Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries

2021 ◽  
pp. 103-107
Author(s):  
Matthew K. Janssen ◽  
Steven J. Ralston
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Case Scenario ◽  
Centers Of Excellence ◽  
Cesarean Deliveries ◽  
Multicenter Prospective Cohort Study ◽  
Multiple Repeat ◽  
Multicenter Prospective Cohort ◽  
Landmark Study

The article provides a review of a landmark study characterizing the risk of repeat cesarean deliveries. This multicenter prospective cohort study of over 30,000 cesarean deliveries demonstrates that risks of cesarean delivery increase sequentially, even in the absence of placenta accreta. The most dramatic increase is noted in the high rates of accreta with placenta previa and multiple cesarean deliveries, greater than 40% with 3 of more cesarean deliveries. This review highlights the key findings, methodology, and impact of this landmark study. It discusses other studies that continue to verify these results as well as contextualize them in the management of placenta accreta with developing centers of excellence. Finally, the article provides a sample clinical case scenario that applies the findings of this study.

Maternal Morbidity with Repeated Cesarean Deliveries

2021 ◽  
Author(s):  
Rebecca Klahr ◽  
Kevin Cheung ◽  
Emily S. Markovic ◽  
Mackenzie Naert ◽  
Andrei Rebarber ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Placenta Previa ◽  
Adverse Outcomes ◽  
Wound Complications ◽  
Chi Square ◽  
Maternal Fetal Medicine ◽  
Cesarean Deliveries ◽  
Key Points ◽  
The Absolute ◽  
Uterine Dehiscence

Objective This study aimed to estimate the association between adverse maternal outcomes and the number of repeated cesarean deliveries (CDs) in a single obstetrical practice. Study Design Retrospective cohort study of all CDs between 2005 and 2020 in a single maternal fetal medicine practice. We used electronic records to get baseline characteristics and pregnancy/surgical outcomes based on the number of prior CDs. We performed two subgroup analyses for women with and without placenta previa. Chi-square for trend and one-way analysis of variance (ANOVA) were used. Results A total of 3,582 women underwent CD and met inclusion criteria. Of these women, 1,852 (51.7%) underwent their first cesarean, 950 (26.5%) their second, 382 (10.7%) their third, 191 (5.3%) their fourth, 117 (3.3%) their fifth, and 84 (2.3%) their sixth or higher CDs. The incidence of adverse outcomes (placenta accreta, uterine window, uterine rupture, hysterectomy, blood transfusion, cystotomy, bowel injury, need for a ventilator postpartum, intensive care unit admission, wound complications, thrombosis, reoperation, and maternal death) increased with additional CDs. However, the absolute rates remained low. In women without a placenta previa, the likelihood of adverse outcome did not differ across groups. In women with a placenta previa, adverse outcomes increased with increasing CDs. However, the incidence of placenta previa did not increase with increasing CDs (<5% in each group). The incidence of a uterine dehiscence increased significantly with additional CDs: first, 0.2%; second, 2.0%; third, 6.6%; fourth, 10.3%; fifth, 5.8%; and sixth or higher, 10.4% (p < 0.001). Conclusion Maternal morbidity increases with CDs, but the absolute risks remain low. For women without placenta previa, increasing CDs is not associated with maternal morbidity. For women with placenta previa, risks are highest, but the incidence of placenta previa does not increase with successive CDs. The likelihood of uterine dehiscence increases significantly with increasing CDs which should be considered when deciding about timing of delivery in this population. Key Points

Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries

2006 ◽  
Vol 107 (6) ◽  
pp. 1226-1232 ◽  
Author(s):  
Robert M. Silver ◽  
Mark B. Landon ◽  
Dwight J. Rouse ◽  
Kenneth J. Leveno ◽  
Catherine Y. Spong ◽  
...  
Keyword(s):  
Maternal Morbidity ◽  
Cesarean Deliveries ◽  
Multiple Repeat

scholarly journals Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 111
Author(s):  
Nicolae Gică ◽  
Carina Ragea ◽  
Radu Botezatu ◽  
Gheorghe Peltecu ◽  
Corina Gică ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Morbidity Rate ◽  
Maternal Outcomes ◽  
Peripartum Hysterectomy ◽  
Cesarean Deliveries ◽  
Life Saving ◽  
Emergency Peripartum Hysterectomy ◽  
Placenta Accreta Spectrum

Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.

Placenta Accreta Spectrum: In Vitro Fertilization and Non-In Vitro Fertilization and Placenta Accreta Spectrum in a Massachusetts Cohort

2020 ◽  
Author(s):  
Anna M. Modest ◽  
Thomas L. Toth ◽  
Katherine M. Johnson ◽  
Scott A. Shainker
Keyword(s):  
In Vitro Fertilization ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
The United States ◽  
Lower Prevalence ◽  
Vitro Fertilization ◽  
Cesarean Deliveries ◽  
Increased Risk ◽  
Placenta Accreta Spectrum

