Intraoperative blood volume loss according to gestational age at delivery among pregnant women with placenta accreta spectrum (PAS): an 11-year experience in Songklanagarind Hospital

2021 ◽  
pp. 1-6
Author(s):  
Nuttaporn Maison ◽  
Athithan Rattanaburi ◽  
Ninlapa Pruksanusak ◽  
Rakchai Buhachat ◽  
Sathana Tocharoenvanich ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Blood Volume ◽  
Gestational Age ◽  
Placenta Accreta ◽  
Volume Loss ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum

scholarly journals Outcomes in emergency versus elective cases of placenta accreta spectrum disorder managed by caesarean-hysterectomy within a dedicated multidisciplinary care team: retrospective cohort study.

2021 ◽  
Author(s):  
Homero Flores Mendoza ◽  
Anjana Chandran ◽  
Carlos Hernandez-Nieto ◽  
Ally Murji ◽  
Lisa Allen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Placenta Accreta ◽  
Perinatal Outcomes ◽  
Elective Delivery ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy

Objective: Compare maternal and perinatal outcomes between emergency and elective caesarean-hysterectomy for placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team. Design and setting: Single-centre retrospective cohort study Population: 125 cases of antenatally suspected and pathologically confirmed PAS disorder. Methods: Maternal and perinatal outcomes were analyzed. Multivariate logistic regression was used to test associations, adjusting for potential confounders. Survival curves exploring risk factors for emergency delivery were sought. Main Outcome Measures: Maternal outcomes including hemorrhagic morbidity, operative complications. Perinatal outcomes included gestational age at delivery, birthweight, Apgar scores and perinatal death. Results: 25 (20%) and 100 (80%) patients had emergency and elective delivery, respectively. Emergency delivery had a higher estimated blood loss (median IQR 2772 [2256.75] vs. 1561.19 [1152.95], p<0.001), with a higher rate of coagulopathy (40 vs. 6%; p<0.001) and bladder injury (44 vs. 13%; p<0.001). Emergency delivery was associated with increased rates of blood transfusion (aOR 4.9, CI95% 1.3-17.5, p=0.01), coagulopathy (aOR 16.4, CI95% 2.6-101.4, p=0.002) and urinary tract injury (aOR 6.96, CI95% 1.5-30.7, p=0.01). Gestational age at delivery was lower in the emergency group (mean SD 35.19 [2.77] vs. 31.55 [4.75], p=0.001), no difference in perinatal mortality was found (aOR 0.01, CI95% <0.001-17.5, p=0.53). A sonographically short cervix and/or history of APH had an increased cumulative risk of emergency delivery with advancing gestational age. Conclusions: Patients with PAS disorders managed in a tertiary centre by a multidisciplinary team requiring emergency delivery have increased maternal morbidity and poorer perinatal outcomes than those with elective delivery.

Circulating CD31+ Exosomes are Significantly Elevated with a Proliferative and Angiogenic but Anti-apoptotic mRNA Signature in Pregnant Women with Placenta Accreta Spectrum

Placenta ◽  
2019 ◽  
Vol 83 ◽  
pp. e14-e15
Author(s):  
Qian-Rong Qi ◽  
Josh Makhoul ◽  
Thomas Lechuga ◽  
A. Al-Khan ◽  
Nick Illsley ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Placenta Accreta ◽  
Placenta Accreta Spectrum

Intraplacental Fetal Vessel Diameter May Help Predict for Placental Invasiveness in Pregnant Women at High Risk for Placenta Accreta Spectrum Disorders

Radiology ◽  
2020 ◽  
pp. 200273 ◽  
Author(s):  
Charis Bourgioti ◽  
Anastasia Evangelia Konstantinidou ◽  
Konstantina Zafeiropoulou ◽  
Aristeidis Antoniou ◽  
Stavros Fotopoulos ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Placenta Accreta ◽  
Vessel Diameter ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders ◽  
Fetal Vessel

