scholarly journals Maternal and neonatal outcomes in planned versus emergency cesarean delivery for placenta accreta spectrum: A multinational database study

2021 ◽  
Author(s):  
Maddalena Morlando ◽  
Alexander Schwickert ◽  
Vedran Stefanovic ◽  
Mina M. Gziri ◽  
Petra Pateisky ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Neonatal Outcomes ◽  
Database Study ◽  
Emergency Cesarean ◽  
Maternal And Neonatal Outcomes ◽  
Placenta Accreta Spectrum

scholarly journals A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Kasraeian ◽  
Atefe Hashemi ◽  
Kamran Hessami ◽  
Shaghayegh Moradi Alamdarloo ◽  
Razie Vahdani ◽  
...  
Keyword(s):  
Blood Loss ◽  
Multidisciplinary Approach ◽  
Placenta Accreta ◽  
Antenatal Diagnosis ◽  
Neonatal Outcomes ◽  
Peripartum Hysterectomy ◽  
Resource Limited ◽  
Maternal And Neonatal Outcomes ◽  
Placenta Accreta Spectrum ◽  
The Mean

Abstract Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.

scholarly journals Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei Zhong ◽  
Fang Zhu ◽  
Shengqiong Li ◽  
Jin Chen ◽  
Fengya He ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Neonatal Outcomes ◽  
Adjusted Relative Risk ◽  
Emergency Procedures ◽  
Maternal And Neonatal Outcomes ◽  
Placenta Accreta Spectrum ◽  
Nicu Admission ◽  
Strength Of Association

Objective: To compare maternal and neonatal outcomes for women with placenta accreta syndrome (PAS) delivering via a planned or emergent approach.Methods: A systematic search for relevant studies was conducted by screening the PubMed, Scopus, Web of Science, and Google Scholar electronic databases. Included studies should have been retrospective record-based or prospective in design. They must have compared maternal and/or neonatal outcomes for PAS patients delivering via planned and emergency procedures. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0.Results: Nine articles were included in the meta-analysis. PAS patients undergoing planned deliveries had increased gestational ages, required fewer units of transfused blood, experienced shorter hospital stay durations, and presented reduced risks for maternal ICU admission and severe maternal morbidity. Neonates born to mothers undergoing planned deliveries had increased birth weights and decreased NICU admission risk.Conclusion: These findings indicate a planned approach for delivery is better for maternal and neonatal outcomes compared to urgent/emergency delivery for PAS patients.

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

scholarly journals Maternal and Neonatal Outcomes after Attempted External Cephalic Version among Women with One Previous Cesarean Delivery

2018 ◽  
Vol 08 (04) ◽  
pp. e349-e354 ◽  
Author(s):  
Rodney McLaren ◽  
Fouad Atallah ◽  
Nelli Fisher ◽  
Howard Minkoff
Keyword(s):  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
External Cephalic Version ◽  
Multivariable Logistic Regression Analysis ◽  
Success Rates ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes ◽  
Previous Cesarean

Objective This study was aimed to evaluate success rates of (1) external cephalic version (ECV) among women with one prior cesarean delivery (CD) and (2) maternal and neonatal outcomes after ECV among women with prior CD. Study Design Two linked studies using U.S. Natality Database were performed. First we performed a retrospective cohort comparing ECV success rates of women with prior CD and women without prior CD. Then we compared the outcomes of TOLACs (trial of labor after cesarean delivery) that occurred after ECV with those that occurred without ECV. Multivariable logistic regression analysis was used to estimate adverse outcomes. Results A total of 715 women had ECV after 36 weeks with prior CD and 9,976 had ECV without prior scar. ECV success rate with scar was 80.6% and without scar was 86.4% (p < 0.001). Seven hundred and sixteen women underwent TOLAC after ECV attempt and 234,617 underwent TOLAC without a preceding attempt. Women with preceding version had increased risks of maternal transfusion (1 vs. 0.4%, adjusted OR [odds ratio]: 2.48 [95% CI (confidence interval): 1.17–5.23]), unplanned hysterectomy (0.4 vs. 0.06%, adjusted OR: 6.90 [95% CI: 2.19–21.78]), and low 5-minute Apgar's score (2.5 vs. 1.5%, adjusted OR: 1.76 [95% CI: 1.10–2.82]). Conclusion Women with prior CD may have a decrease in the rate of successful ECV. While the absolute risks are low, ECV appears to increase risks of adverse maternal and neonatal outcomes among women undergoing a trial of labor.

Nonmedically Indicated Induction of Labor Compared with Expectant Management in Nulliparous Women Aged 35 Years or Older

2018 ◽  
Vol 36 (01) ◽  
pp. 045-052 ◽  
Author(s):  
Katherine Bowers ◽  
Jane Khoury ◽  
Tetsuya Kawakita
Keyword(s):  
Intensive Care Unit ◽  
Cesarean Delivery ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Expectant Management ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Nulliparous Women ◽  
Maternal And Neonatal Outcomes ◽  
Nicu Admission

Objective This article compares maternal and neonatal outcomes in women aged ≥ 35 years who experienced nonmedically indicated induction of labor (NMII) versus expectant management. Study Design This was a retrospective cohort study of nulliparas aged ≥ 35 years with a singleton and cephalic presentation who delivered at term. Outcomes were compared between women who underwent NMII at 37, 38, 39, and 40 weeks' gestation and those with expectant management that week. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated, controlling for predefined covariates. Results Of 3,819 nulliparas aged ≥ 35 years, 1,409 (36.9%) women underwent NMII. Overall at 39 weeks' gestation or later, maternal and neonatal outcomes were similar or improved with NMII. At 37, 38, and 39 weeks' gestation, NMII compared with expectant management was associated with decreased odds of cesarean delivery at 37, 38, and 39 weeks' gestation. At 40 weeks' gestation, NMII compared with expectant management was associated with an increased odds of operative vaginal delivery and a decreased odds of neonatal intensive care unit (NICU) admission. Conclusion In nulliparous women aged ≥ 35 years, NMII was associated with decreased odds of cesarean delivery at 37 to 39 weeks' gestation and decreased odds of NICU admission at 40 weeks' gestation compared with expectant management.

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

Outcomes Associated With Trial of Labor After Cesarean Delivery

2021 ◽  
pp. 86-91
Author(s):  
Hadi Erfani ◽  
Alireza A. Shamshirsaz
Keyword(s):  
Cesarean Delivery ◽  
Study Design ◽  
Population Study ◽  
Patient Population ◽  
Neonatal Outcomes ◽  
Clinical Scenario ◽  
Trial Of Labor ◽  
Maternal And Neonatal Outcomes

This article provides a summary of a prominent study in obstetrics. What are the risks of adverse maternal and neonatal outcomes associated with trial of labor after cesarean delivery? With this question, the article presents the basics of the study, including funding, location, patient population, study design, endpoints, results, and criticism and limitations. It then briefly reviews other relevant studies in the field and information and the main recommendations of the most recent practice bulletin provided by the American College of Obstetricians and Gynecologists and concludes with a relevant clinical scenario.

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