RESUMEN

OBJECTIVES: Placenta previa-accreta spectrum disorders are a cause of obstetric hemorrhage that can lead to maternal fetal mortality and morbidity. We aimed to describe the use of a uterine isthmic tourniquet left in situ as a new uterus-preserving approach for patients with placenta previa-accreta. METHODS: In this retrospective comparative study, the patients who underwent surgery for placenta previa between 2017 and 2024 at our tertiary hospital were reviewed. Primary outcome of the study is to evaluate feasibility of uterine isthmic tourniquet left in situ for uterine preserving by preventing postpartum hemorrhage for patients with placenta previa-accreta. As a secondary outcome, group 1 (n=28) patients who were managed with uterine isthmic tourniquet left in place were compared with patients in group 2 (n=32) who were managed with only bilateral uterine artery ligation. RESULTS: This new approach uterine isthmic tourniquet technique prevented postpartum hemorrhage with a rate of 100 percent in group 1 patients, while uterine artery ligation prevented postpartum hemorrhage with a rate of 75 % in group 2. Postoperative additional interventions (relaparotomy hysterectomy, balloon tamponade application, uterine or vaginal packing) were performed for eight patients in group 2 (25 %) but not in group 1 (0 %) (p=0.015). The haemoglobin levels before caesarean section were similar in both groups (p=0.235), while the postoperative haemoglobin levels were lower in group 2 (9.69 ± 1.37 vs. 8.15 ± 1.32) (p=0.004). Erythrocyte suspension was given to two patients in group 1 and 12 patients in group 2 (2/28 7 % vs. 12/32 37 %, p=0.018). CONCLUSIONS: The uterine isthmic tourniquet left in situ technique is a safe, simple and effective for preventing postpartum hemorrhage and preserving uterus during placenta previa accreta surgery as superior to uterine artery ligation alone.

RESUMEN

BACKGROUND: Recently, a history of endometriosis has been reported to be associated with several perinatal complications. However, it is unknown whether pre-pregnancy treatment for endometriosis reduces perinatal complications. In this study, we aimed to clarify the association between endometriosis and perinatal complications and investigate whether there is a significant difference in the incidence of placenta previa depending on the degree of surgical completion of endometriosis before pregnancy. METHODS: This case-control study included 2781 deliveries at the Hirosaki University Hospital between January 2008 and December 2019. The deliveries were divided into a case group with a history of endometriosis (n = 133) and a control group without endometriosis (n = 2648). Perinatal outcomes and complications were compared between the case and control groups using a t-test and Fisher's exact test. Multiple logistic regression models were used to identify the risk factors for placenta previa. Additionally, we examined whether the degree of surgical completion of endometriosis before pregnancy was associated with the risk of placenta previa. RESULTS: Patients with a history of endometriosis had a significantly higher risk of placenta previa (crude odds ratio, 2.66; 95% confidence interval, 1.37‒4.83). Multiple logistic regression analysis showed that a history of endometriosis was a significant risk factor for placenta previa (adjusted odds ratio, 2.30; 95% confidence interval, 1.22‒4.32). In addition, among patients with revised American Society for Reproductive Medicine stage III-IV endometriosis, the incidence of placenta previa was significantly lower in patients who underwent complete surgery (3/51 patients, 5.9%) than in those who did not (3/9 patients, 33.3%) (p = 0.038). CONCLUSIONS: A history of endometriosis is an independent risk factor for placenta previa. Given the limitations of this study, further research is needed to determine the impact of endometriosis surgery on perinatal complications.

Asunto(s)

RESUMEN

OBJECTIVE: To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction. DESIGN: Multicenter retrospective cohort study. SETTING: A total of 103 French maternity units. PATIENTS: Deliveries by 368,935 women (377,338 infants) from 1999 through 2016. EXPOSURE: Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) MAIN OUTCOMES MEASURES: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates. RESULTS: Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups. CONCLUSION: Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis.

