm cesarean delivery in women diagnosed with placenta previa totalis. Methods: We conducted a retrospective study at a single medical center, comprising 48 pregnant women diagnosed with placenta previa totalis. Cervical length was precisely measured through transvaginal ultrasound. Patients were categorized based on cervical length (CL): CL &amp;gt;30mm, CL 25-30 mm, and CL &amp;lt;25 mm. Primary outcomes included preterm birth, postpartum hemorrhage, and emergency cesarean section. Results: Women with CL &amp;lt;25 mm exhibited a notably elevated risk of postpartum hemorrhage (60%) and emergency cesarean section (80%). While preterm birth rates displayed variations among groups, statistical significance remained elusive. APGAR scores demonstrated consistency across cervical length categories. Conclusion: Evaluation of cervical length holds promise as a valuable tool in the comprehensive management of placenta previa totalis. Women presenting with a cervical length less than 25 mm may warrant intensified monitoring and targeted interventions to mitigate adverse perinatal outcomes. Further research endeavors are imperative to corroborate these findings and advance the care provided for these intricate pregnancies.

Case Study: Placenta Previa, Accreta, Hypertension, and Anemia in Pregnant Women at 35-36 Weeks Gestation with Previous Cesarean Section

Intoduction : Placenta accreta is a rare but serious pregnancy complication where the placenta attaches abnormally in the uterus. It affects around 0.9% of pregnancies and is linked to risks like placenta previa and prior C-sections, with its incidence rising due to increased C-section rates. Prompt diagnosis is essential as it contributes to 7-10% of global maternal deaths. Case report : This case study involves a 39-year-old pregnant woman at 35-36 weeks with placenta previa and suspected accreta. Vaginal bleeding and pain raised concerns. Anemia and gestational hypertension further complicated matters. Ultrasound and MRI confirmed total placenta previa and suspected accreta, with a PAI score of 4. A cesarean section and supravaginal hysterectomy successfully managed the situation. FIGO grade II placenta accreta was found.&#x0D; Conclusion : Early detection and management are key for neonatal maturity and maternal safety.Imaging and risk factor identification and diagnosis. Multidisciplinary teamwork among obstetricians, radiologists, and specialists is crucial. This case underscores diagnosing and managing placenta accreta, using imaging and teamwork for optimal outcomes. It highlights the importance of addressing abnormal placental conditions, emphasizing accurate diagnosis, and a collaborative approach for effective management.&#x0D; Conclusion: this case underscores the urgent need for early diagnosis, multidisciplinary management, and advanced imaging techniques to address the life-threatening

Plasenta akreta spektrumunu öngörmeye yönelik bir skorlama sistemi: prospektif bir çalışma

Purpose: The aim of this study was to assess the utility of a scoring system using selected ultrasonographic features to predict placenta accreta spectrum (PAS) and its severity in suspicion of PAS.&#x0D; Materials and Methods: This prospective study was conducted with a total of 27 pregnant women with placenta previa totalis with suspicion of PAS between 24 and 37 weeks gestation between July 2019 and January 2020. PAS score was calculated with the following parameters: loss of clear zone, number, size, and regularity of placental lacunae, turbulent flow in lacunae, uterovesical or subplacental hypervascularity, bridging vessels, and the number of previous cesarean section. Patients were divided into groups due to PAS scores and the severity of PAS. Receiver operating characteristics curves were performed to assess the performance of the PAS scoring system.&#x0D; Results: In a total of 27 patients, 7 (25.9%) patients did not have PAS, 5 (18.5%) patients had accreta, 7 (25.9%) patients had increta, and 8 patients (29.6) had percreta. In groups with PAS scores higher than 8, 86% of patients had placenta percreta. PAS score was 2.8±1.4 in the no PAS group, 3.6±1.9 in the accreta group, 5.1±2.4 in the increta group, 9.8±1.6 in the percreta group and statistically higher in the percreta group. The optimal cut-off values of the PAS score to predict abnormal placental invasion was 4.5 (60% sensitivity, 86% specificity), 7.5 for differentiation percreta from increta (87.5% sensitivity, 75% specificity)&#x0D; Conclusion: A PAS scoring system that combines several ultrasound and clinical characteristics may greatly improve prenatal risk assessment and prediction of PAS.

