Evaluation of maternal serum VEGF, TNF-alpha, IL-4, and IL-10 levels in differentiating placenta accreta spectrum from isolated placenta previa.

OBJECTIVE: Our study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) using maternal serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin-4 (IL-4), and IL-10. METHODS: The case group consisted of 77 patients with placenta previa, and the control group consisted of 90 non-previa pregnant women. Of the pregnant women in the case group, 40 were diagnosed with PAS in addition to placenta previa and 37 had placenta previa with no invasion. The maternal serum VEGF, TNF-alpha, IL-4, and IL-10 levels were compared between the case and control groups. Then the success of these markers in differentiating between PP and PAS was evaluated. RESULTS: We found the VEGF, TNF-alpha, and IL-4 levels to be higher and the IL-10 level to be lower in the case group compared to the control group (p < 0.001). We observed a statistically significantly lower IL-10 level in the patients with PAS than those with PP (p = 0.029). In the receiver operating characteristic analysis, the optimal cut-off of IL-10 in the detection of PAS was 0.42 ng/mL). In multivariate analysis, the risk of PAS was significant for IL-10 (odds ratio (OR) 0.45, 95 % confidence interval (CI) 0.25-0.79, p = 0.006) and previous cesarean section (OR 2.50, 95 % Cl 1.34-4.66, p = 0.004). The model's diagnostic sensitivity and specificity, including previous cesarean section, preoperative hemoglobin (Hb), TNF-alpha, and IL-10 were 75 % and 72.9 %, respectively. CONCLUSION: The study showed that the IL-10 level was lower in patients with PAS than in those with PP. A statistical model combining risk factors including previous cesarean section, preoperative Hb, TNF-alpha, and IL-10 may improve clinical diagnosis of PAS in placenta previa cases. Cytokines may be used as additional biomarkers to the clinical risk factors in the diagnosis of PAS.

Evaluation of maternal serum thiol and ischemia-modified albumin levels in cases of placenta previa: A case-control study in a tertiary center.

AIM: We aim to compare the maternal serum thiol and ischemia-modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP). METHODS: Fifty-five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated. RESULTS: The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05). CONCLUSIONS: Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases.

Customizing EV-CATCHER to Purify Placental Extracellular Vesicles from Maternal Plasma to Detect Placental Pathologies.

Placenta Accreta Spectrum (PAS) is a life-threatening condition in which placental trophoblastic cells abnormally invade the uterus, often up to the uterine serosa and, in extreme cases, tissues beyond the uterine wall. Currently, there is no clinical assay for the non-invasive detection of PAS, and only ultrasound and MRI can be used for its diagnosis. Considering the subjectivity of visual assessment, the detection of PAS necessitates a high degree of expertise and, in some instances, can lead to its misdiagnosis. In clinical practice, up to 50% of pregnancies with PAS remain undiagnosed until delivery, and it is associated with increased risk of morbidity/mortality. Although many studies have evaluated the potential of fetal biomarkers circulating in maternal blood, very few studies have evaluated the potential of circulating placental extracellular vesicles (EVs) and their miRNA contents for molecular detection of PAS. Thus, to purify placental EVs from maternal blood, we customized our robust ultra-sensitive immuno-purification assay, termed EV-CATCHER, with a monoclonal antibody targeting the membrane Placental Alkaline Phosphatase (PLAP) protein, which is unique to the placenta and present on the surface of placental EVs. Then, as a pilot evaluation, we compared the miRNA expression profiles of placental EVs purified from the maternal plasma of women diagnosed with placenta previa (controls, n = 16); placenta lying low in uterus but not invasive) to those of placental EVs purified from the plasma of women with placenta percreta (cases, n = 16), PAS with the highest level of invasiveness. Our analyses reveal that miRNA profiling of PLAP+ EVs purified from maternal plasma identified 40 differentially expressed miRNAs when comparing these two placental pathologies. Preliminary miRNA pathway enrichment and gene ontology analysis of the top 14 upregulated and top nine downregulated miRNAs in PLAP+ EVs, purified from the plasma of women diagnosed with placenta percreta versus those diagnosed with placenta previa, suggests a potential role in control of cellular invasion and motility that will require further investigation.

A 35-Year-Old Woman With Placenta Previa and Postpartum Cardiovascular Collapse.