Placenta Accreta and Vaginal Bleeding According to Gestational Age at Delivery

2015 ◽  
Vol 125 (4) ◽  
pp. 808-813 ◽  
Author(s):  
Martha W.F. Rac ◽  
C. Edward Wells ◽  
Diane M. Twickler ◽  
Elysia Moschos ◽  
Donald D. McIntire ◽  
...  
Keyword(s):  
Gestational Age ◽  
Vaginal Bleeding ◽  
Placenta Accreta ◽  
Gestational Age At Delivery

Urological Involvement in the Multidisciplinary Management of Placenta Accreta Spectrum in a Centralised, High-Volume Centre: A Retrospective Analysis

2022 ◽  
Vol 3 (1) ◽  
Author(s):  
Brian D. Kelly ◽  
Rebecca Moorhead ◽  
David Wetherell ◽  
Tracey Gilchrist ◽  
Marcalain Furrer ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Rare Condition ◽  
High Volume ◽  
Tertiary Referral Centre ◽  
Data Set ◽  
Optimal Outcomes ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum ◽  
Urological Intervention ◽  
Ureteric Injuries

Objectives Placenta accreta spectrum (PAS) significantly increases the complexity of childbirth and frequently involves urologic organs. Multidisciplinary team (MDT) care is paramount to ensure optimal outcomes. We aimed to evaluate urologic interventions in patients with PAS at a centralised, tertiary referral centre. Methods An analysis of a prospectively collected data set, consisting of all women presenting with PAS at our institution between November 2013 and June 2019. Patients who required urological intervention were identified, and perioperative details were retrieved. Results Forty-two cases of PAS were identified. The mean maternal age was 35 years, and mean gestational age at delivery was 34 weeks. Thirty-seven cases were managed electively, with 5 cases managed conservatively (no hysterectomy) and 5 requiring emergency management. Fifteen patients (36%) had suspected bladder invasion on MRI. A total of 36 patients (86%) had ureteric catheters inserted, 14 (33%) required bladder repair, and 2 had ureteric injuries (5%). Conclusions PAS frequently requires urological intervention to prevent and repair injury to the urinary bladder and ureter. PAS is a rare condition that is best managed in an MDT setting in a centralised, tertiary, high-volume centre with access to a variety of medical and surgical sub-specialities.

scholarly journals apoA2 correlates to gestational age with decreased apolipoproteins A2, C1, C3 and E in gestational diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e001925
Author(s):  
Manjunath Ramanjaneya ◽  
Alexandra E Butler ◽  
Mohammed Bashir ◽  
Ilham Bettahi ◽  
Abu Saleh Md Moin ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Gestational Age ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcome ◽  
Adverse Outcomes ◽  
Bivariate Analysis ◽  
Premature Delivery ◽  
Gestational Age At Delivery

IntroductionPregnant women with gestational diabetes mellitus (GDM) are at risk of adverse outcomes, including gestational hypertension, pre-eclampsia, and preterm delivery. This study was undertaken to determine if apolipoprotein (apo) levels differed between pregnant women with and without GDM and if they were associated with adverse pregnancy outcome.Research design and methodsPregnant women (46 women with GDM and 26 women without diabetes (ND)) in their second trimester were enrolled in the study. Plasma apos were measured and correlated to demographic, biochemical, and pregnancy outcome data.ResultsapoA2, apoC1, apoC3 and apoE were lower in women with GDM compared with control women (p=0.0019, p=0.0031, p=0.0002 and p=0.015, respectively). apoA1, apoB, apoD, apoH, and apoJ levels did not differ between control women and women with GDM. Pearson bivariate analysis revealed significant correlations between gestational age at delivery and apoA2 for women with GDM and control women, and between apoA2 and apoC3 concentrations and C reactive protein (CRP) as a measure of inflammation for the whole group.ConclusionsApoproteins apoA2, apoC1, apoC3 and apoE are decreased in women with GDM and may have a role in inflammation, as apoA2 and C3 correlated with CRP. The fact that apoA2 correlated with gestational age at delivery in both control women and women with GDM raises the hypothesis that apoA2 may be used as a biomarker of premature delivery, and this warrants further investigation.

