Abnormal Placentation After Caesarean Section: A Retrospective Study.

Introduction Caesarean section (CS) is a lifesaving operation; it can have many complications in subsequent pregnancies. Since the uterine wall and cavity are not normal after CS, the implantation and subsequent trophoblastic invasion and placenta formation may be affected. This study was carried out to find out implantation and placental problems encountered in subsequent pregnancies. The spectrum includes placenta accreta, increta, and percreta and is characterized microscopically by a complete or partial absence of decidua and placental adherence to or invasion of the myometrium. The study was performed to find out the complications of CS in subsequent pregnancies and take measures to detect them early and take appropriate action.  Materials and methods This retrospective study was carried out at Dr. D.Y. Patil Medical College and Research Centre Pimpri, Dr DY Patil Vidyapeeth, a large tertiary care centre. Many complications like placenta previa, adherent placenta, ectopic pregnancy, obstetrical hysterectomy, etc, the ones directly related to implantation and placentation, were recorded and compared with the literature. Results and observations The study was over a period of three years. During this period, there were 10,296 antenatal cases registered; of all the registered cases, 2,544 were cases of post-caesarean pregnancy. There were three cases of tubal ectopic pregnancy, two were diagnosed as the patients complained of amenorrhoea, spotting, and pain abdomen, confirmed on sonography and one was picked up on a routine first-trimester scan. There were two cases of scar ectopic pregnancy. Both the cases were diagnosed as threatened abortion initially and ultrasound confirmed the diagnosis; both were managed medically. Five cases of placenta previa were encountered. There were three cases of morbidly adherent placenta, and two cases underwent obstetrical hysterectomy. Conclusion All surgical procedures have become safe, but they all have some complications. Many complications in the next pregnancy after caesarean are life-threatening and dangerous. These complications should be detected early to prevent any catastrophic event.

A Rare Case of Placenta Increta at Uterine Fundus.

Adherent placenta means a placenta that is not delivered spontaneously or even after manual removal within 30 minutes of baby birth. It is an uncommon and frequently unanticipated event with serious potential health circumstances and it should be managed by the medical team. This case study presents a rare instance of placenta increta in a 25-year-old woman, second gravida, at 36 weeks of gestation, with a history of cesarean section 16 months prior due to chorioamnionitis. The patient presented to the labor room in active labor, and antenatal ultrasound indicated placental implantation on the posterior surface of the upper uterine segment. Given the short inter-delivery interval, an emergency preterm lower segment cesarean section (LSCS) was performed, resulting in the birth of a healthy baby girl weighing 1.8 kg. During surgery, a morbidly adherent placenta was found over the fundus of the uterus. Following consultations with the patient and her relatives, an emergency obstetric total hysterectomy was performed. Intraoperatively, the patient received one unit of packed cell volume (PCV) and, postoperatively, two additional units of PCV and two units of fresh frozen plasma (FFP) were administered. On the third postoperative day, the patient developed right lung consolidation, necessitating a five-day stay in the Obstetric Intensive Care Unit (OBICU). The remaining postoperative period was uneventful, and the patient was discharged on the 10th postoperative day with the healthy infant. Placenta accreta, including its variants increta and percreta, represents abnormal placental implantation into the uterine wall, a condition whose incidence is rising due to increased cesarean sections and improved imaging detection.

Efficacy and Safety of Microsomal Ferric Pyrophosphate Supplement for Iron Deficiency Anemia in Pregnancy.

Introduction Anemia during pregnancy is characterized by decreased hemoglobin levels. Iron deficiency poses a significant global health concern, especially in pregnant women, where increased iron demands are crucial for both maternal and fetal well-being. Method In the current study, we investigated the effectiveness and safety of 30 mg SunActiveTM Fe (Taiyo GmbH, Yokkaichi, Japan), emulsified microsomalTM ferric pyrophosphate (EMFP) tablets in treating iron deficiency anemia in 27 second-trimester singleton pregnant women. Results Our study results demonstrated that hemoglobin levels increased significantly within 30 days of treatment and continued to remain higher than baseline throughout the study. Serum ferritin levels exhibited a 6.61-fold increase, maintaining elevated levels consistently. Serum iron also increased significantly by 46.9%. Additionally, symptoms such as nausea, breathlessness, dizziness, irritability, and heartburn were notably reduced, leading to improved quality of life. Subjects reported decreased overall fatigue, indicating an enhanced quality of life. Babies born during the study showed healthy birth weights, with uncomplicated deliveries. High treatment compliance of 99.5% underscored patient commitment to the study. Furthermore, the investigational product demonstrated a favorable safety profile, with only two mild adverse events observed, unrelated to the treatment. Conclusion These findings suggest that EMFP could be a valuable therapeutic option for managing iron deficiency anemia in pregnant women, promoting better maternal and fetal outcomes. Further research with an increased sample size is warranted to delve into the underlying mechanisms behind these positive outcomes, nonetheless, our study provides a promising foundation for addressing this critical health issue.