CASE PRESENTATION: A 35-year-old woman at 36 weeks and 4 days gestation with known complete anterior placenta previa and no other medical history presented for routine obstetric follow-up. She reported increasing fatigue in the prior week but otherwise endorsed no new concerns. She denied recent vaginal bleeding or discharge, abdominal pain, contractions, or extremity swelling. On evaluation, her BP was 126/74 mm Hg with a heart rate of 72 beats per min. The results from the physical examination were normal. There was a category II fetal heart rate tracing and a 6/10 biophysical profile (ie, no fetal breathing movements, nonreactive nonstress test), which prompted referral to the hospital. On admission, sonogram confirmed cephalic presentation and redemonstrated complete anterior placenta previa with no evidence of hemorrhage. She received antenatal steroids and was scheduled for a cesarean section delivery. She received bupivacaine spinal anesthesia for the procedure. The surgical procedure progressed with a low transverse uterine incision and subsequent delivery of the baby with no complications noted. Immediately after delivery of the baby and during gentle traction of the placenta, the patient experienced rapid cardiovascular collapse in the form of hypotension and bradycardia.

Placenta prévia: um estudo baseado nas teorias de enfermagem / Placenta previa: a study based on nursing theories / Placenta previa: un estudio basado en las teorías de enfermería

Introdução: A gestação, apesar de ser um processo fisiológico na saúde da mulher, é uma etapa complexa que exige atenção diferenciada na assistência à saúde. Outrossim, existem algumas condições que provocam danos durante essa fase, como a placenta prévia. Objetivo: Este estudo tem como escopo evidenciar o processo de enfermagem frente à assistência à gestante com tal diagnóstico. Metodologia: A pesquisa tem caráter qualitativo, teórico com subsídio na bibliografia científica, envolvendo a compreensão holística e integral da paciente para a implementação de estratégia para o processo de enfermagem. A partir do estudo das teorias e da fisiopatologia e impactos clínicos, empregou-se as taxonomias do NANDA-I para traçar os diagnósticos de enfermagens mais condizentes. Resultados: Foram identificados 15 diagnósticos que contemplaram os dez domínios encontrados no NANDA. Considerações Finais: Os dados eleitos e o confronto com a literatura enfatizam a relevância positiva na prescrição de diagnósticos de enfermagem na escolha dos cuidados prestados e as teorias subsidiam a assistência materno-fetal.

Introduction: Pregnancy, despite being a physiological process in women's health, is a complex stage that requires special attention in health care. Also, there are some conditions that cause damage during this phase, such as placenta previa. Objective: The purpose of this study is to highlight the nursing process regarding care for pregnant women with such a diagnosis. Methodology: The research is qualitative, theoretical with support in the scientific bibliography, involving the patients holistic and integral understanding for the implementation of a strategy for the nursing process. Based on the study of theories and pathophysiology and clinical impacts, the NANDA-I taxonomies were used to outline the most consistent nursing diagnoses. Results: 15 diagnoses were identified that included the ten domains found in NANDA. Final Considerations: The chosen data and the confrontation with the literature emphasize the positive relevance in the prescription of nursing diagnoses in the choice of care provided and the theories subsidize maternal-fetal assistance.

Introducción: El embarazo, a pesar de ser un proceso fisiológico en la salud de la mujer, es una etapa compleja que requiere especial atención en el cuidado de la salud. Además, existen algunas condiciones que causan daños durante esta fase, como la placenta previa. Objetivo: El propósito de este estudio es resaltar el proceso de enfermería en relación con la atención a las gestantes con dicho diagnóstico. Metodología: La investigación es cualitativa, teórica con apoyo en la bibliografía científica, involucrando la comprensión holística e integral de las pacientes para la implementación de una estrategia para el proceso de enfermería. Con base en el estudio de teorías y fisiopatología e impactos clínicos, se utilizaron las taxonomías NANDA-I para delinear los diagnósticos de enfermería más consistentes. Resultados: Se identificaron 15 diagnósticos que incluían los diez dominios encontrados en la NANDA. Consideraciones finales: Los datos escogidos y la confrontación con la literatura enfatizan la relevancia positiva en la prescripción de los diagnósticos de enfermería en la elección de los cuidados prestados y las teorías subsidian la asistencia materno-fetal.

Guideline No. 402: diagnosis and management of placenta previa

To summarize the current evidence and to make recommendations for diagnosis and classification of placenta previa and for managing the care of women with this diagnosis. To manage in hospital or as an outpatient and to perform a cesarean delivery preterm or at term or to allow a trial of labour when a diagnosis of placenta previa or a low-lying placenta is suspected or confirmed. Prolonged hospitalization, preterm birth, rate of cesarean delivery, maternal morbidity and mortality, and postnatal morbidity and mortality.

