Lower uterine segment scar assessment at 11‐14 weeks gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery

2021 ◽  
Author(s):  
A. Bhatia ◽  
M. Palacio ◽  
A. M. Wright ◽  
G. S. H. Yeo
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Lower Uterine Segment ◽  
Scar Assessment ◽  
Placenta Accreta Spectrum

scholarly journals 646 Characterizing placenta accreta spectrum in patients without prior cesarean delivery

2021 ◽  
Vol 224 (2) ◽  
pp. S406
Author(s):  
Teodora Kolarova ◽  
Rebecca Simon ◽  
Hayley MacKinnon ◽  
Ralph N. Burns ◽  
Kelsey Olerich ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Accreta Spectrum

Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum

2021 ◽  
Author(s):  
Kathy C. Matthews ◽  
Andrew S. Quinn ◽  
Stephen T. Chasen
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Placenta Accreta ◽  
External Cephalic Version ◽  
Cesarean Sections ◽  
Medical Indication ◽  
Placenta Accreta Spectrum ◽  
Primary Cesarean Delivery ◽  
Insured Patients ◽  
Privately Insured

Background Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. Objective The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum. Study Design This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” recommendations. Fisher's exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant. Results Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM “Safe Prevention of the Primary Cesarean Delivery” publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004). Conclusion Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level. Key Points

Prior Cesarean Delivery Healthcare Facilities Variations in Pregnancy Outcomes of Placenta Accreta Spectrum with Placenta Previa: A retrospective study from a tertiary transferal center (Preprint)

2021 ◽  
Author(s):  
Xuan Gao ◽  
Shaoshuai Wang ◽  
Lijie Wei ◽  
Peng Gao ◽  
Jiaqi Li ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Placenta Percreta ◽  
County Level ◽  
Healthcare Facilities ◽  
Placenta Accreta Spectrum ◽  
Province Level ◽  
Rural Township ◽  
Previous Cesarean

BACKGROUND The prevalence of Placenta Accreta Spectrum(PAS) is increasing rapidly linked with the cesarean rate increase worldwide, creating a threatening condition from severe postpartum hemorrhage to various maternal morbidities. The socio-economic imbalance, geographical, qualification, and specialty variations of the previous cesarean delivery healthcare facilities resulted in assessment and management difficulties. OBJECTIVE To assess variations of prior cesarean delivery healthcare facilities on pregnancy outcomes on current PAS with Placenta Previa. METHODS This retrospective study was conducted in a tertiary referral center from Nov.2015 to Nov.2020 in central China. Healthcare facilities were classified by geographical, hospital grading, ownership, and specialty variations. The primary outcome was postpartum hemorrhage(PPH), secondary outcomes included Placenta Percreta and maternal-fetal morbidities. RESULTS In total, 252 patients were enrolled, 58(23%) patients had Placenta Accreta, 131(52%) had Placenta Increta and 63(25%) had Placenta Percreta. The overall incidence of PPH was 47.2%(119 out of 252). As the administrative geographical level becoming smaller and more distant, PPH incidence climbed up: province-level(10, 32.3%), prefecture-level(65, 48.5%), county-level(30, 42.3%), and rural township(14, 82.5%), P for trend= 0.019. The odds of PPH in rural township clinics was 5.84(P=0.03, 95%CI 1.18~28.77) compared to the province-level hospitals. Similarly, when hospital grades declined, PPH incidence raised: tertiary(26, 39.4%), secondary(28, 43.8%), primary(14, 38.9%) and unclassified(51, 59.3%), P for trend= 0.047. Unclassified hospitals had 2.16(P= 0.046, 95%CI 1.02~4.61) times odds of PPH compared to tertiary medical centers. PPH showed no statistical significance based on ownership or specialty variations. Also, Placenta Percreta increased when geographical location shifted from urban to rural: three (9.7%) from province-level, 34(25.6%) from prefecture-level, 18(25.4%) from county-level and eight(47.1%) from rural township clinics, P= 0.04, P for trend =0.018. Patients with previous rural township clinics cesarean delivery had a 7.49 times risk((P=0.011, 95%CI 1.59~35.19) of developing Placenta Percreta compared with province-level hospitals. CONCLUSIONS Healthcare facilities variations of the previous cesarean delivery have upcoming impacts on subsequent pregnancy. The tendency of experiencing adverse maternal outcomes is more significant with prior cesarean in the rural township clinics and unclassified hospitals. The findings call for physicians’ alertness, persistent efforts in urban-rural disparity reduction, and measures to achieve equitable management.

Early prediction of placenta accreta spectrum in women with prior cesarean delivery using transvaginal ultrasound at 11 to 14 weeks

2020 ◽  
Vol 2 (4) ◽  
pp. 100183
Author(s):  
Georgios Doulaveris ◽  
Katherine Ryken ◽  
Daphne Papathomas ◽  
Fatima Estrada Trejo ◽  
Melissa J. Fazzari ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Transvaginal Ultrasound ◽  
Early Prediction ◽  
Placenta Accreta Spectrum

scholarly journals Experience of Managing Suspected Placenta Accreta Spectrum with or without Internal Iliac Artery Balloon Occlusion in Two Lithuanian University Hospitals

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 345
Author(s):  
Egle Savukyne ◽  
Laura Liubiniene ◽  
Zita Strelcoviene ◽  
Ruta Jolanta Nadisauskiene ◽  
Edita Vaboliene ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Endovascular Procedure ◽  
Intraoperative Blood Loss ◽  
Internal Iliac ◽  
Placenta Accreta Spectrum

Background and objectives: Placenta previa and placenta accreta spectrum are considered major causes of massive postpartum hemorrhage. Objective: To determine whether the placement of an occlusion balloon catheter in the internal iliac artery could reduce bleeding and other related complications during cesarean delivery in patients with placenta previa and placenta accreta spectrum. Materials and Methods: A retrospective analysis was conducted at two tertiary obstetric units of Lithuania. From January 2016 to November 2019 patients with placenta previa and antenatally suspected invasive placenta were included in the intervention group and underwent cesarean delivery with endovascular procedure. From January 2014 to December 2015 patients with placenta previa and suspected placenta accreta spectrum were included in the non-intervention group. The primary outcomes were reduction in intraoperative blood loss and transfusion volumes in the intervention group. Secondary outcomes were the incidence of hysterectomy and maternal complications. Results: Nineteen patients underwent cesarean delivery with preoperative endovascular procedure, and 47 women underwent elective cesarean delivery. The median intraoperative blood loss (1000 (400–4500) mL vs. 1000 (400–5000) mL; p = 0.616) and the need for red blood cell transfusion during operation (26% vs. 23%; p = 0.517) did not differ significantly between the patients groups. Seven patients in the intervention group and two patients in the non-intervention group underwent perioperative hysterectomy (p = 0.002). None of the patients had complications related to the endovascular procedure. Conclusion: The use of intermittent balloon occlusion catheter in patients with placenta pathology is a safe method but does not significantly reduce intraoperative blood loss during cesarean delivery.

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