scholarly journals A prediction model for placenta accreta spectrum: A multicentre external validation study.

2021 ◽  
Author(s):  
Shubhangi Singh ◽  
Daniela Carusi ◽  
Penny Wang ◽  
Elena Reitman-Ivashkov ◽  
Ruth Landau ◽  
...  
Keyword(s):  
Placenta Accreta ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
External Validation ◽  
Placenta Praevia ◽  
Care Hospital ◽  
Net Benefit ◽  
Threshold Probability ◽  
Placenta Accreta Spectrum ◽  
Ultrasound Features

Objective: To validate the Weiniger model, a multivariable prediction model for placenta accreta spectrum (PAS). Design: Multicentre external validation study. Setting: Two tertiary care hospitals in the United States. Population: Cohort A included patients with risk factors (prior caesarean delivery, placenta praevia) and/or ultrasound features of PAS (variable risk) presenting to a tertiary care hospital. Cohort B patients were referred to a tertiary care hospital specifically for ultrasound features of PAS (higher risk). Methods: Weiniger model variables (prior caesarean deliveries, placenta praevia and ultrasound features of PAS) were retrospectively collected from both cohorts and predictive performance of the model was evaluated. Main Outcome Measures: Surgical and/or pathological diagnosis of PAS. Results: The model c-statistic in cohorts A and B was 0.728 (95% CI: 0.662, 0.794) and 0.866 (95% CI: 0.754, 0.977) signifying acceptable and excellent discrimination, respectively. Based on calibration curves, the model underestimated average PAS risk in both cohorts. In both cohorts, high risk was overestimated and low risk underestimated. Use of this model compared to a “treat all” strategy had greater net benefit at a threshold probability of > 0.25 in cohort A, but no net benefit in cohort B. Conclusions: This study provides multicentre external validation of the Weiniger model for PAS prediction, making it a useful triaging tool for management of this high-risk obstetric condition. Clinical usefulness of this model is influenced by the incidence of risk factors and PAS ultrasound features, with better performance in a variable-risk population at threshold probability >25%.

scholarly journals Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls

2021 ◽  
Author(s):  
Anshika Gulati ◽  
Rama Anand ◽  
Kiran Aggarwal ◽  
Shilpi Agarwal ◽  
Shaili Tomer
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Tertiary Care Hospital ◽  
Color Doppler ◽  
Tertiary Care ◽  
Histopathological Analysis ◽  
Care Hospital ◽  
Imaging Features ◽  
Predictive Values ◽  
Placenta Accreta Spectrum

Abstract Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance. Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section. Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at least one prior cesarean section were included in the study. Following imaging features were evaluated: (1) gray scale covering intraplacental lacunae, disruption of uterovesical interface, myometrial thinning, loss of retroplacental clear space, and focal exophytic masses; and (2) color Doppler covering intraplacental lacunar flow, hypervascularity of uterine serosa–bladder wall interface, and perpendicular bridging vessels between placenta and myometrium. Study Design Present study is a prospective one in a tertiary care hospital. Results Of the 19 PAS cases, 18 were correctly diagnosed on ultrasonography (USG) and confirmed either by histopathological analysis of hysterectomy specimen or per-operatively due to difficulty in placental removal. PAS was correctly ruled out in 27 of 31 patients. The diagnostic accuracy of USG was 90%. The sensitivity, specificity, positive, and negative predictive values were 94.7, 87.1, 81.8, and 96.4%, respectively. Conclusion Ultrasound is indispensable for the evaluation of pregnant patients. It is an important tool for diagnosing PAS, thereby making the operating team more cautious and better equipped for difficult surgery and critical postoperative care. It can be relied upon as the sole modality to accurately rule out PAS in negative patients, thereby obviating unnecessary psychological stress among patients due to possible hysterectomy.

scholarly journals A study of emergency peripartum hysterectomy in a tertiary care hospital

2018 ◽  
Vol 7 (5) ◽  
pp. 1934
Author(s):  
Jeyamani Janaki Bhaskaran ◽  
Subha Sivagami Sengodan ◽  
Aiswarya Rangesh ◽  
Praveena Murugesan
Keyword(s):  
Placenta Accreta ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Age Group ◽  
Early Referral ◽  
Maternal Characteristics ◽  
Peripartum Hysterectomy ◽  
Emergency Peripartum Hysterectomy ◽  
Indications And Complications

Background: Emergency peripartum hysterectomy is a lifesaving procedure done as a last resort to save mother’s life. This study is to analyse the incidence, maternal characteristics, indications and complications following peripartum hysterectomy.Methods: A retrospective analysis of emergency peripartum hysterectomy cases performed over a period of 3 years from January 2015 to December 2017.Results: During the study period, 82 emergency peripartum hysterectomies were performed giving an incidence of 3.47/1000 delivery. Most of the women belong to the age group of 21-30 years (70.7%) and the women of parity two and three (65.8%). Atonic PPH was the most common indication accounting for 59.8% of cases followed by placenta accreta (19.5%).Conclusions: Emergency peripartum hysterectomy remains a lifesaving procedure. Proper antenatal care, early referral, blood bank facilities and timely decision greatly influences maternal outcome.

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 STUDY OF PLACENTA ACCRETA SPECTRUM DISORDERS IN TERTIARY CARE HOSPITAL

2020 ◽  
pp. 1-4
Author(s):  
Shrinivas Gadappa ◽  
Ankita Shah ◽  
Rupali Gaikwad ◽  
Susmita Pawar
Keyword(s):  
Conservative Management ◽  
Placenta Accreta ◽  
Elective Surgery ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Multidisciplinary Care ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Aims and objectives To study the range of Placenta Accreta Spectrum (PAS) disorders, management of PAS, maternal outcome in PAS and post-operative complications in patients managed either by conservative or non-conservative management. Methodology Patient were diagnosed antenatally by 2D grey scale USG (ultrasonography) as PAS 0, 1 ,2 and 3 along with colour doppler studies. The decision of conservative versus non conservative management was taken by MDT (multidisciplinary team) along with the patients and relatives and after written and informed consent and elective surgery was planned between 34-35 weeks of gestation. Results Total number of cases studied over the period of 1 year were 45. On 2D gray scale USG, PAS 0 was seen in 60% followed by PAS 3 in 17.77% and only 6.66% of PAS 2. According to weeks of gestation OH with IIAL (internal iliac ligation) was performed in 42.22 % and OH without IIAL was performed in 37.77% and 20% patients who were managed by conservative method, 6 of them needed peripartum hysterectomy. Massive transfusion protocol was activated in all the cases. Conclusion The highest risk of placenta accreta spectrum disorders are amongst women whose pregnancy is complicated by placenta previa and with a prior scar on the uterus, due to the abnormal placental implantation on the scar site. The management of PAS disorders should be at tertiary care centre along with multidisciplinary care team.

Confidence toward vaccination as reported by parents of children admitted to a tertiary care hospital in Riyadh, Saudi Arabia: A cross sectional study

Vacunas ◽  
2020 ◽  
Vol 21 (2) ◽  
pp. 95-104 ◽  
Author(s):  
Y.M. AlGoraini ◽  
N.N. AlDujayn ◽  
M.A. AlRasheed ◽  
Y.E. Bashawri ◽  
S.S. Alsubaie ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional
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