Evaluation of the Tramline Sign in the Prediction of Placenta Accreta Spectrum and Perioperative Outcomes in Anterior Placenta Previa

2021 ◽  
Author(s):  
Andrea Dall’Asta ◽  
Francesco Forlani ◽  
Harsha Shah ◽  
Gowrishankar Paramasivam ◽  
Joseph Yazbek ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
3D Ultrasound ◽  
Perioperative Outcomes ◽  
Pathology Report ◽  
Full Bladder ◽  
Estimated Blood Loss ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum

Abstract Purpose To evaluate perioperative outcomes and the prognostic role of the tramline sign in a cohort of women with anterior placenta previa. Materials and Methods Retrospective analysis of 3D ultrasound volumes from women with anterior placenta previa who underwent ultrasound examination beyond 32 weeks. 3D and 3D color volumes were obtained from a sagittal section of the uterus bisecting a partially full bladder and processed using Crystal Vue and Crystal Vue Flow rendering to look for the “tramline sign”. “Partial obliteration” was defined as a loss of some or part of the uterine-serosal interface and “full obliteration” as when both interfaces were interrupted. Postnatal ascertainment of placenta accreta spectrum (PAS) was confirmed by findings recorded intraoperatively or on a pathology report. Results 65 cases were included. The tramline sign was “partially” (17) or “fully” (19) obliterated in 36 cases (55.4 %), and present in 29 (44.6 %). Obliteration was associated with earlier gestational age at delivery (35 + 1 (26 + 3–38 + 3) vs. 36 + 4 (25 + 3–38 + 0) weeks, p = 0.005), greater estimated blood loss (800 (400–11 000) vs. 600 (300–2100) mls, p = 0.003), longer operative time (155 (60–240) vs. 54 (25–80) minutes, p < 0.001), higher rate of hysterectomy (97.2 % vs. 0.0 %, p < 0.001), longer postoperative admission (7 (3–19) vs. 3 (1–5) days, p < 0.001) and a 100 % rate of postnatal diagnosis of PAS. The finding of an “obliterated” tramline sign identified all women that required hysterectomy and all cases of PAS. Conclusion A “partially or fully obliterated” tramline sign is strongly associated with indicators of operative complexity, the postnatal confirmation of PAS, and the need for peripartum hysterectomy.

scholarly journals Prediction of Placenta Accreta Using Hyperglycosylated Human Chorionic Gonadotropin

2018 ◽  
Vol 8 (2) ◽  
pp. 142-146
Author(s):  
Maad Mahdi Shalal ◽  
Shaymaa Kadhim Jasim ◽  
Huda Khalil Abd
Keyword(s):  
Caesarean Section ◽  
Pregnant Women ◽  
Chorionic Gonadotropin ◽  
Gestational Age ◽  
Human Chorionic Gonadotropin ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Control Group ◽  
Previous Caesarean Section ◽  
Hyperglycosylated Human Chorionic Gonadotropin

Objectives: Hyperglycosylated human chorionic gonadotropin (hCG) is a variant of hCG. In addition, it has a different oligosaccharide structure compared to the regular hCG and promotes the invasion and differentiation of peripheral cytotrophoblast. This study aimed to measure hyperglycosylated hCG as a predictor in the diagnosis of placenta accreta. Materials and Methods: In general, 90 pregnant women were involved in this case-control study among which, 30 ladies (control group) were pregnant within the gestational age of ≥36 weeks with at least one previous caesarean section and a normal sited placenta in transabdominal ultrasound (TAU). The other 60 pregnant women (case group) were within a gestational age of ≥36 weeks at least, one previous caesarean section and placenta previa with or without signs of placenta accreta in TAU. Hyperglycosylated hCG and total hCG were measured in each group and the results of the surgery were followed up. Results: Hyperglycosylated hCG showed higher serum levels in patients with placenta accreta compared to those with placenta previa and control women. Hyperglycosylated hCG with an optimal cut point of (3) IU/L predicted placenta accreta in pregnant women with 90% specificity, 76.7% sensitivity, and 81.1% accuracy. Conclusions: The high specificity of the above approach makes it a good diagnostic tool (as a single test) for confirming placenta accreta in clinical settings. When this test is added to our established workup, its high positive predictive value makes it a suitable method within the algorithm of accreta confirmation when there is a high suspicion or insufficient evidence to the diagnosis of placenta accreta.