RESUMEN

INTRODUCTION: To investigate the risk factors affecting patients with placenta previa (PP) and to construct an effective prediction model for the severity of PAS in PP. METHODS: A total of 240 pregnant women with PP were enrolled in this study. An MRI+Ultrasound-based model was developed to classify patients into placental implantation and non-placental implantation groups. Multivariate nomograms were created based on imaging features. The model was evaluated using Receiver Operating Characteristic (ROC) curve analysis. The predictive accuracy of the nomogram was assessed through calibration plots and decision curve analysis. RESULTS: The MRI+Ultrasound-based prediction model demonstrated favorable discrimination between the placental implantation and non-placental implantation groups. The calibration curve exhibited agreement between the estimated and actual probability of placental implantation. Additionally, decision curve analysis indicated a high clinical benefit across a wide range of probability thresholds. The Area under the ROC curve (AUC) was 0.911 (95 % CI: 0.76-0.947), with a sensitivity of 88.40 % and specificity of 88.10 %. CONCLUSION: The MRI+Ultrasound-based prediction model could be a valuable tool for preoperative prediction of the percentage of implantation. Our study enables obstetricians to conduct more adequate preoperative evaluations.

Asunto(s)

RESUMEN

OBJECTIVES: To assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa. STUDY DESIGN: This retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis. RESULTS: Reduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm3; OR: 0.993, 95 % CI: 0.990-0.995 and OR: 1.007, 95 % CI: 1.005-1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 - 0.88 and OR: 1.7, 95 % CI: 1.4 - 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2-250, p = 0.001). CONCLUSIONS: Placental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.

Asunto(s)

RESUMEN

This case involves a 34-year-old pregnant woman, gravida 6 para 5, with a gestational age of 32 weeks plus one day. After imaging studies, doctors suspected that she had an abnormal placentation and referred her to a secondary hospital for further management. Surgeons there performed a successful elective cesarean section and a total abdominal hysterectomy with a multidisciplinary approach in mind.

RESUMEN

BACKGROUND: Placental accreta spectrum disorders (PAS) are a high-risk group for severe postpartum hemorrhage (SPPH), with the incidence of PAS increasing annually. Given that cesarean section and anterior placenta previa are the primary risk factors for PAS, therefore, our study aims to investigate the predictive value of clinical characteristics and ultrasound indicators for SPPH in patients with anterior placenta previa combined with previous cesarean section, providing a theoretical basis for early prediction of SPPH. METHODS: A total of 450 patients with anterior placenta previa combined with previous cesarean section were retrospectively analyzed at Shengjing Hospital affiliated with China Medical University between January 2018 and March 2022. Clinical data and ultrasound indicators were collected. Patients were categorized into SPPH (blood loss >2000mL, 182 cases) and non-SPPH (blood loss ≤ 2000mL, 268 cases) groups based on the blood loss within 24 h postpartum. The population was randomly divided into training and validation cohorts at a 7:3 ratio. LASSO and multifactorial logistic regression analyses were utilized to identify independent risk factors for SPPH. Accordingly, a nomogram prediction model was constructed, the predictive performance was assessed using receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). RESULTS: Among the 450 patients, 182 experienced SPPH (incidence rate, 40.44%). Preoperative systemic immune-inflammatory index, preoperative D-dimer level, preoperative placenta accreta spectrum ultrasound scoring system (PASUSS) score, and one-step-conservative surgery were identified as independent risk factors for SPPH in patients with anterior placenta previa combined with previous cesarean section. A nomogram was constructed based on these factors. The areas under the ROC curves for the training and validation cohorts were 0.844 (95%CI: 0.801-0.888) and 0.863 (95%CI: 0.803-0.923), respectively. Calibration curves and DCA indicated that this nomogram demonstrated good predictive accuracy. CONCLUSIONS: This nomogram presents an effective and convenient prediction model for identifying SPPH in patients with anterior placenta previa combined with previous cesarean section. It can guide surgical planning and improve prognosis.

Asunto(s)

