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1.
Acta Obstet Gynecol Scand ; 100 Suppl 1: 50-57, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33811335

RESUMO

INTRODUCTION: It has been suggested that women with obesity have increased risk of developing placenta accreta spectrum (PAS). It is unclear if this is independent of the increased risk of cesarean delivery seen with obesity itself. The aim of this study was to explore the association between maternal obesity and PAS, particularly severe PAS (percreta). MATERIAL AND METHODS: This is a cohort study based on cases recorded in the International Society for Placenta Accreta Spectrum (IS-PAS) database between April 2008 and May 2019. Multivariable logistic regression was used to explore the effect of maternal obesity on severity of PAS; this model was adjusted for other known risk factors including previous cesarean deliveries, maternal age, and placenta previa. The estimated rate of obesity in a hypothetical cohort with similar characteristics (previous cesarean delivery and same parity) was calculated and compared with the observed rate of obesity in the women of the PAS cohort (one sample test of proportions). RESULTS: Of the 386 included women with PAS, 227 (58.8%) had severe disease (percreta). In univariable analysis, maternal obesity initially appeared to be associated with increased odds of developing the most severe type of PAS, percreta (odds ratio [OR] 1.87; 95% CI 1.14-3.09); however, this association was lost after adjustment for other risk factors including previous cesarean delivery (OR 1.44; 95% CI 0.85-2.44). There was no difference in the observed rate of obesity and the rate estimated based on the risk of cesarean delivery from obesity alone (31.3% vs 36.8%, respectively; P = .07). CONCLUSIONS: Obesity does not seem to be an independent risk factor for PAS or severity for PAS. These findings are relevant for clinicians to provide accurate counseling to women with obesity regarding increased risks related to pregnancy.


Assuntos
Obesidade Materna/epidemiologia , Placenta Acreta/epidemiologia , Complicações na Gravidez/epidemiologia , Índice de Gravidade de Doença , Adulto , Cesárea/estatística & dados numéricos , Estudos de Coortes , Bases de Dados Factuais , Europa (Continente)/epidemiologia , Feminino , Humanos , Idade Materna , Placenta Prévia/epidemiologia , Gravidez , Fatores de Risco
2.
Medicine (Baltimore) ; 99(51): e23166, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371061

RESUMO

ABSTRACT: To identify the risk factors associated with velamentous cord insertion (VCI) and investigate the association between adverse pregnancy outcomes and VCI in singleton pregnancies and those with vasa previa.A total of 59,976 single cases admitted from Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014 were included in this study. We retrospectively analyzed the perinatal complications, neonatal complications, and the clinical features, as well as the Color Doppler ultrasonography findings of the velamentous placenta and placenta previa.We reviewed the clinical data of 59,976 women with singleton pregnancies delivered in Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014. Risk factors and the risks of adverse pregnancy outcomes including admission to a neonatal unit, fetal death, preterm delivery, low birth weight of <2500 g, the infant being small for its gestation age, low Apgar scores (<7) at 1 and 5 minute were evaluated separately among women with and without VCI by means of logistic regression analyses.The prevalence of velamentous umbilical cord insertion was 0.84%, and the prevalence of vasa previa was 0.0017%. The independent risk factors for VCI were nulliparity, obesity, fertility problems, placenta previa, and maternal smoking. VCI was associated with a 1.83-, 2.58-, 3.62-, and 1.41-fold increase in the risk of retention in the neonatal unit, preterm delivery (<37 gestation weeks), low birth weight, and small-for-gestational age, compared to pregnancies involving normal cord insertion. Of the women with VCI, 16.1% underwent emergency cesarean section compared to 8.9% (P < .001) of women without VCI.The prevalence of VCI was 0.84% in singletons. The results suggest that VCI is a moderate risk condition resulted in increased risks of prematurity and impairment of fetal growth.


Assuntos
Placenta Prévia/epidemiologia , Resultado da Gravidez/epidemiologia , Cordão Umbilical/patologia , Vasa Previa/epidemiologia , Adulto , Índice de Apgar , China/epidemiologia , Feminino , Morte Fetal/etiologia , Humanos , Recém-Nascido de Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Placenta Prévia/diagnóstico por imagem , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Cordão Umbilical/diagnóstico por imagem , Vasa Previa/diagnóstico , Adulto Jovem
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1074-1081, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051421

