Clinical and Ultrasound Predictors of Placenta Accreta in Pregnant Women with Antepartum Diagnosis of Placenta Previa: A Multicenter Study.

BACKGROUND/AIMS: Abnormally invasive placenta (AIP) includes placenta accreta, increta, and percreta and represents major complications of pregnancy. This study was designed to assess the role of ultrasonography in the identification of AIP among pregnant women with antepartum diagnosis of placenta previa. METHODS: A cross-sectional study was performed between May 2015 and April 2016 in 11 centers, including 242 women with antepartum diagnosis of placenta previa. RESULTS: Ninety-eight out of 242 (40.49%) women had a histological diagnosis of placenta accreta. A higher number of caesarean deliveries (p = 0.001) and curettages (p = 0.027) and older age of the woman at the delivery (p = 0.031) were identified as risk factors for placenta accreta. The presence of irregularly shaped placental lacunae (vascular spaces) within the placenta (p = 0.008), protrusion of the placenta into the bladder (p < 0.0001), and turbulent blood flow through the lacunae on Doppler ultrasonography (p = 0.008) were predictors of placenta accreta. CONCLUSIONS: Women with a prior delivery by caesarean section have a high incidence of placenta accreta among women with antepartum diagnosis of placenta previa.

Subsequent Safe Pregnancy with Cesarean Delivery in a Patient with a History of Peripartum Takotsubo Syndrome Complicated by Cardiogenic Shock.

Takotsubo syndrome (TTS) is an acute and reversible heart failure syndrome, usually occurring in females but rarely in the peripartum period. In women with a history of peripartum TTS, it is unclear how to manage subsequent pregnancies. A 39-year-old female with a history of peripartum TTS complicated by cardiogenic shock became pregnant again. She underwent close cardiological follow-up for monitoring left ventricular systolic function and hemodynamic conditions. Epidural anesthesia was preferred to avoid catecholamine surge during cesarean delivery. After a few days of hospitalization, the patient and the newborn were discharged in good health. In our patient with a history of complicated peripartum TTS, close cardiological follow-up, appropriate management therapy, and anesthesia modality allow us to guide safely a new pregnancy.

Is Tako-tsubo syndrome in the postpartum period a clinical entity different from peripartum cardiomyopathy?

AIMS: To conduct a systematic review of case reports about Tako-tsubo syndrome (TTS) after delivery in order to assess whether TTS in the postpartum period is a peculiar entity or only a variant form of peripartum cardiomyopathy. METHODS: We performed a systematic literature search on the occurrence of TTS after Cesarean section or spontaneous delivery using the scientific literature databases Medline, EMBASE and the Cochrane library. We selected 14 case reports in English. Primary/elective cesarean section or spontaneous delivery; absence of preexisting cardiovascular disease or fetal malformations; identification of diagnostic criteria for TTS; onset of TTS symptoms after delivery were the inclusion criteria. RESULTS: Fifteen cases were selected. Cesarean section 24 h before the onset of TTS was reported in 13. All patients presented dyspnea or chest pain. The majority had mild troponin elevation, non-ST-segment elevation. Apical ballooning was observed in 60% of cases, midventricular ballooning in 33%, basal ballooning in 7%. Although 13 patients experienced acute cardiac complications (pulmonary edema, cardiogenic shock, cardiac arrest), in all left ventricular systolic function normalized within 13.43 ± 10.96 days. CONCLUSION: Women in the postpartum period, notably after Cesarean delivery, may represent another new vulnerable group at increased risk for TTS. TTS in the postpartum period should be considered a clinical entity different from peripartum cardiomyopathy with specific clinical, therapeutic and prognostic implications.