RESUMEN

STUDY QUESTION: Do obstetric and perinatal complications vary according to different blastocyst developmental parameters after frozen-thawed single-blastocyst transfer (SBT) cycles? SUMMARY ANSWER: Pregnancies following the transfer of a blastocyst with a grade C trophectoderm (TE) were associated with an increased risk of placenta previa compared to those with a blastocyst of grade A TE. WHAT IS KNOWN ALREADY: Existing studies investigating the effect of blastocyst morphology grades on birth outcomes have mostly focused on fetal growth and have produced conflicting results, while the risk of obstetric complications has rarely been reported. Additionally, growing evidence has suggested that the appearance of TE cells could serve as the most important parameter for predicting implantation and live birth. Given that the TE ultimately develops into the placenta, it is plausible that this independent predictor may also impact placentation. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study at a tertiary-care academic medical center included 6018 singleton deliveries after frozen-thawed SBT cycles between January 2017 and December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Singleton pregnancies were grouped into two groups according to blastocyst developmental stage (Days 5 and 6), four groups according to embryo expansion (Stages 3, 4, 5, and 6), three groups according to inner cell mass (ICM) quality (A, B, and C), and three groups according to TE quality (A, B, and C). The main outcomes included pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, preterm premature rupture of membrane, placenta previa, placental abruption, placenta accreta, postpartum hemorrhage, preterm birth, low birth weight, small for gestational age, and birth defects. Multivariate logistic regressions were performed to evaluate the effect of blastocyst developmental stage, embryo expansion stage, ICM grade, and TE grade on measured outcomes adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE: No association was found between blastocyst developmental stage and obstetric or perinatal outcomes both before and after adjusting for potential confounders, and similar results were found with regard to embryo expansion stage and ICM grade. Meanwhile, the incidence of placenta previa derived from a blastocyst with TE of grade C was higher compared with those derived from a blastocyst with TE of grade A (1.7%, 2.4%, and 4.0% for A, B, and C, respectively, P = 0.001 for all comparisons). After adjusting for potential covariates, TE grade C blastocysts had 2.81 times the likelihood of resulting in placenta previa compared to TE grade A blastocysts (adjusted odds ratio 2.81, 95% CI 1.11-7.09). No statistically significant differences were detected between any other measured outcomes and TE grades both before or after adjustment. LIMITATIONS, REASONS FOR CAUTION: The study is limited by its retrospective, single-center design. Additionally, although the sample size was relatively large for the study group, the sample size for certain subgroups was relatively small and lacked adequate power, particularly the ICM grade C group. Therefore, these results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: The study extends our knowledge of the potential downstream effect of TE grade on placental abnormalities. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the National Key Research and Development Program of China (2023YFC2705500, 2023YFC2705501, 2023YFC2705505, 2019YFA0802604); National Natural Science Foundation of China (82130046, 82320108009, 82371660, 32300710); Shanghai leading talent program, Innovative research team of high-level local universities in Shanghai (SHSMU-ZLCX20210201, SHSMU-ZLCX20210200, SHSMU-ZLCX20180401), Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital Clinical Research Innovation Cultivation Fund Program (RJPY-DZX-003), Science and Technology Commission of Shanghai Municipality (23Y11901400), Shanghai's Top Priority Research Center Construction Project (2023ZZ02002), and Three-Year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.1-36). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: N/A.

RESUMEN

INTRODUCTION AND IMPORTANCE: Bleeding during pregnancy or during childbirth can cause significant morbidity and mortality for the mother and baby, this can be overcome by performing a caesarean section (C-section) and blood transfusions. Although blood transfusions can save lives, there is a risk such as transfusion reactions, transmission of infection, and anaphylaxis. Giving autologous blood transfusion can reduce the risk of these events. This case report aims to investigate the advantages of autologous blood transfusion in managing the patient's hemodynamic status compared to homologous blood transfusion. CASE PRESENTATION: A 21-year-old female (G2P1A0) with antepartum hemorrhage (APH) due to placenta previa underwent emergency C-section with intrauterine device installation and hysterectomy. The patient received an autologous transfusion to improving the hematocrits and hemoglobin within 30 min. Autologous transfusion provided routine postoperative hemodynamics, electrolytes, and blood stability. However, it could not completely replace homologous transfusion. CLINICAL DISCUSSION: Autologous transfusion reduces transfusion response, infection risk, and immunosuppression. Consequently, it reduces the need for allogenic blood supplies and enables safer transfusion for people with rare blood types and various auto-antibodies. CONCLUSION: Autologous transfusions may provide better outcomes in C-section surgery for APH patients due to placenta previa. Thus, we recommend the use of autologous over homologous transfusion. Further research is required to compare them to a large population.