The effect of prenatal yoga and acupressure on lowering blood pressure in pregnant women

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Hypertension in pregnancy is one of the contributors to the maternal mortality rate (MMR) in Indonesia. The combination of yoga and acupressure was expected to help pregnant women in lowering blood pressure.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study aimed to test the combination of prenatal yoga and acupressure against blood pressure in pregnant women who had hypertension.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study was a quasi-experiment using a pre-post-test design with control group. The population in this study was all pregnant women in the Depok Regional Health Center. The inclusion criteria for this study included: pregnant women aged &amp;gt; 20 weeks of pregnancy, suffering from hypertension, namely systolic TD ≥140 mmHg and diastolic ≥90 mmHg. As for pregnant women who had a history of preeclampsia, had a history of bleeding in this pregnancy, pregnant women with placenta previa totalis were excluded from this study. The sample was taken by purposive sampling with the number of respondents as many as 30 pregnant women in the intervention group and 30 pregnant women in the control group. Data analysis used SPSS version 20 with descriptive and Chi-square tests for respondent characteristics. Bivariate analysis was analyzed with the Wilcoxon test, while to find out the difference in blood pressure between the two groups, the Mann-Witney U test was used.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Statistical results obtained that there was a significant difference in the blood pressure of pregnant women before and after yoga and acupressure. In addition, there were significant differences in blood pressure reduction between the intervention group and the control group.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Yoga and acupressure combination was proven to reduce blood pressure. It is hoped that midwives or other health workers could implement it by teaching pregnant women, especially who suffer hypertension&lt;/em&gt;&lt;/p&gt;

Placenta Previa et Percreta: A Potentially Life-Threatening Condition.

Placenta percreta occurs in about 5% of placenta accreta spectrum (PAS) and causes high maternal and fetal peripartum morbidity/mortality. A 34-year-old multiparous 4G2P (1xcesarean section (CS)) was admitted to hospital at the 34th week of gestation. Transvaginal ultrasound revealed a placenta previa totalis et percreta with a small tissue layer towards the bladder. Ultrasound was crucial for further planning. An interdisciplinary setting was established based on this life-threatening diagnosis. Due to the onset of labor one day later, a CS was performed. Intraoperatively, the suspicion was confirmed of a placenta previa et percreta with CS scar infiltration. Due to the life-threatening bleeding risk, simultaneous subtotal hysterectomy was needed. The diagnosis was confirmed histologically. The higher the number of previous CS, the higher the PASrate. Placenta percreta is the most severe form of this, characterized by placental invasion through the entirety of the myometrium and possibly into extrauterine tissues. This case demonstrates the great importance of prenatal diagnosis with the realization of dimensions of this very rare finding, especially with an increasing CS rate and other associated complications. Due to the close interdisciplinary cooperation of the prenatal diagnosticians, obstetricians, and anesthesiologists with optimal care in a specialized center, the otherwise high morbidity/mortality can be minimized.

Effect of intraoperative blood transfusion on inflammatory response in parturients with placenta previa undergoing cesarean section: A prospective observational study

BackgroundThe neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red cell distribution width (RDW) have been reported as useful biomarkers for evaluating inflammation and a predictor of surgical prognosis. Although there have been recent reports that transfusion may affect inflammatory responses, studies on the post-transfusion inflammatory response in parturients are rare. Therefore, this study aimed to observe changes in inflammatory response after transfusion during cesarean section (C-sec) through NLR, PLR, and RDW. MethodsParturients aged 20–50 years who underwent C-sec under general anesthesia due to placenta previa totalis from March 4, 2021, to June 10, 2021 were participated in this prospective observational study. We compared postoperative NLR, PLR, and RDW between the transfusion and non-transfusion groups. ResultsA total of 53 parturients were included in this study, of which 31 parturients received intraoperative transfusions during C-sec. There were no significant difference in preoperative NLR (3.6 vs. 3.4, p = 0.780), PLR (132.8 vs. 111.3, p = 0.108), and RDW (14.2 vs. 13.6, p = 0.062) between the two groups. However, postoperative NLR was significantly higher in the transfusion group than in the non-transfusion group (12.2 vs. 6.8, p < 0.001). Postoperative RDW was significantly higher in the transfusion group than in the non-transfusion group (14.6 vs. 13.9, p = 0.002) whereas postoperative PLR was not significantly different between the two groups (108.0 vs. 117.4, p = 0.885). ConclusionsPostoperative NLR and RDW, the inflammatory biomarkers, were significantly higher in the transfused C-sec parturients. These results suggest a significant association between postoperative inflammatory response and transfusion in obstetric practice.