Placenta percreta con invasión a vejiga; reporte de un caso y descripción de la técnica quirúrgica / Placenta percreta with invasion of the bladder: case report and description of surgical technique

La placenta percreta es una de las variedades de acretismo placentario más graves, con consecuencias catas-tróficas, entidad rara con alta morbimortalidad materno-fetal. Se reporta un caso de una paciente de 18 años con antecedente de una cesárea, que cursó con embarazo de 36 semanas de gestación y acude por sangrado transvaginal. Durante su estancia se corrobora diagnóstico de placenta previa parcial y acretismo placentario. Durante la laparotomía se observa placenta percreta con invasión a vejiga. Actualmente hay diversos abordajes quirúrgicos, todos encaminados a disminuir complicaciones asociadas; en este caso se realizó cesárea-histerectomía modificada como una alternativa terapéutica a considerar

Placenta percreta is one of the most serious varieties of placental accreta, with catastrophic consequences, a rare entity with high maternal-fetal morbidity and mortality. We report a case of an 18-year-old woman with a history of a cesarean section, who was pregnant at 36 weeks of gestation and went for transvaginal bleeding. During her stay, diagnosis of partial placenta previa and placental accreta was corroborated. During the laparotomy she was observed placenta percreta with bladder invasion. There are currently several surgical approaches, all aimed at reducing associated complications; in this case modified cesarean-hysterectomy was performed as a therapeutic alternative to be considered

Extrofia vesical en el recién nacido. Diagnóstico antenatal y postnatal / Bladder exstrophy in the newborn. Antenatal and postnatal diagnosis

Entre las semanas 6ª y 7ª de amenorrea, el disco embrionario se pliega en cuatro direcciones: cefálico, caudal y laterales, izquierdo y derecho. Cada uno de los pliegues converge a nivel del ombligo con lo que se oblitera el celoma extraembrionario. Las cinco anomalías asociadas a defectos de pared abdominal son el onfalocele, la gastrosquisis, la ectopia cordis, la anomalía body stalk y la extrofia de cloaca en la que se incluye, la extrofia vesical. Presentamos el caso de una gestante con feto afecto de genitales ambiguos diminutos cuyo diagnóstico postnatal fue la extrofia vesical (AU)

Between the 6th and 7th weeks of amenorrhea, the embryonic disc folds on both longitudinal and transverse plains. The embryonic plate converges at the level of the umbilicus, thereby closing the extracelomic area. The following five anomalies are associated with abdominal wall defects: onphalocele, gastroschisis, ectopia cordis, Body stalk anomaly and cloacal exstrophy which includes bladder extrophy. We describe the case of a pregnant woman with fetus diagnosed with ambiguous genitalia during pregnancy, and postnatal diagnosis of bladder exstrophy (AU)

Conceito, diagnóstico e tratamento de placenta prévia acreta com invasão de bexiga: revisão sistemática da literatura / Concept, diagnosis and treatment of placenta previa accreta with urinary bladder invasion: systematic revision of literature

A placenta prévia consiste na implantação placentária no segmento inferior, distando no máximo 7 cm do colo do útero. Ao aderir-se diretamente ao miométrio, denomina-se placenta acreta; ao estender-se mais profundamente, placenta increta, e ao invadir a serosa uterina ou órgãos adjacentes, percreta. A incidência de placenta prévia varia de 0,3 a 1,7%, e a incidência do acretismo varia de 1:540 a 1:93.000 partos. Essa com acretismo é relacionada à alta morbimortalidade materna e, maior necessidade de terapêutica transfusional; a complicações durante a cesárea e à infecção. O acretismo é diagnosticado por ultrassom, ressonância magnética e, ultrassom com Doppler. A adequada detecção do acretismo permitirá o planejamento da via de parto e das medidas de segurança, com consequente redução da mortalidade materna. Feito o diagnóstico antenatal de acretismo placentário e invasão da bexiga, a conduta será a cesárea eletiva às 35 semanas com posterior histerectomia total abdominal, sempre com necessidade de uma equipe multidisciplinar (anestesistas, obstetras, cirurgião vascular intervencionista e urologista)

