scholarly journals Placenta praevia: percreta and accreta, our experience

2020 ◽  
Vol 9 (3) ◽  
pp. 928
Author(s):  
Preeti F. Lewis ◽  
Shreya Chinchoriya
Keyword(s):  
Risk Factors ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
History Of ◽  
Previous Cesarean

Background: morbidly adherent placenta has an increasing incidence over decades. The purpose of this study is to identify risk factors and etiology of placenta previa- accreta and percreta.Methods: A cross sectional observational study of patients with morbidly adherent placenta previa including placenta accreta and placenta percreta were studied over a period of three years from June 2017 to June 2019 in a tertiary care centre, Mumbai.Results: Cases showed a higher incidence in patients with previous cesarean delivery (CS), grandmultiparity, abortions without the history of check curettage and anterior/central placentae.Conclusions: History of uterine surgeries and previous cesarean are some important risk factors for accreta in placenta previa patients.

scholarly journals PLACENTA ACCRETA IN PLACENTA PREVIA

2018 ◽  
Vol 21 (05) ◽  
pp. 892-896
Author(s):  
Farzana Majid ◽  
Robina Ali ◽  
Shazia Shaheen
Keyword(s):  
Placenta Accreta ◽  
Placenta Previa ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
History Of ◽  
Scarred Uterus ◽  
Demographic Features ◽  
Previous Cesarean

Objective: To calculate the frequency of placenta accreta in placenta previawith or without scarred uterus and compare clinico demographic features of cases with orwithout placenta accreta. Study Design: Cross sectional study. Place and Duration of Study:Department of Obst & Gynae Allied Hospital, Faisalabad from 1st June 2007 to 31st May 2008.Methodology: 200 patients of placenta previa, 100 with history of previous cesarean sectionand 100 without history of previous C-section fulfilling inclusion criteria were taken. They wereevaluated by history, examination and ultrasound noting placental location and type. Placentaaccreta was diagnosed during delivery. Results: Out of 200 patients, frequency of placentaaccreta was significantly increased with history of previous C-section. It was 20% in patientswith previous C-sections and 6% in patients without previous C-sections. Conclusions: Ourdata suggests that frequency of placenta accreta is greater in patients with previous C-sectionand its frequency increases with increasing number of C-sections especially with anterior andcentral placenta previa.

scholarly journals A retrospective analysis on placenta previa in a tertiary care center of Jharkhand

2021 ◽  
Vol 10 (9) ◽  
pp. 3389
Author(s):  
Tanu Sharma
Keyword(s):  
Risk Factors ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Adherent Placenta ◽  
History Of ◽  
Nicu Admission

Background: When the placenta is implanted partially or completely in the lower uterine segment, it is called placenta previa. Previa is a Latin word means going before. About one-third of APH belongs to placenta previa and now a day’s incidence is increasing in primigravida patients. The objective of this study was to analyze the incidence, risk factors, maternal morbidity, mortality and perinatal outcome in women with placenta previa in a tertiary care center of Jharkhand.Methods: Total 193 cases of placenta previa were studied between September 2018 to August 2019 in the department of obstetrics and gynecology, RIMS, Ranchi with respect to their age, parity, gestational age, clinical presentation, previous history of curettage/hysterotomy/caesarean, ICU admission, need for NICU admission, maternal morbidity and mortality and perinatal outcome.Results: In this study, 1.94% of the deliveries were complicated with placenta previa. 31.6% were above 30 years, 87% were multigravida, 122, i.e.; 62.7% were having history of curettage or previous caesarean or hysterotomy. 49.7% had prior caesarean deliveries, 21.5% had prior abortion with history of D and C. 49.2% had true placenta previa. 68.4% had preterm delivery. 11.9% patients presented in shock and maximum i.e.; 184 (95.3%) out of 193 presented with painless bleeding per vaginum and 9 cases with no complaints. Malpresentation seen in 16.6% cases and 8.3% had adherent placenta previa. There were 45.6% ICU admission and 54.9% NICU admission, 2.5% maternal mortality and 32.6% perinatal mortality.Conclusions: Advanced maternal age, multiparty, scarred uterus as in prior CS or D and C are independent risk factors for placenta previa. Also, it remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa and associated adherent placenta should encourage a careful evaluation, timely diagnosis and delivery to reduce associated maternal and perinatal complications.