Objective The incidence of placenta accreta spectrum (PAS) has been increasing in the United States. In addition, there has also been an increase in the utilization of in vitro fertilization (IVF). The IVF pregnancies confer an increased risk of adverse obstetric and neonatal outcomes, but there is limited data on whether IVF is associated with PAS. The aim of this study is to assess the association between IVF and the risk of PAS. Study Design This was a retrospective cohort study of deliveries from January 1, 2013 to August 1, 2018 at a tertiary hospital in the Massachusetts. IVF pregnancies were compared with non-IVF pregnancies, and PAS diagnosis was confirmed by histopathology reports. Hospital administrative data and medical record review were used, and supplemented with data from birth certificates from the Massachusetts Department of Public Health. Results We identified 28,344 pregnancies that met inclusion criteria, of which 1,418 (5.0%) were IVF pregnancies. The overall incidence of PAS was 0.4% (2.2% in the IVF group and 0.3% in the non-IVF group). Women who underwent IVF had 5.5 times the risk of PAS (95% confidence interval [CI]: 3.4–8.7) compared with women in the non-IVF group, adjusted for maternal age, nulliparity, and year of delivery (Table 5). Compared with women in the non-IVF group, the IVF group had fewer prior cesarean deliveries (22.6 vs. 64.2%) and a lower prevalence of placenta previa (19.4 vs. 44.4%). Conclusion Women with an IVF pregnancy carry an increased risk of PAS compared with non-IVF. Among women who underwent IVF, there was a lower prevalence of prior cesarean deliveries and placenta previa. Future work is needed to identify the mechanism of association for this increased risk as well as a reliable tool for antenatal detection in this cohort of women. Key Points

scholarly journals The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

2020 ◽  
Vol 28 (3) ◽  
pp. 176-182
Author(s):  
Şener Gezer ◽  
Mehmet Zeki Türe ◽  
Sibel Balcı ◽  
İzzet Yücesoy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Maternal Morbidity ◽  
Blood Product ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Previous Cesarean Section ◽  
Short Term ◽  
History Of ◽  
Previous Cesarean

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone.

scholarly journals PLACENTA ACCRETA SPECTRUM - A CASE SERIES

2020 ◽  
pp. 1-4
Author(s):  
Medha Dadaji Davile ◽  
Anil Charandas Humane ◽  
Ashwini Kuchnur
Keyword(s):  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Obstetric Hemorrhage ◽  
Adherent Placenta ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening ◽  
History Of ◽  
Placenta Accreta Spectrum

Morbidly adherent placenta is a major cause for massive obstetric hemorrhage, which leads to maternal morbidity and mortality. Most accepted hypothesis for etiology of placenta accreta spectrum is defect in the endometrial–myometrial interface which leads to failure of normal decidualization in the uterine scar, which allows abnormal deep infiltration of placental anchoring villi and trophoblast. Maternal morbidity and mortality can occur as a result of massive and sometimes life-threatening obstetric hemorrhage which often requires blood transfusion. It becomes exponential and life threatening when placenta previa is associated with placenta accreta spectrum. There are several risk factors for placenta accreta spectrum, most common being previous caesarian section. Antenatal diagnosis of placenta accreta is highly desirable as outcomes are optimized when timely delivery occurs at a tertiary care facility accustomed to handle such cases. Here we are reporting six cases of placenta accreta spectrum managed by conventional and expectant way at our tertiary care hospital. Methods: Study was carried out in Government Medical College & Hospital, Nagpur. Case records of patients with placenta accreta syndrome between December 2019 and March 2020 were reviewed and analysed. Results: Six cases of placenta accreta syndrome were studied.100% patients had history of previous caesarean section, 5 patients had associated placenta previa. One out of six patients one had history of dilatation and evacuation for missed abortion.4 out of six underwent caesarean hysterectomy and 2 underwent conservative management with uterine preservation. Average blood loss was 2500 ml. Conservative management was successful in two patients. There was no maternal mortality in series. Conclusion : Among many risk factors, previous caesarean section is the most common. Therefore reducing rate of caesarean deliveries can reduce the prevalence of placenta accreta syndromes. Adherent placenta should be suspected in cases of previous caesarean with placenta previa, high parity, uterine curettage, and uterine surgeries.Conservative management should be reserved for selected patients. MRI is not mandatory for diagnosis of the condition.

scholarly journals Successful management of total placenta previa with placenta accreta presenting with massive obstetric hemorrhage: A case report

2018 ◽  
Vol 7 (8) ◽  
pp. 3417
Author(s):  
Sairem Mangolnganbi Chanu ◽  
Biswajit Dey ◽  
Samarjit Dey ◽  
Khairul Hadi ◽  
Nalini Sharma ◽  
...  
Keyword(s):  
Case Report ◽  
Postpartum Hemorrhage ◽  
Maternal Morbidity ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Obstetric Hemorrhage ◽  
Successful Management

Placenta previa and placenta accreta are important causes of serious fetal and maternal morbidity and even mortality necessitating hysterectomy. We report a case of total placenta previa with accreta in a 39-year-old female in the 32+2 weeks of pregnancy with successful delivery by cesarean. However, hysterectomy was performed to control postpartum hemorrhage.

scholarly journals Placenta accreta in a referred post hysterotomy case: a bold step into the unknown

2021 ◽  
Vol 10 (2) ◽  
pp. 765
Author(s):  
Shrinivas N. Gadappa ◽  
Rupali A. Gaikwad ◽  
Anurag A. Sonawne ◽  
Ankita R. Shah ◽  
Shrutika O. Makde ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Multidisciplinary Care ◽  
Fold Increase ◽  
Tertiary Care Centre ◽  
Cesarean Deliveries ◽  
Multidisciplinary Care Team ◽  
Placenta Accreta Spectrum

Placenta accreta spectrum encompasses a range of pathological adherence of placenta and causes significant maternal and neonatal morbidity and mortality. With the increase in the number of cesarean deliveries over the last few decades, there has been an 8 fold increase in the incidence of placenta accreta. The single most important risk factor reported in about half the cases of PAS disorders is placenta previa. Management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta. We discuss a rare case of a patient who underwent hysterotomy in an outside hospital and was referred to our tertiary care centre as atonic PPH. Undiagnosed antenatally and at the time of hysterotomy, she was diagnosed as a case of placenta accreta on exploration at our institute and was surgically managed.

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