Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa

Objective: Investigate the different methods for termination at mid-trimester in pregnant women with placenta previa. Methods: A retrospective study was conducted on 264 cases for termination at mid-pregnancy in our hospital, and 34 cases with placenta previa were set as the observation group, and 230 cases with normal placenta were set as control group. Among them, the preferred methods of termination at first were Mifepristone combined with Misoprostol/Rivanol in the observation group, and Mifepristone combined with Misoprostol/Rivanol/cervical double balloon (CDB) in the control group. If the volume of prenatal bleeding was up to 100 mL in the observation group, emergency artery embolization (UAE) was implemented to stop bleeding, then CDB plus with curettage were used in order. If it failed to induce in the control group, CDB was used subsequently followed with Misoprostol/Rivanol. Then, all those cases were set as the comprehensive-induce group, and the others were set as the simple-induce group.Results: the average maternal age, the number of gravidity/parities, the rate of cesarean section, the hospitalization days and cost, the induction time, the rate of postpartum hemorrhage, puerperal infection were higher in the observation group than those in the control group(p<0.05). There were 4 cases used UAE+CDB+curettage in the observation group and 6 cases used CDB after Misoprostol/Rivanol in the control group. The duration time of termination, the rate of postpartum hemorrhage and transferring to ICU, hospitalization days and cost in the comprehensive-induce group were significantly higher than those in the simple-induce group (p<0.05). All cases were delivered through vaginal successfully.Conclusion: We should pay more attention to the complications of prenatal bleeding, postpartum hemorrhage, puerperal infection during the induction at mid-trimester in pregnant women with placenta previa. Emergency UAE + CDB +curettage is a good combination method in prenatal hemorrhage of placenta previa during termination, and CDB was a good tool for cervical ripen with immature cervical condition in mid-trimester for induction of labor.

GROSSESSE GEMELLAIRE ASSOCIANT UNE MOLE COMPLETE ET UNE GROSSESSE SINGLETON NORMALE: A PROPOS DUN CAS

Twin pregnancy involving a complete mole and a normal singleton pregnancy with its own healthy trophoblast is a rare entity. The most serious complication is the progression to gestational trophoblastic disease. Reporting the case of a 38-year-old pastry, G5P4, consultant for bleeding after pregnancy of 16 weeks not followed, whose pelvic ultrasound showed the appearance of an association of a complete hydatidiform mole and a normal singleton pregnancy .The patient had a spontaneous abortion 48 hours after her hospitalization. The anathomopathologic study confirmed the diagnosis of the association of a complete mole and a normal placenta. The evolution is marked by the non-evolution towards gestational trophoblastic disease. 

Magnetic resonance imaging of the placenta: a systematic approach to the description of normal placenta

Background. Currently, one of the topical issues of prenatal magnetic resonance imaging is accurate and timely diagnosis of pathological conditions of extrafetal structures of the fetus. In particular, the most acute problem is the need to improve the diagnostic accuracy of recognition and differentiation of placental adhesive-invasive pathology (PAIP). In the literature, there is no unified approach to the methodology and description of MRI examination of the placenta. Objective. To improve the diagnostic methods of the method of magnetic resonance imaging for the study of the placenta. Design and methods. A total of 293 MRI studies of the small pelvis of pregnant women aged 22 to 45 years (average — 35 years), in gestational age from 14 to 38 weeks (average 36 weeks) were performed and analyzed. Results. A clinical three-stage method of MRI of the placenta and an algorithm for systematized description of MRI of the placenta of pregnant women have been developed and implemented. Conclusion. The developed systematic approach to the study of the placenta will help improve the capabilities of the MRI method for examining the placenta in connection with the demand for accurate and correct interpretation of this organ in vivo.