PLACENTA PREVIA AND PLACENTA ACCRETA SPECTRUM (PAS) DISORDER: INCIDENCE, RISK FACTOR AND FETOMATERNAL OUTCOME IN A TERTIARY CARE CENTER

2021 ◽  
pp. 15-17
Author(s):  
Ramona Perhar ◽  
Rubi Devi ◽  
Ruchi Patel ◽  
Jagriti Jagriti
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Care Center ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Adherent Placenta ◽  
Placenta Accreta Spectrum

Introduction: Placenta Previa is characterised by Placental implantation into the lower uterine segment covering whole or part of the cervix . It complicates 0.4% of pregnancy at term The average incidence is 0.3% or 1 case per 300 to 400 deliveries. The presence of placenta previa can also increase a woman's risk for placenta accreta spectrum (PAS). This spectrum of conditions includes placenta accreta, increta, and percreta. Uncontrolled postpartum hemorrhage from placenta previa or PAS may necessitate a blood transfusion, hysterectomy thus leaving the patient infertile, admission to the ICU, or even death. Material and method: Study was conducted in department of obstetrics & gynecology , swaroop rani hospital, Allahabad for 1 year . A total of 102 pregnant women presenting to antenatal OPD or admitted in IPD with history of antepartum hemorrhage and conrmed case of PP or MAP in Ultrasonography were selected. The follow up till the fetomaternal outcome was done and risk factors were evaluated for 102 cases. Result: Out of the total 2342 deliveries in one year 95 patients had PP and the incidence was 4.04% and 7 patients had morbidily adherent Placenta which accounts to an incidence of 0.29%. Previous LSCS, Multiparity, increase maternal age, Dialatation and curettage were risk factors in both Placenta Previa and Morbidily Adherent Placenta. Antenatal complication were antepartum hemmorrhage , Anemia, preterm labor. Emergency LSCS is more common mode of delivery in cases of Placenta previa. Caesarean hysterectomy were done in 3.2% cases of Placenta Previa and all cases of Morbidily adherent placenta . Most common perinatal complications in both groups were prematurity and low birth weight. Conclusion: Now a days Placenta previa and Morbidily adherent placenta are very common. Incidence increases as the rate of cesaerean section or abdominal surgery were increases.Earlydiagnosis and pre plan mode of delivery will decrease the risk of prematurity and low birth weight.

Alpha Feto-Protien as a Biochemical Marker in Prediction of Morbidly Adherent Placenta

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hassan Tawfik Khairy ◽  
Mohammed Saeed Eldin El Safty ◽  
Rasha Medhat Abd El Hadi ◽  
Kyrollos Refat Khalf Marzok
Keyword(s):  
Cesarean Delivery ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Power Doppler ◽  
Morbidly Adherent Placenta ◽  
Adherent Placenta ◽  
3D Power Doppler ◽  
Tertiary Center ◽  
Previous Cesarean

Abstract Background Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Aim of the Work To compare between alpha-fetoproteine as biological marker & ultrasound & Doppler findings for prenatal predication of morbid adherent placentation in anterior placenta on scar of previous cesarean section. Patients and Methods The current study is a prospective cohort study, conducted at a tertiary center: Ain Shams University Maternity Hospital during the period between February 2018 and April 2019,where 150 pregnant women having placenta previa covering scar of previous uterine surgery had been recruited from the outpatient obstetrics clinic or emergency room and admitted to antepartum inpatient high risk service, but 50 patients were dropped out due to loss in follow up because of emergency antepartum haemorrhage & C.S., others escaped follow up. Results The results of the current study showed a significant association between all criteria of the 3DPD with multislice view and presence of placental adherence, need for added surgical steps, CS hysterectomy and bladder injury with sensitivity 83% & specificity 57%, PPV 76%, NPV 66%. Conclusion The current study suggests that AFP assay, it isn't good test alone as regards its sensitivity &specificity &its level of accuracy 55% as compared to 2D &3D power doppler with multislice view, so it is unreliable test alone for antenatal diagnosis of morbidly adherent placenta.

