Role of Abdominal Aortic Balloon Placement in Planned Conservative Management of Placenta Previa With Placenta Increta or Percreta

Background: We investigated the role of balloon placement in the abdominal aorta (BPAA) in planned conservative management of placenta previa with placenta increta or percreta and the effects of BPAA on perinatal adverse maternal events.Methods: This retrospective case-control study included women with placenta previa (increta or percreta), who underwent pregnancy termination at the Qilu Hospital of Shandong University between January 2016 and June 2019. Patients were categorized into the BPAA and non-BPAA groups based on the BPAA placement before delivery. The Chi-square and non-parametric rank-sum tests were used for the intergroup comparison of patient characteristics. The propensity score matching algorithm was used to minimize the intergroup differences in clinical characteristics. Logistic regression analysis was used to identify the factors associated with a high risk of adverse pregnancy outcomes. The area under the receiver operating characteristic curve [area under the curve (AUC)] was used to evaluate the classification of the selected high-risk factors.Results: The study included 260 patients, and 104 patients were identified after propensity score matching. In the post-matched cohort, intraoperative blood loss was significantly lower in the BPAA than in the non-BPAA group (median 1,000 vs. 2,250 ml, P < 0.001). Intraoperative B-Lynch suture was performed in fewer patients in the BPAA (15.4 vs. 34.6%, P = 0.024) than in the non-BPAA group. The packed red blood cell (PRBC) transfusion rate was lower in the BPAA group (median 4 vs. 8 units, P < 0.001). Overall, 46 (45.1%) patients developed adverse maternal events; however, the rate of adverse maternal events was lower in the BPAA group (19.6 vs. 80.4%, P < 0.001). No ligation of the ascending branch of the uterine artery (P = 0.034), no BPAA (P < 0.001), intraplacental vascular lacunae (P = 0.046), and cervical hypervascularity (P = 0.001) were associated with a high risk of adverse perinatal maternal events. The AUC of the high-risk factors was 0.89 in the post-matched and 0.76 in the pre-matched cohorts.Conclusion: Planned conservative management using BPAA significantly minimized the intraoperative blood loss, the need for a B-Lynch suture, and PRBC transfusion in patients with severe placenta accreta spectrum and placenta previa.

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Placenta previa with posterior extrauterine adhesion: clinical features and management practice

BMC Surgery ◽

10.1186/s12893-020-01027-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yoshikazu Nagase ◽

Shinya Matsuzaki ◽

Masayuki Endo ◽

Takeya Hara ◽

Aiko Okada ◽

...

Keyword(s):

Propensity Score ◽

Blood Loss ◽

Cesarean Delivery ◽

Clinical Features ◽

Surgical Outcomes ◽

Multivariate Regression ◽

Placenta Previa ◽

Control Group ◽

Intraoperative Blood Loss ◽

Intraoperative Bleeding

Abstract Background A diagnostic sign on magnetic resonance imaging, suggestive of posterior extrauterine adhesion (PEUA), was identified in patients with placenta previa. However, the clinical features or surgical outcomes of patients with placenta previa and PEUA are unclear. Our study aimed to investigate the clinical characteristics of placenta previa with PEUA and determine whether an altered management strategy improved surgical outcomes. Methods This single institution retrospective study examined patients with placenta previa who underwent cesarean delivery between 2014 and 2019. In June 2017, we recognized that PEUA was associated with increased intraoperative bleeding; thus, we altered the management of patients with placenta previa and PEUA. To assess the relationship between changes in practice and surgical outcomes, a quasi-experimental method was used to examine the difference-in-difference before (pre group) and after (post group) the changes. Surgical management was modified as follows: (i) minimization of uterine exteriorization and adhesion detachment during cesarean delivery and (ii) use of Nelaton catheters for guiding cervical passage during Bakri balloon insertion. To account for patient characteristics, propensity score matching and multivariate regression analyses were performed. Results The study cohort (n = 141) comprised of 24 patients with placenta previa and PEUA (PEUA group) and 117 non-PEUA patients (control group). The PEUA patients were further categorized into the pre (n = 12) and post groups (n = 12) based on the changes in surgical management. Total placenta previa and posterior placentas were more likely in the PEUA group than in the control group (66.7% versus 42.7% [P = 0.04] and 95.8% versus 63.2% [P < 0.01], respectively). After propensity score matching (n = 72), intraoperative blood loss was significantly higher in the PEUA group (n = 24) than in the control group (n = 48) (1515 mL versus 870 mL, P < 0.01). Multivariate regression analysis revealed that PEUA was a significant risk factor for intraoperative bleeding before changes were implemented in practice (t = 2.46, P = 0.02). Intraoperative blood loss in the post group was successfully reduced, as opposed to in the pre group (1180 mL versus 1827 mL, P = 0.04). Conclusions PEUA was associated with total placenta previa, posterior placenta, and increased intraoperative bleeding in patients with placenta previa. Our altered management could reduce the intraoperative blood loss.