The placenta previa consists of a placental implantation in the inferior segment, distant at the most 7 cm of the cervix uteri. When adhering directly to the myometrium, it is called placenta accreta; when extending more deeply, increta and when invading the uterine's serous or even adjacent organs, the percreta. The placenta previa incidence varies from 0,3 to 1,7%, and the accretism from 1:540 to 1:93.000 childbirths. The placenta previa accreta is associated with high maternal morbidity and mortality, need of blood transfusion, complications during cesarean section and infection. The accretism is diagnosed by ultrasound, magnetic resonance and, ultrasound with Doppler. The appropriate detection of the accretism will allow the childbirth planning and safety's measures, with consequent reduction of maternal mortality. When the antenatal diagnosis of placenta accreta and invasion of the bladder are made, the conduct will be the elective cesarean section to the 35 weeks with subsequent abdominal total hysterectomy, with the aid of a team (anesthetists, obstetricians, surgeon vascular and urologist)

Hemorragia en la gestación / Haemorrhage in gestation

La hemorragia es una de las causas más frecuentesy potencialmente más graves en la consulta de urgenciasdurante la gestación. En esta revisión hemos realizadoun enfoque global para el manejo de una gestante queacude a urgencias por un sangrado vaginal, y posteriormentede manera más específica el manejo de algunasde las entidades más frecuentes de la hemorragia obstétrica.En cuanto a las hemorragias del primer trimestrese ha hecho mayor hincapié en el manejo del aborto,puesto que otras entidades que también son frecuentesse valoran de manera específica en otros capítulos. Enel segundo trimestre se ha realizado una revisión detres entidades que abarcan el mayor porcentaje de hemorragiasen ese periodo, como son la placenta previa,el desprendimiento prematuro de placenta normalmenteinserta y la rotura uterina. Hemos valorado en cadauna de ellas la etiopatogenia, la actitud diagnóstica y elmanejo de la forma más sistemática posible(AU)

A haemorrhage is one of the most frequent, and potentiallymost serious, causes for emergency consultationduring gestation. In this review we offer an overallapproach to managing a pregnant woman who attendsAccidents and Emergencies due to vaginal bleeding andthen, in a more specific way, we consider how to managesome of the most frequent entities of the obstetrichaemorrhage. With respect to haemorrhages in thesecond trimester, we give greater attention to how tomanage a miscarriage, since other entities that are alsofrequent receive a specific evaluation in other chapters.In the second trimester three entities account for thegreatest percentage of haemorrhages, such as placentapraevia, the premature detachment of the normallyinserted placenta and uterine rupture. In each case wehave evaluated the etiopathology, diagnostic attitudeand management in the most systematic way possible(AU)

Cáncer cervical en embarazo de la primera mitad con placenta previa. Reporte de un caso / Cervical cancer in pregnancy of the first half with placenta previa. A case report

El cáncer cervical invasor es una de las causas más frecuentes de muerte en las mujeres de los países en desarrollo. Ocupa el tercer lugar entre las mujeres de todo el mundo. Es raro en mujeres con menos de 30 años y más común en mujeres de 40 años. Se reporta el caso de una pacientede 30 años, atendida en el servicio de Patología de Cuello del Hospital Materno Provincial Ana Josefa Betancourt de Mora, con el diagnóstico de carcinoma epidermoide infiltrante bien diferenciado de cuello uterino en etapa Ib2 y embarazo de la primera mitad con inserción baja placentaria oclusiva total. Se interrumpió este embarazo con el objetivo de mejorar el estado de inmunodepresión de esta paciente y comenzar un tratamiento precoz y oportuno para lograr la supervivencia de esta paciente.

The invasive cervical cancer is one of the most frequent causes of death in women of the developing countries. It occupies the third place among the women of the entire world. Is rare in women with less than 30 years and more common in women of 40 years. The case of a 30 years patient is reported, attended in the Cervix Pathology service at Ana Josefa Betancourt de Mora Provincial Maternal Hospital, with the diagnosis of infiltrating epidermoid carcinoma well differentiated of cervix uteri in phase Ib2 and pregnancy of the first half with total occlusive placental low insertion.This pregnancy was interrupted with the objective to improve the immunodepression state of this patient and to begin an opportune and precocious treatment to achieve the survival of this patient.