RESUMEN

BACKGROUND: Antepartum hemorrhage is defined as any bleeding from or into the genital tract during pregnancy, after the period of viability until delivery of the fetus. APH complicates 2-5% of pregnancies and is a primary cause of perinatal and maternal mortality globally. Aim of this study is to evaluate maternal and perinatal outcome in patients with APH at a tertiary care hospital. METHODS: The present study was a cross sectional study conducted in Obstetrics and Gynaecology department of Paropakar Maternity and Women's Hospital, during a period of 5 months from December 2022 to April 2023. 50 cases of APH were enrolled with gestational age ≥ 34 weeks of gestation. RESULTS: Incidence of APH after 34 weeks of gestation was 0.51%. The most common type of APH was abruption placenta (44%) followed by placenta previa (32%) and undetermined (24%). The age range of 26 to 30 years old accounted for the highest number of APH patients i.e., 21(42%). In placenta previa, 75% and in abruption placenta 63.64% were multigravida. APH was presented mostly between 37-40 weeks. Around 26% of the patients had anemia at the time of admission. Most common mode of delivery was cesarean section (82%). Most common maternal complications were PPH (40%), blood transfusion (28%), DIC (4%), cesarean hysterectomy (4%). Low birth weight and preterm were the most common causes of fetal complications. Maternal mortality was 2% and perinatal mortality was 18% overall. CONCLUSIONS: APH is primary cause of maternal and perinatal morbidity and mortality. In our study, an abruption placenta was the most frequent cause of APH. Cesarean section was the most commonly used mode of delivery. PPH with blood transfusion was the most prevalent maternal complication, while fetal complications included low birth weight and preterm..

Asunto(s)

RESUMEN

OBJECTIVE: To evaluate hemostatic efficacy, complications, and subsequent pregnancy outcomes in women with placenta previa who underwent combined vertical compression sutures in the lower uterine segment and intrauterine balloon tamponade (Hot-Dog method) to achieve hemostasis after cesarean section. METHODS: We retrospectively reviewed data for 117 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between 29 and 38 weeks' gestation. Treatments were as follows: (1) conventional-intravenous oxytocin administration after placental detachment and suturing of bleeding points at the detachment site as needed (conventional group) (n = 47). (2) Intrauterine balloon tamponade alone (balloon group) (n = 41). (3) Vertical compression sutures + intrauterine balloon tamponade (Hot-Dog group) (n = 29). RESULTS: The placenta accreta spectrum prevalence was significantly higher in the balloon and Hot-Dog groups versus the conventional group. The prevalence of anteriorly located placenta was significantly higher in the Hot-Dog versus balloon groups. Intraoperative and total blood loss were significantly higher in the Hot-Dog versus conventional groups. Postoperative blood loss was significantly lower in the Hot-Dog versus balloon groups. Fewer additional procedures for managing postoperative hemorrhage were required in the Hot-Dog versus conventional and balloon groups. The number of subsequent pregnancies in the conventional, balloon, and Hot-Dog groups was 11 (23.4%), 8 (19.5%), and 4 (13.8%), respectively; all resulted in live births at term without serious obstetric complications. CONCLUSION: The Hot-Dog method is a straightforward and safe hemostasis technique for placenta previa that preserves fertility and controls severe bleeding.

RESUMEN

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality.

RESUMEN

INTRODUCTION: Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available. MATERIAL AND METHODS: Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood-specific biomarker(s) during pregnancies with PAS at birth. PRISMA Extension for Scoping Review (PRISMA-ScR) was used to extract data and report results. RESULTS: Of the 441 reviewed articles, 29 met the inclusion criteria reporting on 34 different biomarkers. 14 studies were retrospective and 15 prospective overall including 18 251 participants. Six studies had a cohort design and the remaining a case-control design. Wide clinical heterogeneity was found in the included studies. In eight studies, the samples were obtained in the first trimester; in five, the samples were collected on hospital admission for delivery; and in the rest, the samples were collected during the second and/or third trimester. CONCLUSIONS: Measurements of serum biomarkers, some of which have been or are still used in screening for other pregnancy complications, could contribute to the prenatal evaluation of patients at risk of PAS at delivery; however, important evidence gaps were identified for suitable cutoffs for most biomarkers, variability of gestational age at sampling and the potential overlap of the marker values with other placental-related complications of pregnancy.

RESUMEN

INTRODUCTION: Placenta accreta spectrum disorders (PAS) lead to major complications in pregnancy. While the maternal morbidity associated with PAS is well known, there is less information regarding neonatal morbidity in this setting. The aim of this study is to describe the neonatal outcomes (fetal malformations, neonatal morbidity, twin births, stillbirth, and neonatal death), using an international multicenter database of PAS cases. MATERIAL AND METHODS: This was a prospective, multicenter cohort study based on prospectively collected cases, using the international multicenter database of the International Society for PAS, carried out between January 2020 and June 2022 by 23 centers with experience in PAS care. All PAS cases were included, regardless of whether singleton or multiple pregnancies and were managed in each center according to their own protocols. Data were collected via chart review. Local Ethical Committee approval and Data Use Agreements were obtained according to local policies. RESULTS: There were 315 pregnancies eligible for inclusion, with 12 twin pregnancies, comprising 329 fetuses/newborns; 2 cases were excluded due to inconsistency of data regarding fetal abnormalities. For the calculation of neonatal morbidity and mortality, all elective pregnancy terminations were excluded, hence 311 pregnancies with 323 newborns were analyzed. In our cohort, 3 neonates (0.93%) were stillborn; of the 320 newborns delivered, there were 10 cases (3.13%) of neonatal death. The prevalence of major congenital malformations was 4.64% (15/323 newborns), most commonly, cardiovascular, central nervous system, and gastrointestinal tract malformations. The overall prevalence of major neonatal morbidity in pregnancies complicated by PAS was 47/311 (15.1%). There were no stillbirths, neonatal deaths, or fetal malformations in reported twin gestations. CONCLUSIONS: Although some outcomes may be too rare to detect within our cohort and data should be interpreted with caution, our observational data supports reassuring neonatal outcomes for women with PAS.