scholarly journals Conditions that increase the risk of cesarean-related blood transfusions: a single-center cohort study

2021 ◽  
Vol 29 (3) ◽  
pp. 210-216
Author(s):  
Mehmet Murat Işıkalan ◽  
Eren Berkay Özkaya ◽  
Buşra Özkaya ◽  
Nurullah Şengül ◽  
Enes Ferlibaş ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Uterine Fibroids ◽  
University Hospital ◽  
Preoperative Anemia ◽  
Multiple Gestations ◽  
Anemia During Pregnancy ◽  
Placenta Accreta Spectrum

Objective This study aimed to define the conditions that increase the possibility of receiving a blood transfusion in patients who had a cesarean section. Methods This study was conducted between January 2016 – May 2020 in a university hospital located in Konya, Turkey. Pregnant women undergoing cesarean section were included. Of 4303 eligible patients, 188 women were the transfused group and 4115 women were the non-transfused group. Logistic regression analysis was performed for potential confounding factors. Results A total of 4303 eligible patients were evaluated in this study. There were 4115 patients (95.6%) in the non-transfused group. The transfused group consisted of 188 patients (4.4%). The probability of transfusion was higher in pregnant women with placenta previa, placenta accreta spectrum, thrombocytopenia, preoperative anemia, macrosomia above 4500 g, and multiple gestations [adjusted OR values (95% CI); 10.58 (range 4.75–23.57), 7.75 (range 3.22–18.61), 7.85 (range 3.46–17.79), 5.71 (range 4.21–7.74), 4.22 (range 1.21-14.67) and 2.10 (range 1.18-3.72), respectively]. There was no increase in the possibility of transfusion in 4000–4500 gram macrosomia, uterine fibroids, preeclampsia, premature rupture of membranes, previous cesarean sections and gestational diabetes mellitus. Conclusion Placenta previa, placenta accreta spectrum, thrombocytopenia, preoperative anemia, macrosomia above 4500 g and multiple gestations increase the possibility of transfusion. Perioperative blood preparation is vital in such patients. Prevention of anemia during pregnancy is critical in reducing transfusions.

Local incidence of Jarisch–Herxheimer reaction in pregnancy following penicillin treatment for syphilis: A case series

2021 ◽  
pp. e20210001
Author(s):  
Amreet Dhaliwal ◽  
Alison A Lopez ◽  
Jared Bullard ◽  
Vanessa Poliquin
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Gestational Age ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Antimicrobial Treatment ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gestational Age At Delivery

Background: The literature suggests that the Jarisch–Herxheimer (J-H) reaction following antimicrobial treatment of syphilis is common and may precipitate uterine activity. Local practice is to transfer syphilitic parturients beyond gestational age of viability from rural locations to a tertiary care centre for treatment. Study objectives were to delineate local incidence and risk factors for the J-H reaction among pregnant women receiving treatment for syphilis. Methods: A retrospective chart review was conducted on pregnant women diagnosed with syphilis and treated during pregnancy at a tertiary care centre between 2012 and 2018. J-H reaction was defined as having ≥1 of the following symptoms within 24 hours of antibiotic treatment: fever (temperature ≥38°C), clinical description of a painful or itchy skin lesion, headache, hypotension (systolic BP <90), uterine contractions, or fetal heart rate decelerations. Descriptive statistical analysis was performed with mean and median used as measures of central tendency for continuous and categorical data, respectively. Results: Fifty-eight charts were eligible for inclusion. Mean maternal age was 25.1 (SD 5.6) years, and mean gestational age was 20.4 (SD 9.5) weeks when syphilis was diagnosed. One patient (1/58, 1.7%) met J-H reaction criteria. Mean gestational age at delivery was 37.1 (SD 3.4) weeks. One stillbirth (1.7%) was identified. Conclusions: The J-H reaction is less common at our centre than the literature suggests. Further research is important to identify risk factors associated with J-H reaction to optimize resource allocation in the context of treatment of syphilis during pregnancy.

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