Cáncer cervical en embarazo de la primera mitad con placenta previa. Reporte de un caso / Cervical cancer in pregnancy of the first half with placenta previa. A case report

El cáncer cervical invasor es una de las causas más frecuentes de muerte en las mujeres de los países en desarrollo. Ocupa el tercer lugar entre las mujeres de todo el mundo. Es raro en mujeres con menos de 30 años y más común en mujeres de 40 años. Se reporta el caso de una pacientede 30 años, atendida en el servicio de Patología de Cuello del Hospital Materno Provincial Ana Josefa Betancourt de Mora, con el diagnóstico de carcinoma epidermoide infiltrante bien diferenciado de cuello uterino en etapa Ib2 y embarazo de la primera mitad con inserción baja placentaria oclusiva total. Se interrumpió este embarazo con el objetivo de mejorar el estado de inmunodepresión de esta paciente y comenzar un tratamiento precoz y oportuno para lograr la supervivencia de esta paciente(AU)

The invasive cervical cancer is one of the most frequent causes of death in women of the developing countries. It occupies the third place among the women of the entire world. Is rare in women with less than 30 years and more common in women of 40 years. The case of a 30 years patient is reported, attended in the Cervix Pathology service at Ana Josefa Betancourt de Mora Provincial Maternal Hospital, with the diagnosis of infiltrating epidermoid carcinoma well differentiated of cervix uteri in phase Ib2 and pregnancy of the first half with total occlusive placental low insertion.This pregnancy was interrupted with the objective to improve the immunodepression state of this patient and to begin an opportune and precocious treatment to achieve the survival of this patient(AU)

Localization of Placenta in Scanning by In113m Radiopharmaceuticals

Placenta previa is a common grave complication of late pregnancy, usually manifestated clinically by painless antenatal vaginal bleeding. Digital and rectal examinations are dangerous, due to the possibility that profuse hemorrhage from the vagina may result. Various radiological examinations have been performed in placenta previa for diagnosis and localization. However radioisotopic methods are superior due to safety, simplicity and a lower radiation dose, both fetal and maternal, compared to plain radiography. Among radiopharmaceuticals, In113m (transferrin for blood pool scan) is useful, giving more satisfactory results without any complications or untoward reactions. In our series of 88 cases from March 1971 to April 1975, In113m placental scan was performed and analysed in 62 cases which were confirmed by clinical follow up and the results are as follows: 1) Maternal age pattern. Mothers 31~35 years were 20/62 or 30.6%. 2) Maternal gravida pattern. All were multipara except 8 cases of primipara. 3) Gestational maturity on scan. 40/62 or 64% were before 36weeks or less in maturity. 4) On scan analysis Placenta previa was confirmed in 36/62 cases or 58%. 5) Fetal maturity. On delivery most were full term, 42/62 or 67.7%. 6) Vaginal delivery was done on cases where placenta was localized in the upper uterine segment, except for three who had fetal malpresentation and congenital anomaly of the maternal pelvis. All patients of placenta previa had cesarian section, except 5 cases with a minor degree of placenta previa. 7) Two cases showed false negative, which suggests 97% accuracy in the screening test of placenta previa by scan, wich is a similar result to other reports. Only 4 cases of false positive discrepancy were noted.

Localization of Placenta in Scanning by In113m Radiopharmaceuticals

Placenta previa is a common grave complication of late pregnancy, usually manifestated clinically by painless antenatal vaginal bleeding. Digital and rectal examinations are dangerous, due to the possibility that profuse hemorrhage from the vagina may result. Various radiological examinations have been performed in placenta previa for diagnosis and localization. However radioisotopic methods are superior due to safety, simplicity and a lower radiation dose, both fetal and maternal, compared to plain radiography. Among radiopharmaceuticals, In113m (transferrin for blood pool scan) is useful, giving more satisfactory results without any complications or untoward reactions. In our series of 88 cases from March 1971 to April 1975, In113m placental scan was performed and analysed in 62 cases which were confirmed by clinical follow up and the results are as follows: 1) Maternal age pattern. Mothers 31~35 years were 20/62 or 30.6%. 2) Maternal gravida pattern. All were multipara except 8 cases of primipara. 3) Gestational maturity on scan. 40/62 or 64% were before 36weeks or less in maturity. 4) On scan analysis Placenta previa was confirmed in 36/62 cases or 58%. 5) Fetal maturity. On delivery most were full term, 42/62 or 67.7%. 6) Vaginal delivery was done on cases where placenta was localized in the upper uterine segment, except for three who had fetal malpresentation and congenital anomaly of the maternal pelvis. All patients of placenta previa had cesarian section, except 5 cases with a minor degree of placenta previa. 7) Two cases showed false negative, which suggests 97% accuracy in the screening test of placenta previa by scan, wich is a similar result to other reports. Only 4 cases of false positive discrepancy were noted.

