Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

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Vasa previa: when antenatal diagnosis can change fetal prognosis

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0559 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Miriam Sutera ◽

Anna Garofalo ◽

Eleonora Pilloni ◽

Silvia Parisi ◽

Maria Grazia Alemanno ◽

...

Keyword(s):

Risk Factor ◽

Predictive Value ◽

Placenta Previa ◽

Color Doppler ◽

Transvaginal Ultrasound ◽

Spontaneous Resolution ◽

Fetal Mortality ◽

Second Trimester ◽

Vasa Previa ◽

Fetal Vessels

Abstract Objectives Evaluate ultrasound diagnostic accuracy, maternal−fetal characteristics and outcomes in case of vasa previa diagnosed antenatally, postnatally or with spontaneous resolution before delivery. Methods Monocentric retrospective study enrolling women with antenatal or postnatal diagnosis of vasa previa at Sant’Anna Hospital in Turin from 2007 to 2018. Vasa previa were defined as fetal vessels that lay 2 cm within the uterine internal os using 2D and Color Doppler transvaginal ultrasound. Diagnosis was confirmed at delivery and on histopathological exam. Vasa previa with spontaneous resolutions were defined as fetal vessels that migrate >2 cm from uterine internal os during scheduled ultrasound follow-ups in pregnancy. Results We enrolled 29 patients (incidence of 0.03%). Ultrasound antenatally diagnosed 25 vasa previa (five had a spontaneous resolution) while four were diagnosed postnatally, with an overall sensitivity of 96.2%, specificity of 100%, positive predictive value of 96.2%, and negative predictive value of 100%. Early gestational age at diagnosis is significally associate with spontaneously resolution (p 0.023; aOR 1.63; 95% IC 1.18–2.89). Nearly 93% of our patient had a risk factor for vasa previa: placenta previa at second trimester or low-lying placenta, bilobated placenta, succenturiate cotyledon, velametous cord insertion or assisted reproduction technologies. Conclusions Maternal and fetal outcomes in case of vasa previa antenatally diagnosed are significally improved. Our data support the evaluation of umbilical cord insertion during routine second trimester ultrasound and a targeted screening for vasa previa in women with risk factor: it allows identification of fetus at high risk, reducing fetal mortality in otherwise healthy newborns.

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Perinatal outcomes in pregnant patients presenting with antepartum hemorrhage: Our experiences at a teaching hospital in Central Punjab.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.10.3152 ◽

2019 ◽

Vol 26 (10) ◽

pp. 1645-1650

Author(s):

Rabia Mushtaq ◽

Afroza Abbas ◽

Waqas Ahmed

Keyword(s):

Mortality Rate ◽

Perinatal Mortality ◽

Low Birthweight ◽

Placenta Previa ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Cross Sectional ◽

Perinatal Mortality Rate

Objectives: Antepartum Hemorrhage is bleeding from or into the genital tract from the period of viability of fetus (28 weeks) till the end of second stage of labor. Antepartum hemorrhage is associated with a very high perinatal mortality rate. We present our experience of perinatal outcomes in cases of antepartum hemorrhage with the aim of highlighting the cause of antepartum hemorrhage and the adverse outcomes. Study Design: Descriptive Cross sectional study. Setting: Department of Gynecology & Obstetrics, Sargodha Medical College, Sargodha. Period: Jan 2018 to Jun 2018. Material and Methods: Ninety six pregnant patients between ages of 15-45 years diagnosed as cases of antepartum hemorrhage were enrolled. Patients with coagulation disorders, twin pregnancies, abnormal lie or presentation, previous scar and any known congenital anomaly. Cause of antepartum hemorrhage and mode of delivery was recorded. Perinatal outcomes were determined in terms of frequencies of perinatal mortality, stillbirth and low birthweight babies. Results: The etiology of antepartum hemorrhage in our setup was placenta previa (43.75%); placental abruption (37.5%); Toxemia (10.41%) and unclassified causes in 8.33% patients. The perinatal mortality rate was 43.75% in our study. The overall frequency of low birthweight babies and stillbirth was 62.5% and 27.08% respectively. Conclusion: Antepartum hemorrhage is a major cause of perinatal mortality in our country. A prompt diagnosis of the cause followed by early cesarean section can help reduce the overall mortality.

