Clinical Significance of Velamentous Cord Insertion Prenatally Diagnosed in Twin Pregnancy

Background: The purpose of this study was to evaluate the prevalence of velamentous cord insertion (VCI) and the actual association between pathologically confirmed VCI and perinatal outcomes in twins based on the chorionicity. Methods: All twin pregnancies that received prenatal care at a specialty clinic for multiple pregnancies, from less than 12 weeks of gestation until delivery in a single institution between 2015 and 2018 were included in this retrospective cohort study. Results: A total of 941 twins were included in the study. The prevalence of VCI in dichorionic (DC) twins and monochorionic diamniotic (MCDA) twins was 5.8% and 7.8%, respectively (p = 0.251). In all study population, the prevalence of vasa previa and placenta accreta spectrum was higher in VCI group than that of non-VCI group (p = 0.008 and 0.022). In MCDA twins with VCI, birth weight, 1 and 5-min Apgar score were lower than DC twins with VCI (p = 0.010, 0.002 and 0.000). There was no significant association between VCI and selective fetal growth restriction (p = 0.486), twin-to-twin transfusion syndrome (p = 0.400), and birth-weight discordance (>20% and >25%) (p = 0.378 and 0.161) in MCDA twins. Conclusion: There was no difference in the incidence of VCI in twins based on the chorionicity. Moreover, VCI was not a risk factor for adverse perinatal outcomes excepting vasa previa and placenta accreta spectrum, which had a high incidence in twins with VCI.

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Clinical Significance of Velamentous Cord Insertion Prenatally Diagnosed in Twin Pregnancy

10.20944/preprints202012.0489.v1 ◽

2020 ◽

Author(s):

Hyun-mi Lee ◽

SiWon Lee ◽

Min-Kyung Park ◽

You Jung Han ◽

Moon Young Kim ◽

...

Keyword(s):

Birth Weight ◽

Placenta Accreta ◽

Perinatal Outcomes ◽

Single Institution ◽

Study Results ◽

Study Population ◽

Adverse Perinatal Outcomes ◽

Twin Pregnancies ◽

Minute Apgar Score ◽

Velamentous Cord Insertion

Background The purpose of this study was to evaluate the prevalence of velamentous cord insertion (VCI) and the actual association between pathologically confirmed VCI and perinatal outcomes in twins based on the chorionicity. Methods All twin pregnancies who received prenatal care at a specialty clinic for multiple pregnancies, from less than 12weeks of gestation until delivery in a single institution between 2015 and 2018 were included in this retrospective cohort study. Results A total of the 941 twins were included in the study. The prevalence of VCI in dichorionic (DC) twins and monochorionic diamniotic (MCDA) twins was 5.8% and 7.8%, respectively (p=0.251). In all study population, the prevalence of vasa previa and placenta accreta were higher in VCI group compared to that of non-VCI group (p=0.008 and 0.022). In MCDA twins with VCI, birth weight, 1 and 5-minute Apgar score were lower compared to DC twins with VCI (p=0.010, 0.002 and 0.000). There was no significant association between VCI and selective fetal growth restriction (p=0.708), twin-to-twin transfusion syndrome (p=0.400) and birth-weight discordance (>20% and >25%) (p= 0.378 and 0.161) in MCDA twins. Conclusion VCI in twins was not a risk factor for adverse perinatal outcomes and twin-specific complications.

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Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.01.017 ◽

2018 ◽

Vol 218 (4) ◽

pp. 443.e1-443.e8 ◽

Cited By ~ 25

Author(s):

Yaakov Melcer ◽

Eric Jauniaux ◽

Shlomit Maymon ◽

Anna Tsviban ◽

Marina Pekar-Zlotin ◽

...

Keyword(s):

At Risk ◽

Placenta Accreta ◽

Perinatal Outcomes ◽

Vasa Previa ◽

Placenta Accreta Spectrum

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Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

Journal of Clinical Medicine ◽

10.3390/jcm10040643 ◽

2021 ◽

Vol 10 (4) ◽

pp. 643

Author(s):

Veronica Giorgione ◽

Corey Briffa ◽

Carolina Di Fabrizio ◽

Rohan Bhate ◽

Asma Khalil

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Chi Square ◽

Increased Risk ◽

Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

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Evaluation of outcome of pregnancy in placenta accreta spectrum

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213444 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3331

Author(s):