Placenta Praevia: Review of Clinical Presentation and Management in a Nigerian Teaching Hospital

Background: The study aims at reviewing the clinical presentation and management of placenta praevia in a tertiary health facility. Method: This is a retrospective study of 59 cases of placenta praevia managed at the Nnamdi Azikiwe University Teaching Hospital; Nnewi from January 1997 to December 2001. The case records of 44 of the patients were obtained from the hospital medical records department and analysed. Results: During the five year period; there were 3565 deliveries and 59 cases of placenta praevia giving an incidence of 1.65. Thirty four (77.3) occurred in women aged 35 years and below. The commonest was type III (12 cases; 27.3) followed by type IV (10 cases; 22.7). Previous uterine scar was associated with 22 (50.0) cases. Age had no statistically significant effect on the prevalence. The commonest GA range at presentation (13; 29.6) and at delivery (18; 40.9) was 37-40 weeks. The commonest mode of presentation was antepartum haemorrhage (34;77.3) followed by abnormal lie and malpresentation (4 each; 9.1). The average admission delivery interval was one week in 33 (75.0) cases and only two (4.5) received blood transfusion. Forty (90.9) women had caesarean delivery while 12 (27.3) babies were of low birth weight. There were only 2 (4.5) fetal deaths and one (2.3) caesarean hysterectomy. Conclusion: The commonest predisposing factor to placenta praevia in this study is previous uterine scar. Judicious use of caesarean section especially in the primigravida will help reduce the incidence of placenta praevia. Also a screening ultrasonography at 34-36 weeks gestation (especially in women with previously scarred uterus) is recommended

A multidisciplinary approach to surgical management of placenta previa percreta with bladder invasion: a case report

Placenta previa percreta with bladder invasion occurs rarely. However this disorder has become more common since the increased rate of cesarean deliveries. We present a 26 year old gravida 3, para 2-0-1-2 female with placenta previa, percreta and bladder invasion to stress out the importance of early recognition of this life threatening condition and to point out that the good outcome of this case was mainly due to the multidisciplinary approach chosen during the preoperative and post operative management. The Departments of Obstetrics and Gynecology, Radiology, Anesthesiology, Urology, Neonatology and Pathology were fully involved. A surgical management was chosen since it is the most common and more accepted treatment of placenta previa percreta with bladder invasion.

Inserçäo baixa da placenta / Low insertion of the placenta

Apresenta causas, diagnóstico e conduta adotada nos casos de placenta prévia, visando a reduçäo da mortalidade materna e do concepto

Placenta previa casuística en el Hospital Gineco-Obstétrico Isidro Ayora

La etiología de la placenta previa es desconocida, se presume que la vascularización endometrial disminuida a nivel del fondo y cuerpo uterino, constituyen el factor causal. Hemos analizado 149 historias clínicas, concluyendo que en nuestro medio los factores de riesgo son la edad materna entre 23 a 32 años con una media de 30, multiparidad, teniendo mayor riesgo a una edad gestacional de 37 a 40 semanas con un pico a las 38 semanas, el diagnóstico ecográfico es una gran ayuda pero vemos que en nuestro medio la sospecha clínica puede ser el único examen con el que podemos contar preoperatoriamente en no pocas ocasiones; la presencia o ausencia de dolor no es una sintomatología que nos pueda ayudar a precisar el diagnóstico...

Diagnóstico diferencial de los trastornos adherenciales de la placenta por resonancia magnética nuclear contrastada: acretísmo y percretismo placentario / Differential diagnosis of placental adherential disorders by contrasted nuclear magnetic resonance: placental acretism and percretism

Los trastornos adherenciales de la placenta tales como el acretismo y percretismo placentario, constituyen una de las principales causas de morbinortalidad materna por hemorragia postparto. La placenta previa y la cesárea reiterada son los principales factores de riesgo; en ellos es posible realizar el diagnóstico de acuerdo a signos ecográficos directos e indirectos. Sin embargo, en ciertas ocasiones la información obtenida por el ultrasonido no es concluyente, particularmente en la diferenciación entre el acretismo y el percretismo placentario. En esos casos o en los que se quiera tener información anatómica adicional acerca de la invasión placentaria, de la vascularización o sobre el estado real de la pared uterina y vesical, la resonancia magnética nuclear (RMN) brinda imágenes anatómicas precisas. Las mismas pueden contrastarse con gadolinio y distinguir límites exactos entre el miometro y la placenta. De esa manera se puede planificar correctamente la cirugía y el control vascular proximal más adecuado. En este trabajo se describe la experiencia con RMN contrastada en 15 pacientes de riesgo, la característica distintiva de las imágenes diferenciales y su correlación quirúrgica