Placental mesenchymal dysplasia complicated with sudden fetal demise and amniotic fluid embolism: a case report

Placenta mesenchymal dysplasia (PMD) is a rare placental anomaly associated with various fetal and maternal complications. Whether close ultrasound surveillance can prevent intrauterine fetal demise (IUFD) in patients with PMD is still under investigation. Amniotic fluid embolism (AFE) is a rare, lethal, and unpredictable maternal complication that has never been described in association with PMD. Here, we report a case of PMD, in which the fetus eventually demised in utero despite weekly color Doppler monitoring, and the mother subsequently encountered AFE during delivery. A 43-year-old woman who had received three frozen embryo transfer, was found to have a singleton pregnancy with an enlarged multi-cystic placenta at 8 weeks' gestation. Fetal growth restriction (FGR) was noted since the 21stweek. The fetus eventually demised in-utero at 25 weeks despite weekly color Doppler surveillance. Cesarean section was performed under general anesthesia due to placenta previa totalis and antepartum hemorrhage. During surgery, the patient experienced a sudden blood pressure drop and desaturation followed by profound coagulopathy. AFE was suspected. After administration of inotropic agents and massive blood transfusion, the patient eventually survived AFE. PMD was confirmed after pathological examination of the placenta. While FGR can be monitored by color Doppler, our case echoed previous reports that IUFD may be unpreventable even under intensive surveillance in PMD cases. Although AFE is usually considered unpredictable, PMD can result in cumulative risk factors contributing to AFE. Whether a specific link exists between the pathophysiology of PMD and AFE requires further investigation.

Epidural Anesthesia Management in Cesarean Section with Placenta Accreta

Background: In pregnant women, the spectrum of placenta accreta is considered a high risk syndrome. Placenta accreta is responsible for 7-10% of all maternal deaths worldwide. This study reports on a patient with placenta accreta who underwent a cesarean section using epidural anesthesia. Case: A 30-year-old woman (Gravida: 3, Abortus: 1, Partus: 1) with a gestational age of 8 months came to the hospital. with 8 months of gestation was diagnosed with antepartum hemorrhage et causa placenta previa totalis morbidly adherent placenta high risk with planned elective cesarean section with bilateral tubectomy to hysterectomy, Double J (DJ) stent, Ballooning using epidural anesthesia with physical American Society of Anesthesiologists (ASA) II status. Local anesthetic with 2% lidocaine 2 ml, 12 ml of 0.5% bupivacaine given in incremental doses of 4 ml every 5 minutes while monitoring the patient's hemodynamics. Intraoperative drugs consist of intravenous (IV) dexamethasone 5 mg IV, ondansetron 8 mg IV, tranexamic acid 1 gram, paracetamol 1 gram IV, bupivacaine 0.5% 3ml every 1 hour via an epidural catheter. Maintenance using O2 3 lpm. The operation lasted 450 minutes, with stable outcome both maternal and fetal. Conclusion: Anesthesia management in patients with bleeding during labor is very important. In this case, epidural anesthesia provide a good outcome in maternal and fetal after cesarean section in placenta accreta patient.

Regional Anesthesia Conversion to General Anesthesia during Cesarean Section of a Woman with Antepartum Hemorrhage due to Placenta Previa and Ovarian Cyst with Moderate Confirmed COVID-19: A

Physiological changes during pregnancy and COVID-19 may affect one another. This report presents a 37-year-old female G4P10021 with gestational age 37+2 weeks infected with COVID-19 in Dr. Moewardi Hospital Surakarta, Central Java, Indonesia. The patient was diagnosed with antepartum hemorrhage due to total placenta previa with low-risk Morbidly Adherent Placenta score, a history of cesarean section, and ovarian cyst. The patient underwent conversion from spinal anesthesia to general anesthesia. Within 40 min after spinal anesthesia, the patient complained shortness of breath, which then worsened into decreased consciousness and inadequate spontaneous breathing. This may be complicated by the COVID-19 infection which has several effects on pregnancy.