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Role of Colour Doppler in High Risk Pregnancy

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210434 ◽

2021 ◽

Vol 6 (2) ◽

pp. 185-191

Author(s):

Hiral Parekh ◽

Sneha Chaudhari

Keyword(s):

Risk Factors ◽

High Risk ◽

Perinatal Outcome ◽

Umbilical Artery ◽

High Risk Pregnancy ◽

Colour Doppler ◽

High Risk Factors ◽

Risk Pregnancy ◽

A Prospective Study

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of <28 weeks to >35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.

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Mild cases of Covid-19 in children. is it really true or a mirage?

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2020.i08.10 ◽

2020 ◽

Vol 7 (8) ◽

pp. 446-451

Author(s):

Abhishek Mandal ◽

◽

Dr. Santosh Kondekar ◽

Rishi Bothara ◽

◽

...

Keyword(s):

Risk Factors ◽

Insulin Secretion ◽

High Risk ◽

Infectious Diseases ◽

Antioxidant Potential ◽

Trained Immunity ◽

High Risk Factors ◽

Few Data

To date, very few data on pediatric COVID 19 cases have been published, and most reports originatefrom China. There is an urgent need to understand why the course of the coronavirus that started inlate 2019 is affecting different groups of individuals with varying severity during the ongoing globalpandemic. Globally, the greatest burden of most infectious diseases, especially infections of therespiratory system are borne by children, hence the low burden of COVID 19 in children has beenviewed by many as surprising. This article will provide insights regarding the role of constitutionalhigher trained immunity in children, physiological advantages of children, higher insulin secretion,higher ACE2 levels, better antioxidant potential, and absence of high-risk factors in protectingchildren against severe COVID 19 infections.

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Prognostic role of circulating exosomal miRNAs in multiple myeloma

Blood ◽

10.1182/blood-2016-09-742296 ◽

2017 ◽

Vol 129 (17) ◽

pp. 2429-2436 ◽

Cited By ~ 92

Author(s):

Salomon Manier ◽

Chia-Jen Liu ◽

Hervé Avet-Loiseau ◽

Jihye Park ◽

Jiantao Shi ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

High Risk ◽

Survival Prediction ◽

Prognostic Role ◽

High Risk Factors ◽

Key Points ◽

Exosomal Mirnas

Key Points Two circulating exosomal microRNAs, let-7b and miR-18a, improved survival prediction in patients with MM. Circulating exosomal miRNAs enhanced the stratification of patients with high-risk factors.

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P90 Complementary role of 18F- FDG PET/CT for sentinel lymph node algorithm in endometrial cancer with high risk factors for lymphatic metastasis

10.1136/ijgc-2019-esgo.152 ◽

2019 ◽

Author(s):

S Taşkin ◽

B Varli ◽

CC Ersöz ◽

D Altin ◽

Ç Soydal ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Lymph Node ◽

High Risk ◽

High Risk Factors ◽

Complementary Role ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Emergency obstetric hysterectomy: a lifesaving procedure

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181921 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1876

Author(s):

Usha Doddamani ◽

Nirmala Rampure ◽

Sanyogita Kulkarni ◽

Shoba Patil ◽

Neelavati Tambre

Keyword(s):

Risk Factors ◽

High Risk ◽

Antenatal Care ◽

Placenta Previa ◽

Reproductive Capacity ◽

Fetal Mortality ◽

Early Referral ◽

High Risk Factors ◽

Scarred Uterus ◽

Placenta Accrete

Background: Emergency Obstetric Hysterectomy (EOH) is removal of uterus following vaginal delivery, Emergency LSCS or within the puerperium period. Because of increasing caesarean deliveries, the number of scarred uterus is increasing exposing the gravid women to increasing morbidity from uterine rupture, placenta accrete and placenta previa thus increasing the incidence of Emergency obstetric hysterectomy. The aim was to determine the incidence, demographic details, high risk factors and fetomaternal outcome of patients who underwent EOH.Methods: This was a retrospective study where data was collected from the record sheets of patients who underwent Emergency Obstetric Hysterectomy from January 2016 to December 2017 in the department of OBG, GIMS Gulbarga. Maternal age, parity, socioeconomic status, antenatal care, high risk factors and fetomaternal outcome were analysed.Results: During the study period there were 17,820 deliveries out of which 20 cases underwent EOH giving an incidence of 0.12%. Most of patients were uneducated, unbooked, low SES and of rural background and were multiparous. Main cause for EOH were rupture uterus, PPH and morbidly adherent placenta. There were 2 cases of maternal mortality and fetal mortality was 65%.Conclusions: Though EOH is a lifesaving procedure it curtails the reproductive capacity of the women. Proper antenatal care, early referral, timely decision and skill of surgeon in performing this procedure is important.

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