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Risk factors of the previa placenta formation

Journal of obstetrics and women s diseases ◽

10.17816/jowd65325-31 ◽

2016 ◽

Vol 65 (3) ◽

pp. 25-31

Author(s):

Natalya I Fadeeva ◽

Olga A Belnitskaya ◽

Irina A Myadelets ◽

Galina V Serdyuk ◽

Maria G Nikolaeva

Keyword(s):

Risk Factors ◽

Comparative Analysis ◽

High Risk ◽

Placenta Previa ◽

Intrauterine Device ◽

Adverse Outcomes ◽

Second Trimester ◽

Gynecological Disorders ◽

History Of ◽

Autoimmune Processes

Placenta previa is associated with a high risk of adverse outcomes for the fetus and mother. The aim of our study was to identify risk factors form a complete placenta previa. A comparative analysis of clinical and paraclinical characteristics of 70 patients with placenta previa in time delivery, 150 women with favorable migration in the second trimester placenta previa at baseline and 100 women with physiological placentation. It was found that a history of hormone-dependent gynecological disorders (p < 0.001), infertility (p < 0.001), contraceptive intrauterine device (p < 0.05), as well as hypertensive syndrome (p < 0.001), presence of hemostasis and folate metabolism defective alleles genes associations (p < 0.01) hepatitis B and C (p < 0.001), and autoimmune processes (p < 0.001) are risk factors of conservation of total placenta previa to delivery.

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Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1604103 ◽

2017 ◽

Vol 39 (11) ◽

pp. 622-631 ◽

Cited By ~ 7

Author(s):

José Guida ◽

Fernanda Surita ◽

Mary Parpinelli ◽

Maria Costa

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Randomized Clinical Trials ◽

Perinatal Outcomes ◽

Expectant Management ◽

Well Being ◽

Adverse Outcomes ◽

Severe Preeclampsia ◽

Maternal Complications ◽

Pubmed Database

Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developing maternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, the maternal outcomes were similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal well-being, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.

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Placental Migration of Low-Lying Placenta Diagnosed on Second Trimester Ultrasonography and Its Fetomaternal Outcome - An Observational Study in a Tertiary Care Health-Facility in West Bengal

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/69 ◽

2021 ◽

Vol 08 (07) ◽

pp. 355-358

Author(s):

Rajib Pal ◽

Basab Bijay Naskar ◽

Tapan Ganguly ◽

Rajugopal Saha ◽

Mrinal Kanti Ghosh ◽

...

Keyword(s):