Uma Veludandi ◽

B. Aruna Suman ◽

S. Nagamani ◽

Medha Hothur

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Placenta Accreta ◽

Intrauterine Device ◽

Tertiary Care ◽

Bladder Injury ◽

Placenta Accreta Spectrum ◽

Caesarean Hysterectomy ◽

Placenta Accrete

Background: Aim of the study was to evaluate the outcome of pregnancy in placenta accrete spectrum in third trimester pregnancy at tertiary care centreMethods: This hospital based retrospective study was carried out from 2017 to 2019. The case records of all women identified as placenta accrete spectrum from the hospital registers were retrieved. A total of 166 patients with the diagnosis of placenta accrete spectrum were included in the study.Results: The incidence of morbidly adherent placenta is 5 per 10,000 deliveries with mean age being 32.4±4.2 (23-39) years. and showed its relation with risk factors such as previous caesarean section (CS), placenta praevia and multiparity. The mean duration of MICU stay in placenta previa was 6.7±1.9 days (range 2-12 days). With complications in 18 cases of which urinary bladder injury (3%), infection (9%), PPH and coagulopathy (4.2%). The placenta was removed successfully in 141 while 25 cases had caesarean hysterectomy (2.4%). In total 166 cases 26 (16.8%) cases are intrauterine device (IUD) and still births. 5 (3%) cases are very low birth weight, 24 cases (14.5%) are low birth weight babies, 76 (45.8%) cases had neonatal intensive care unit (NICU) admissions followed by 10 (6%) cases with <5 APGAR score.Conclusions: Placenta accreta spectrum can be identified antenatally with a high index of suspicion in the presence of known risk factors and proper radiological studies, allowing for planned attempts to avoid life-threatening haemorrhage and caesarean hysterectomy.

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Perinatal outcomes of twin pregnancies with birth weight discordance

Akusherstvo i ginekologiia ◽

10.18565/aig.2020.5.78-84 ◽

2020 ◽

Vol 5_2020 ◽

pp. 78-84

Author(s):

Kostyukov K.V. Kostyukov ◽

Ionov O.V. Ionov ◽

Shakaya M.N. Shakaya ◽

◽

Keyword(s):

Birth Weight ◽

Perinatal Outcomes ◽

Twin Pregnancies

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Spontaneous Version of Fetal Presentation in Twin Pregnancies During Third Trimester: Longitudinal Assessment

Twin Research and Human Genetics ◽

10.1017/thg.2018.24 ◽

2018 ◽

Vol 21 (3) ◽

pp. 269-274

Author(s):

Jeong Woo Park ◽

Seung Mi Lee ◽

Hye-Sim Kang ◽

Soon-Sup Shim ◽

Jong Kwan Jun

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Gestational Age ◽

Retrospective Cohort ◽

Longitudinal Assessment ◽

Third Trimester ◽

Study Population ◽

Vertex Presentation ◽

Twin Pregnancies ◽

Second Twin

Little is known about longitudinal changes of the first twin presentation in twin gestations. This is a retrospective cohort study including 411 women who were admitted consecutively and delivered live-born twins at 36 weeks of gestation or more. Longitudinal assessment of the first twin presentation was conducted during gestation and at birth in all cases. Gestational age at antenatal assessment was divided into two intervals: early-third trimester (28–31 weeks) and mid-third trimester (32–35 weeks). Fetal presentation was categorized as vertex or non-vertex. We analyzed change of fetal presentation between antepartum intervals and birth. First twin presentation at early-third trimester had the same presentation at birth in 87.6% (360/411) of the study population. In this ‘no change’ group, vertex presentation was seen in 95.6% (283/296) and non-vertex was seen in 67.0% (77/115) of cases. In total, 96.1% (395/411) of the study population maintained their presentation between mid-third trimester and birth. Vertex presentation was seen in 98.4% (310/315) and non-vertex was seen in 88.5% (85/96) of cases. When comparing vertex with non-vertex, vertex presentation during third trimester was a more reliable predictor of presentation at birth (p < .001). The only factor that contributed significantly to spontaneous version of the first twin during mid-third trimester and birth was a lower birth weight of the first twin compared with the second twin. In conclusion, first twin presentation with vertex during third trimester is not likely to change into non-vertex at birth. We concluded that vertex presentation in twin gestations at early- and mid-third trimester is very predictable. In contrast, a non-vertex first twin presentation is relatively unstable.

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Outcomes in emergency versus elective cases of placenta accreta spectrum disorder managed by caesarean-hysterectomy within a dedicated multidisciplinary care team: retrospective cohort study.

10.22541/au.163253036.69537467/v1 ◽

2021 ◽

Author(s):

Homero Flores Mendoza ◽

Anjana Chandran ◽

Carlos Hernandez-Nieto ◽

Ally Murji ◽

Lisa Allen ◽

...