RESUMEN

INTRODUCTION: Prediction of intraoperative massive hemorrhage is still challenging in placenta previa. Radiomics analysis has been investigated as a new evaluation method for analyzing medical images. We used radiomics analysis on placental magnetic resonance imaging (MRI) images to predict intraoperative hemorrhage in placenta previa. METHODS: We used the sagittal MRI T2-weighted sequence in placenta previa. Using the rectangular region from the uterine os to the anterior wall, we extracted 97 radiomics features. We also collected patient demographics and blood test data as clinical variables. Combining these radiomics features and clinical variables, logistic regression models with a stepwise method were built to predict the risk of hemorrhage, defined as blood loss of > 2000 ml. We evaluated the prediction performance of the models using accuracy and area under the curve (AUC), also analyzing the important variables for the prediction by stepwise methods. RESULTS: We enrolled a total of 63 placenta previa cases including 30 hemorrhage cases from two institutes. The model combining clinical variables and radiomics features showed the best prediction performance with an accuracy of 0.70 and an AUC of 0.69 in the internal validation data, and accuracy of 0.41 and an AUC of 0.70 in the external validation data, compared with human experts (accuracy of 0.62). Regarding variable selection, two radiomics features. 'original_glrlm_LowGrayLevelRunEmphasis,' and 'diagnostics_Image-original_Minimum,' were important predictors for hemorrhage by the stepwise method. DISCUSSION: Radiomics features based on MRI could be used as effective predictive variables for hemorrhage in placenta previa. Radiomics analysis of placental imaging could lead to further analysis of quantitative variables related to obstetric diseases.

Asunto(s)

RESUMEN

OBJECTIVE: This study aims to investigate the correlation between endometriosis (EMS) and adverse obstetric outcomes. METHODS: In this retrospective study 2,925 cesarean section cases were analyzed at the Women and Children's Hospital of Ningbo University, Department of Obstetrics, between May 2019 and December 2023. The study included 1,363 women diagnosed with endometriosis during pregnancy at the time of surgery (study group) and 1,562 women without such a diagnosis (control group). The comparative assessment covered the age of first-time mothers, number of pregnancies and births, gestational age at delivery, incidence rates of assisted reproductive technology (ART), spontaneous abortion, preterm birth, placenta previa, placental adhesion, and postpartum hemorrhage. RESULTS: The study group demonstrated a higher average age of first-time mothers, fewer pregnancies and births, and a significantly shorter gestational age at delivery (P < 0.05) compared to the control group. Incidences of primary infertility, spontaneous abortion, and ART utilization were higher in the study group. The occurrence of placenta previa, placental adhesion, and postpartum hemorrhage was also higher in the study group, indicating significant statistical differences (P < 0.05). No significant difference was observed in preterm birth rates between the groups (P > 0.05). CONCLUSION: Pregnancy in women with endometriosis is associated with a higher likelihood of adverse outcomes, therefore highlighting the need for increased clinical awareness.