scholarly journals Current placenta previa management and outcome in a rural tertiary care centre

2017 ◽  
Vol 6 (5) ◽  
pp. 2050
Author(s):  
Reena Sood ◽  
Swati Sharma ◽  
Madhu Nagpal ◽  
Madhurima Arora
Keyword(s):  
Risk Factors ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Gestational Age At Delivery ◽  
History Of ◽  
Obstetric Services ◽  
The Mean ◽  
Present Case Study

Background: The reported incidence for placenta previa averages 0.3% or 1 case in 300 to 400 deliveries. Multiparity, advanced maternal age, cigarette smoking, previous caesarean delivery, history of abortions or uterine surgical procedures are some of the risk factors contributing to the development of placenta previa. Massive obstetrical haemorrhage in placenta previa is associated with severe maternal morbidity and mortality. A significant number of mothers can be saved if right approach of management is followed in placenta previa.Methods: The present case study is a retrospective analysis carried out in a tertiary care centre to study the risk factors and maternal and perinatal outcome in cases of placenta previa. The study included antenatal patients diagnosed as placenta previa on sonography at or >26 weeks of pregnancy. Data was compiled and statistically analysed.Results: Incidence of Placenta Previa in our study was 0.54%. 73.2% patients had history of previous cesarean sections. 53.6% patients were referred from outside. 98.2% patients delivered by caesarean section. Obstetric hysterectomy was required in 3.5% of total cases. 10.7% cases required the ICU admission after delivery. There was no maternal mortality in the study group. The mean gestational age at delivery was 35±2.4weeks. The mean APGAR at 5 min was 9±2.2.Conclusions: Increasing rates of caesarean sections in present era indicate that incidence of Placenta Previa is expected to rise. Good antenatal care, availability of emergency obstetric services, infrastructure, blood bank facility, HDU and ICU care and NICU services can improve maternal and neonatal outcome.

scholarly journals Risk Factors and Pregnancy Outcome in Women With a History of Cesarean Section Complicated by Placenta Accreta

2020 ◽  
Author(s):  
Yingyu Liang ◽  
lizi Zhang ◽  
Shilei Bi ◽  
Jingsi Chen ◽  
Shanshan Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Cesarean Sections ◽  
Han Ethnicity ◽  
Parity Number ◽  
History Of ◽  
Independent Risk Factors ◽  
Previous Cesarean

Abstract Objective: To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta.Methods: This retrospective study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in 7 provinces of China between January 2017 and December 2017. According to the intraoperative findings or the pathologic diagnosis after delivery, the study population was divided into placenta accreta (PA) and non-PA groups. We compared the pregnancy outcomes between the 2 groups, used multivariate logistic regression to analyze the risk factors for placental accreta, and used receiver operating characteristic curves to evaluate the value of the risk factors.Results: For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage, severe postpartum hemorrhage, diffuse intravascular coagulation, puerperal infection, intraoperative bladder injury, hysterectomy, and blood transfusion was significantly increased in the placenta accreta group (P<0.05)). At the same time, the rate of neonatal low-birth weight, the probability of neonatal comorbidities, and the rate of neonatal intensive care unit admission also increased significantly (P<0.05). Weight, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membrane, previous cesarean-section transverse incisions, history of placenta previa, and the combination of prenatal hemorrhage and placenta previa were all independent risk factors for placenta accreta; while non-Han ethnicity was an independent protective factor for placenta accreta (P<0.05). The area under the ROC curve (AUC) was 0.93 (95% CI=0.92-0.94); and the specificity, sensitivity, and accuracy rate were 0.87, 0.93, and 0.93, respectively.Conclusions: There was an increased risk of adverse outcomes in pregnancies complicated by placenta accreta in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, Han ethnicity, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with placenta accreta in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placental accreta in pregnancies of women with a history of cesarean section.