Keyword(s):

Cohort Study ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Placenta Accreta ◽

Perinatal Outcomes ◽

Elective Delivery ◽

Gestational Age At Delivery ◽

Placenta Accreta Spectrum ◽

Caesarean Hysterectomy

Objective: Compare maternal and perinatal outcomes between emergency and elective caesarean-hysterectomy for placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team. Design and setting: Single-centre retrospective cohort study Population: 125 cases of antenatally suspected and pathologically confirmed PAS disorder. Methods: Maternal and perinatal outcomes were analyzed. Multivariate logistic regression was used to test associations, adjusting for potential confounders. Survival curves exploring risk factors for emergency delivery were sought. Main Outcome Measures: Maternal outcomes including hemorrhagic morbidity, operative complications. Perinatal outcomes included gestational age at delivery, birthweight, Apgar scores and perinatal death. Results: 25 (20%) and 100 (80%) patients had emergency and elective delivery, respectively. Emergency delivery had a higher estimated blood loss (median IQR 2772 [2256.75] vs. 1561.19 [1152.95], p<0.001), with a higher rate of coagulopathy (40 vs. 6%; p<0.001) and bladder injury (44 vs. 13%; p<0.001). Emergency delivery was associated with increased rates of blood transfusion (aOR 4.9, CI95% 1.3-17.5, p=0.01), coagulopathy (aOR 16.4, CI95% 2.6-101.4, p=0.002) and urinary tract injury (aOR 6.96, CI95% 1.5-30.7, p=0.01). Gestational age at delivery was lower in the emergency group (mean SD 35.19 [2.77] vs. 31.55 [4.75], p=0.001), no difference in perinatal mortality was found (aOR 0.01, CI95% <0.001-17.5, p=0.53). A sonographically short cervix and/or history of APH had an increased cumulative risk of emergency delivery with advancing gestational age. Conclusions: Patients with PAS disorders managed in a tertiary centre by a multidisciplinary team requiring emergency delivery have increased maternal morbidity and poorer perinatal outcomes than those with elective delivery.

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Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0252654 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252654

Author(s):

Sara Ornaghi ◽

Alice Maraschini ◽

Serena Donati ◽

Keyword(s):

Blood Transfusion ◽

Cesarean Section ◽

Placenta Accreta ◽

Placenta Previa ◽

Geographical Area ◽

Perinatal Outcomes ◽

Population Based ◽

Source Population ◽

Italian Regions ◽

Placenta Accreta Spectrum

Introduction Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15–50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75–0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.

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Clinical Profile and Feto-Maternal Outcome of Preterm Prelabour Rupture of The Membrane in a Tertiary Level Hospital

KYAMC Journal ◽

10.3329/kyamcj.v12i3.56560 ◽

2021 ◽

Vol 12 (3) ◽

pp. 166-171

Author(s):

Sanjida Hossain ◽

Syeda Sharmin Sultana ◽

Joyti Rani Biswas ◽

Mosammat Salma Noor ◽

Sharmin Farzana

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Clinical Profile ◽

Fetal Membrane ◽

Weight Category ◽

Study Results ◽

History Of ◽

Study Population ◽

The Mean

Background: The rupture of fetal membrane before onset of labour at less than 37 completed weeks of gestation. Incidence of Preterm prelabour rupture of membrane (PPROM) ranges from 3.0-10.0% of all deliveries and causes around 25-30% of all preterm deliveries. Objective: To see the clinical profile, maternal and fetal outcome of preterm prelabour rupture of the membrane. Materials and Methods: One hundred fifteen pregnant women with 28-37 weeks of gestation and diagnosed as PPROM admitted in different units selected by purposive sampling, fulfilled the inclusion and exclusion criteria were enrolled as study population in this study. Results: The mean age was 24.65(±3.68) years. Majority (75.65%) were primi para. The mean gestational age was 32.34(±2.86) weeks, 79.13% had gestational age between 30-36 weeks and 20.87% had up to 30 wks. The common risk factors of the study population were history of coitus, CPD, infection and history of abortion which were 42.61%, 9.57%, 5.22% and 4.35% respectively. Majority 55.65% women had vaginal delivery, 44.35% had caesarian section. Majority of the babies born to PPROM group were in the very low birth weight category (53 cases 62.3%), whereas only 32 cases (37.6%) were of normal birth weight. Infection and perinatal mortality was significantly associated with PPROM. Conclusion: PPROM can be prevented avoiding the certain risk factors by proper ante natal checkup, strict follow up, good obstetrical care and perinatal care , making mass awareness of the sequele. KYAMC Journal. 2021;12(3): 166-171

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