New Frontiers in Placenta Tissue Imaging

The placenta is a highly vascularised organ with unique structural and metabolic complexities. As the primary conduit of fetal support, the placenta mediates transport of oxygen, nutrients, and waste between maternal and fetal blood. Thus, normal placenta anatomy and physiology is absolutely required for maintenance of maternal and fetal health during pregnancy. Moreover, impaired placental health can negatively impact offspring growth trajectories as well as increase the risk of maternal cardiovascular disease later in life. Despite these crucial roles for the placenta, placental disorders, such as preeclampsia, intrauterine growth restriction, and preterm birth, remain incompletely understood. Effective noninvasive imaging and image analysis are needed to advance the obstetrician’s clinical reasoning toolkit and improve the utility of the placenta in interpreting maternal and fetal health trajectories. Current paradigms in placental imaging and image analysis aim to improve the traditional imaging techniques that may be time-consuming, costly, or invasive. In concert with conventional clinical approaches such as ultrasound, advanced imaging modalities can provide insightful information on the structure of placental tissues. Herein, the authors discuss such imaging modalities; their specific applications in structural, vascular, and metabolic analysis of placental health; and emerging frontiers in image analysis research in both preclinical and clinical contexts.

Case Report of Nuchal Cord Associated Stillbirth: What to Learn From the Complaints to the Diagnosis?

Nuchal cord is the umbilical cord accident least associated with stillbirths. It is a common occurrence; however, the expertise to diagnose multiple and tight loops on ultrasound is minimal, especially in limited-resource settings. We report a 30 year-old gravida 1, who presented at a gestation of 39/40+6/7 with a 2 day history of inability to appreciate foetal movements. An urgent obstetric ultrasound revealed absent foetal cardiac activity, reduced amniotic fluid and normal placenta but the report had no comments on the umbilical cord. She delivered a macerated male infant with a tight cord around the neck thrice. This case report highlights the importance of third trimester sonography screening of umbilical cord abnormalities and the mechanism of intrauterine foetal death associated with umbilical cord accidents.

Term Delivery of a Complete Molar Pregnancy with a Coexistent Normal Pregnancy

Twin pregnancy with a complete mole and a coexistent normal fetus reaching term is a rare occurrence. We report a case of a 21-yrs G2P1L0 un-booked patient at 39 weeks who was referred for the same condition diagnosed incidentally on ultrasound scan which showed a singleton pregnancy in breech presentation with a normal placenta and a heterogeneous cystic lesion seen anteriorly, suggesting a coexistent molar pregnancy. Cesarean section was done, and a healthy male baby was delivered with a grossly normal placenta and a second placenta with grape like vesicles. Histopathology confirmed the diagnosis of complete mole and normal placenta. Postoperative period was uneventful, and the patient was kept on beta hcg follow-up to monitor progression to gestational trophoblastic neoplasia, but it normalized by 12 weeks.

Partial Mole Coexistence with a Normal Live Fetus in Twin Pregnancy

We present a case of dizygotic diamiontic twin pregnancy in which one fetus was normal with normal placenta, the 2nd fetus was normal appearing with partial molar placenta. All required investigation and clinical assessments were carried out and revealing partial molar pregnancy in one fetus and normal placenta of the other one. Maternal BhCG was high for gestational age.The patient was a 31-year-old presented to Central Private Hospital; her gestational age was 22 weeks +5 days following IVF (after 10 years of primary infertility) of diazygotic diamiontic twin pregnancy as a case of vaginal bleeding from 8 weeks of gestation with uterine contractions. The patient had gestational DM & hyperthyroidism. Appropriate treatment regarding her conditions was implemented All appropriate management was implemented. The patient continued to bleed. Within few days of admission she had premature uncomplicated labor with normal vaginal delivery (gestational age was23 Wks +3 days), both babies appeared normal, one placenta morphologically &histologically typical of H.mole. The other one completely was normal. Monitoring of serum BhCG and follow up transvaginal US was done until BhCG level returned to normal after 3 months of delivery without chemotherapy. Close monitoring of pregnancy from early stages and discussing the possible complications to mother and baby (such as baby may be chromosomally abnormal &may not survive) with parents is important to manage such complications. It is also necessary to have post-natal close follow up for maternal BhCG levels to assess any possibility of invasive mole or choriocarcinoma.