Asunto(s)

RESUMEN

BACKGROUND: The incidence of placenta accreta spectrum (PAS) increases in women with placenta previa (PP). Many radiologists sometimes cannot completely and accurately diagnose PAS through the simple visual feature analysis of images, which can affect later treatment decisions. The study is to develop a T2WI MRI-based radiomics-clinical nomogram and evaluate its performance for non-invasive prediction of suspicious PAS in patients with PP. METHODS: The preoperative MR images and related clinical data of 371 patients with PP were retrospectively collected from our hospital, and the intraoperative examination results were used as the reference standard of the PAS. Radiomics features were extracted from sagittal T2WI MR images and further selected by LASSO regression analysis. The radiomics score (Radscore) was calculated with logistic regression (LR) classifier. A nomogram integrating Radscore and selected clinical factors was also developed. The model performance was assessed with respect to discrimination, calibration and clinical usefulness. RESULTS: A total of 6 radiomics features and 1 clinical factor were selected for model construction. The Radscore was significantly associated with suspicious PAS in both the training (p < 0.001) and validation (p < 0.001) datasets. The AUC of the nomogram was also higher than that of the Radscore in the training dataset (0.891 vs. 0.803, p < 0.001) and validation dataset (0.897 vs. 0.780, p < 0.001), respectively. The calibration was good, and the decision curve analysis demonstrated the nomogram had higher net benefit than the Radscore. CONCLUSIONS: The T2WI MRI-based radiomics-clinical nomogram showed favorable diagnostic performance for predicting PAS in patients with PP, which could potentially facilitate the obstetricians for making clinical decisions.

Asunto(s)

RESUMEN

Placenta previa poses significant risks to maternal and perinatal health, yet its management remains challenging. This comprehensive review synthesizes current evidence on maternal and perinatal outcomes in placenta previa, addressing its epidemiology, pathophysiology, diagnosis, and management strategies. Placenta previa complicates pregnancies, with increasing incidence linked to factors such as advanced maternal age and rising cesarean rates. Maternal complications, including hemorrhage and placenta accreta spectrum disorders, pose substantial risks. At the same time, perinatal outcomes are marked by increased rates of preterm birth, intrauterine growth restriction, and neonatal morbidity and mortality. Timely diagnosis and appropriate management, including antenatal corticosteroids and multidisciplinary care, are critical for optimizing outcomes. Future research should focus on improving diagnostic methods, evaluating novel interventions, and assessing long-term neurodevelopmental outcomes. This review underscores the importance of informed clinical practice and ongoing research efforts to enhance outcomes for women and infants affected by placenta previa.

RESUMEN

Key Clinical Message: Placenta previa, accompanied by placenta percreta, which involves invasion of the bladder, presents a significant risk of excessive bleeding during and after delivery. This case highlights that prophylactic embolization, conservative surgery, and careful monitoring offer an effective approach to avoid hysterectomy in cases of placenta percreta with adjacent organ involvement. Abstract: Placenta previa complicated by placenta percreta is associated with a high risk of massive intra and post-partum hemorrhage. We present a case of a 35-year-old woman (G2 P1) who was referred to the Akbar-Abadi hospital at 13 weeks of gestation. Color Doppler ultrasound indicated complete placenta previa-percreta with bladder invasion. After induction of fetal demise, bilateral uterine and bladder artery endovascular embolization was conducted for the patient. After 48 h, under ultrasound guidance, surgical resection of residual percreta tissue was conducted as much as possible. Eight weeks later, a follow-up sonography showed the minimum residual placenta tissue and she regained menstrual cycles after 2 months. This case indicated that the combination of prophylactic embolization, conservative surgical management with placenta left in situ, and follow-up with serial color Doppler monitoring, is an optimum method to avoid hysterectomy in placenta percreta patient with adjacent organ invasion.

RESUMEN

PURPOSE: There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin pregnancies with endometriosis. This study aimed to compare the pregnancy outcomes and complications in twin pregnancies with or without endometriosis in a single institution. MATERIALS AND METHODS: From January 2011 to July 2022, a retrospective analysis of twin pregnancies was conducted. The endometriosis group included patient with histological or visual confirmation before pregnancy or during cesarean section. Pregnancy outcomes and complications were compared between the two groups. RESULTS: Out of 1714 patients examined, 127 (7.4%) were included in the endometriosis group. Maternal body mass index (BMI) was lower in the endometriosis group (p<0.001). There were no significant differences in maternal age, mode of conception, chorionicity, and pregnancy outcomes, such as gestational age at delivery (p=0.835) and the preterm birth rate (p=0.579). The endometriosis group had a significantly higher rate of obstetrical complication: small for gestational age (SGA) <10% (p=0.029). However, after adjustment for BMI, the endometriosis group showed no statistical significance in obstetrical complications, including SGA (adjusted odds ratio, 1.568; 95% confidence interval, 0.984-2.499; p=0.059). CONCLUSION: Twin pregnancies with endometriosis were not related to adverse effects on pregnancy outcomes and obstetrical complications. To confirm these outcomes, further large prospective studies are required.

Asunto(s)