A theoretical analysis of prophylactic common iliac arterial occlusion for potential massive bleeding during cesarean delivery: Decision-making considerations — A 2-year retrospective study

ObjectiveAccording to the American College of Obstetricians and Gynecologists, there has been a rapid increase in the total cesarean birth rates. The rate of placenta accreta is increasing, and previous cesarean delivery is the most common risk factor. Labor is a major challenge in cases with an abnormally invasive placenta, considering the risk of massive blood loss during cesarean delivery and patient wishes for uterine preservation. Materials and methodsWe retrospectively obtained clinical data and surgical outcomes of high-risk cases of placenta previa totalis and placenta accreta admitted between March 2018 and September 2020. A multidisciplinary discussion was conducted before surgery. We also constructed an organizational flowchart detailing this decision-making process. ResultsPatients who underwent cesarean delivery for suspected placenta accreta or placenta previa totalis with clinical risk factors were reviewed. No patient required an emergency hysterectomy or intensive care unit admission. ConclusionWe shared our experience of multidisciplinary decision-making by presenting high-risk cases of placenta previa totalis with clinical risk factors or suspected placenta accreta. Based on our multidisciplinary decision-making process, all patients were discharged without complications.

Uterovesical fistula after uterine compression suture

Uterovesical fistula is a rare complication. In this case, a utero-fetal fistula developed in a patient with lower uterine segment compression suture in cesarean section due to placenta previa totalis is described.

Total Placenta Previa with High-risk MAP and Transverse Lie Fetal Position

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Massive obstetric haemorrhage on post caesarean subtotal hysterectomy due to late detection of occult placenta percreta: A case report.

IntroductionPlacenta accreta syndrome is a significant cause of maternal mortality and morbidity. Therefore, a multidiscipline approach is essential to overcome this life-threatening disorder for the mother and fetus.Presentation of caseA 32-year-old women gravida 3 parity 2, 34 weeks gestation come due to recurrent antepartum haemorrhage. She had twice prior caesarean section. Ultrasound assessment suggests total placenta previa and elevating suspicion to placenta accreta. However, intraoperatively its sign is unavailable. Although we have done subtotal hysterectomy, massive bleeding still occurring. Therefore, we present management of unexpected placenta percreta.DiscussionManagement of unexpected placenta percreta involves prenatal diagnosis, haemoglobin optimization, surgical management anticipating haemorrhage, dedicated maternal ICU, blood bank providing massive transfusion and blood component.ConclusionClose monitoring is important in catastrophe management of Placenta Accreta Syndrome.

Delta Neutrophil Index as a Promising Biomarker for Placental Implantation Disorders.

We aimed to investigate the value of maternal serum delta neutrophil index (DNI) levels in predicting placenta accreta spectrum in patients with placenta previa. The patients who were found to have placenta previa totalis were included in our study. Location of placental implantation and depth of myometrial invasion were defined by transabdominal and transvaginal 2D gray scale and Doppler sonography and confirmed during cesarean section and histopathological evaluation. Patients were subjected to complete blood counts, including prenatal hemoglobin level, total white blood cell count, differential leukocyte count, and platelet count. The following formula was used to calculate the DNI level: DNI (%)=(leukocyte subfraction analyzed by cytochemical reaction in the MPO channel) - (leukocyte subfraction analyzed using the nuclear lobularity channel with reflected light beam measurements). Placenta previa was detected in 295 patients; 31 of them had PAS. As the control group, 189 patients were evaluated. In the group with PAS, the DNI value was significantly higher (p<0.05) than the other groups. DNI value in the group with previa only was also significantly higher (p<0.05) than the control group. In the univariate model, a significant (p<0.05) effect of DNI value and number of cesarean sections was observed in separating patients with previa only and PAS. In the multivariate model, a significant independent (p>0.05) effect of the DNI value was observed in separating patients with previa only and PAS. Significant efficiency of DNI value [area under the curve 0.899 (0.814-0.984)] was observed in differentiating patients with previa only and PAS. Significant efficacy of DNI 5 cut-off value [area under the curve 0.858 (0.770-0.946)] was observed in distinguishing patients with previa only and PAS (sensitivity 80.0%, positive predictive value 64.9%, specificity 91.6%, negative predictive value 95.9%) CONCLUSION: Maternal DNI values seem to be beneficial with respect to both previa and invasion prediction. Although more comprehensive studies are needed to test this proposition, prediction studies of this practical test should be done in different trimesters and its usability with respect to preventing maternal-fetal morbidity should be investigated.

Total Placenta Previa with High-Risk Morbidly Adherent Placenta and Transverse Lie Fetal Position

Abstract Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk morbidly adherent placenta score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.