Placenta Previa ◽

Tertiary Care ◽

Newborn Care ◽

Obstetric Care ◽

Second Trimester ◽

Third Trimester ◽

Maternal Complications ◽

Factors Affecting ◽

Near Term

BACKGROUND We wanted to determine the incidence of a low-lying placenta diagnosed on routine ultrasonography in second trimester and those diagnosed as placenta previa in the third trimester. We also wanted to evaluate the factors affecting such migration and evaluate the fetomaternal outcome. METHODS In this prospective study all cases of low-lying placenta detected on routine ultrasound scan in second trimester were followed up with serial sonography evaluating placental migration in third trimester and also in those whose placentas never cleared of internal os and persisted as placenta previa. The study included a total 200 antenatal primigravida mothers without any risk factors and was conducted over a period of one year. RESULTS Out of 200 mothers, 13 patients had no further follow-up, sonographic examinations or obstetric care in our institution leaving 187 patients. Among 187 women, placental migration occurred in 175 women and 12 had placenta previa. Anterior low lying placentas were more common and most of them migrated from internal os between 28w - 31w 9d of gestation. A small number of placentas cleared after 36 weeks but before delivery. Anterior placenta previa were more common than posterior ones. Diagnosis of low lying placenta occurred at 18w - 18w 9d of gestation. Among low lying placenta in mid trimester whose initial distance from internal cervical os was < 10 mm are not migrated, and end in placenta previa. Maternal complications like antepartum haemorrhage, postpartum haemorrhage were more common in low lying placenta. Fetal complications include intrauterine growth restriction (IUGR), preterm birth and neonatal complications like low Apgar score at birth, and sick newborn care unit (SNCU) admissions were more common in placenta previa compared to normal location of placenta. CONCLUSIONS A low lying placenta diagnosed by ultrasonography in second trimester resolves by mid of third trimester. Only rarely 6.4 % persist to term or near term. Follow up sonography is required to diagnose persistence of placenta previa. KEYWORDS Low Lying Placenta, Placental Migration, Placenta Previa, Sonography

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CD68 Immunostaining in the Evaluation of Chronic Histiocytic Intervillositis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2011-0328-oa ◽

2012 ◽

Vol 136 (6) ◽

pp. 657-659 ◽

Cited By ~ 13

Author(s):

Debra S. Heller

Keyword(s):

Intrauterine Growth Retardation ◽

Chromosomal Abnormalities ◽

Perinatal Outcomes ◽

University Hospital ◽

High Recurrence Rate ◽

Second Trimester ◽

High Power Field ◽

Intrauterine Growth ◽

Institutional Review ◽

The Mean

Context.—Chronic histiocytic intervillositis is an uncommon and poorly recognized lesion associated with poor perinatal outcomes, including intrauterine growth retardation and stillbirth. It has a high recurrence rate. Objective.—To evaluate utility of CD68 immunostaining in the evaluation of chronic histiocytic intervillositis. Design.—Institutional review board–approved retrospective review was performed. Cases were selected from the departmental archives of University Hospital, Newark, New Jersey, between 2002 and 2009. Controls were from second-trimester pregnancies with chromosomal abnormalities or multiple severe anomalies. Results.—There were 9 cases and 11 controls. The mean CD68+ count per high-power field for the cases was 88 ± 23 (range, 51–180) and for the controls, 8 ± 5 (range, 0–24), P < .001. Conclusions.—This study establishes a range for histiocyte counts in chronic histiocytic intervillositis and pregnancies without chronic histiocytic intervillositis, and suggests that CD68 staining may have utility in the diagnosis, particularly for nonperinatal pathologists, who may be less familiar with this lesion.

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HPV Prevalence and its Association with Perinatal Outcomes among Singleton Mothers: Analysis of Pregnancy Risk Assessment and Monitoring System (PRAMS) Data, 2004-2011

Current Women s Health Reviews ◽

10.2174/1573404814666180517085022 ◽

2019 ◽

Vol 15 (2) ◽

pp. 143-149 ◽

Cited By ~ 1

Author(s):

Harpriya Kaur ◽

Delf Schmidt-Grimminger ◽

Baojiang Chen ◽

K.M. Monirul Islam ◽

Steven W. Remmenga ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Monitoring System ◽

Large Population ◽

Perinatal Outcomes ◽

Hpv Infection ◽

Adverse Outcomes ◽

P Value ◽

Pregnancy Risk

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

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Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

Scientific Reports ◽

10.1038/s41598-021-92037-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yanxia Xie ◽

Xiaodong Wang ◽

Yi Mu ◽

Zheng Liu ◽

Yanping Wang ◽

...

Keyword(s):

Adolescent Pregnancy ◽

Gestational Age ◽

Rural Areas ◽

Reference Group ◽

Perinatal Outcomes ◽

Severe Anaemia ◽

Adverse Outcomes ◽

Near Miss ◽

Adolescent Women ◽

Adolescent Pregnancies

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

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