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 Anaesthetic Practices and Maternal Outcome in Rising Placenta Accreta Spectrum in Tertiary Care Hospital

2020 ◽  
Vol 24 (2) ◽  
pp. 108-111
Author(s):  
Sumbal Rana ◽  
Ali Arslan Munir ◽  
Qudsia Anjum Quraishi ◽  
Amim Muhammad Akhtar ◽  
Erum Pervaiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multidisciplinary Team ◽  
Maternal Age ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Care Hospital ◽  
Placenta Accreta Spectrum ◽  
Team Interventions ◽  
Previous Cesarean

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

scholarly journals Clinical and Etiological Profile of Mycotic Keratitis from a Tertiary Care Centre in South India

2021 ◽  
Vol 10 (27) ◽  
pp. 2001-2006
Author(s):  
John Britto Augustin ◽  
Sureshbaboo Variamkandi
Keyword(s):  
Risk Factors ◽  
Corneal Ulcer ◽  
Fusarium Species ◽  
Tertiary Care ◽  
Government Medical College ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Medical College ◽  
Corneal Ulcers ◽  
Prompt Treatment

BACKGROUND Corneal ulcer is the leading cause of ocular morbidity and monocular blindness worldwide. To effectively prevent blindness in patients with corneal ulcer, a proper understanding of the risk factors predisposing to ulceration, its clinical and microbiological characteristics are essential. Timely identification of aetiological agents causing corneal ulcers and their prompt treatment helps to save the vision. We wanted to detect aetiological agents of corneal ulcer with special references to fungal causes and characterize the fungal aetiological agents to species level. METHODS This is a cross sectional study, conducted in Government Medical college, Kozhikode, between January 2016 and June 2017. All patients who were clinically diagnosed as cases of infectious corneal ulcer in the Ophthalmology department, Government Medical College, Kozhikode were included in the study. Corneal scrapings collected from the infected eye were subjected to microbiological examination and culture. A total of 120 cases were analysed. Each patient was examined with the slit lamp bio microscope after staining with fluorescein. Scrapings from cornea at the site of corneal ulcer were collected by ophthalmologist after a detailed clinical history and examination of the affected eye. The laboratory procedures used in the diagnosis of infectious keratitis were based on direct visualization of organisms by subjecting corneal scrapings to Gram stain and KOH wet mount and inoculation of material on to blood agar and Sabouraud dextrose agar. RESULTS Among the 120 cases, a total of 49 cases were culture positive. Twenty-one [17.5 %] were bacterial, twenty-two [18.34 %] were fungal and six [5.0 %] were poly microbial [bacteria and fungus]. Among the fungal aetiology, fusarium species was most common [32.14 %], followed by aspergillus species - 25.0 %. Trauma was the major risk factor. Diabetes mellitus, exposure keratitis were the other comorbidities / risk factors. CONCLUSIONS This study shows majority of infected corneal ulcers are associated with risk factors and the aetiology are mainly fungi. Microscopy, culture, and clinical correlation helped in adequate management. Thus, prognosis and outcome of corneal ulcers rely on timely identification of their aetiology and prompt treatment. KEY WORDS Corneal ulcer, Fungal Keratitis

scholarly journals Incidence and Risk Factors for Severe Dehydration in Hospitalized Children in Ujjain, India

2020 ◽  
Author(s):  
Abhishek Sharma ◽  
Aditya Mathur ◽  
Cecilia Stålsby Lundborg ◽  
Ashish Pathak
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
World Health ◽  
Respiratory Pattern ◽  
Care Hospital ◽  
Severe Dehydration ◽  
Cross Sectional ◽  
Oral Rehydration ◽  
History Of ◽  
Independent Risk Factors

Diarrhoea contributes significantly in the under-five childhood morality and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having &ldquo;some dehydration&rdquo; and &ldquo;dehydration&rdquo; according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean &plusmn; standard deviation age of 25.62 &plusmn; 31.85 months; out of which, 70%(95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breast fed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78; p&lt;0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78; p=0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21; p&lt;0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93; p&lt;0.001). The study identified many risk factors associated with severe childhood dehydration; many of them are modifiable though known and effective public health interventions.

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