RESUMO

OBJECTIVES: To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP. METHODS: A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018. Two hundred and fifty cases of PPP with placenta accreta were treated as a case group, and 160 cases of PPP without placenta accreta were treated as a control group. The relationship between clinical data and placenta accreta was analyzed, and the pregnancy outcomes of PPP was observed according to different types of placenta previa. RESULTS: Logistic regression showed that delivery times were more than 2 (OR=3.221), cesarean section times were more than 2 (OR=3.048), central placenta previa (OR=3.607), placental attachment site (anterior wall) (OR=4.592) were independent risk factors for PPP with placenta accrete (P<0.05). Living in cities (OR=0.614), systematic prenatal examination (OR=0.590) were protective factors (P<0.05). Average intraoperative blood loss, postpartum bleeding rate, hysterectomy rate in the central group were all higher than those in the marginal and low-set group. The incidence rates of ICU transfer, complications, and hospital stay were higher or longer than those in the marginal group (P'<0.008). There was no significant difference in stillbirth rate among the 4 groups (P>0.05). Preterm delivery rate was higher than that of the marginal and low-set group, and the birth weight was lower than that of the low-set group. Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups, respectively (P'<0.008). CONCLUSIONS: Delivery times (>2), cesarean section times (≥2), central placenta previa, placenta attachment site (anterior wall) are independent risk factors for PPP with placenta accreta. Living in cities, systematic prenatal examination were protective factors. The central PPP is more likely to lead to postpartum hemorrhage, hysterectomy, and increases in the risk of preterm birth, low birth weight as well as asphyxia of fetus, which seriously threatens maternal and fetal life.


Assuntos
Placenta Acreta , Placenta Prévia , Estudos de Casos e Controles , Cesárea , Feminino , Humanos , Recém-Nascido , Placenta Acreta/epidemiologia , Placenta Acreta/cirurgia , Placenta Prévia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(8): 505-509, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32854473

RESUMO

Objective: To compare the preterm birth rate among different age groups and analyze relative high-risk factors of preterm birth. Methods: A retrospective analysis was conducted on clinical data of single pregnant women ≥28 gestational weeks from January 2013 to May 2019 in the First Affiliated Hospital of Chongqing Medical Hospital. All involved women were divided into three groups according to age, Group 1 (aged<35 years), Group 2 (aged 35-39 years), and Group 3 (aged ≥40 years). The preterm birth rate among 3 groups was compared and their high-risk factors were analyzed. Results: There were 48 288 singleton pregnancies during the study period, of which 3 351 were preterm births, preterm birth rate was 6.94% (3 351/48 288). In Group 1, there were 42 020 women, of which 2 699 were preterm births (6.42%, 2 699/42 020); in Group 2, there were 5 061 women, of which 491 were preterm births (9.70%, 491/5 061); and in Group 3, there were 1 207 women, of which 161 were preterm births (13.34%, 161/1 207). Comparing the spontaneous preterm birth rates among the three groups, Group 1 was the lowest one and Group 3 was the highest one (3.72% vs 4.51% vs 5.88%); comparing the medical preterm birth rates among the three groups, Group 1 also was the lowest one and Group 3 also was the highest one (2.70% vs 5.20% vs 7.46%); the differences were statistically significant (P<0.05). The incidence of spontaneous and medical preterm birth according gestational weeks were compared among three groups and there were no significant differences (P>0.05). Comparing and analyzing the high-risk factors of medical preterm birth, the incidence of intrahepatic cholestasis of pregnancy and fetal distress in Group 1 were higher than those in Group 2 and 3; the incidence of placenta praevia were significantly higher in Group 2 and 3 than that in Group 1; the differences were statistically significant (P<0.05). Conclusions: Maternal age is a significant high-risk factor of both spontaneous preterm birth and medical preterm birth, and the risk of preterm birth increases with age. For medical preterm birth, compared with right-age pregnant women, placenta praevia is the high-risk factor for women in advanced maternal age(AMA), which have great effect on medical preterm birth rate of AMA.


Assuntos
Idade Materna , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Distribuição por Idade , Fatores Etários , Colestase Intra-Hepática/epidemiologia , Feminino , Sofrimento Fetal/epidemiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Placenta Prévia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
5.
Medicine (Baltimore) ; 99(28): e21172, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664156

RESUMO

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. The aim of this study was to identify factors associated with preterm birth and examine the heterogeneity and interactions between these factors.We collected data from 1607 pregnant women treated at Nanjing Maternity and Child Health Care Hospital in China. The women included in the study were divided into the full-term group and the preterm-birth group. We used t-tests to compare the characteristics of age and body mass index, Chi-square tests for the other variables, and we used the Wald test to calculate the interaction between factors that may affect preterm birth. The heterogeneity test was used to study the relationship between subgroups. Multivariable logistic regression analysis was used to explore the associations between risk factors and preterm birth, which included all risk factors. All tests were 2-tailed, P < 0.05 was considered significant, and 95% confidence intervals were estimated for percentages.There was no statistical difference in basic characteristics such as age between the full-term and preterm groups. We found 6 independent risk factors that were associated with preterm birth (P < .05): preeclampsia (PE), intrahepatic cholestasis, premature rupture of the membranes (PROM), placenta previa, chorioamnionitis, and scarred uterus. Five combinations of these factors were statistically significant (P < .05) in terms of heterogeneity: PE and PROM; placenta previa and polyhydramnios; chorioamnionitis and PE; PROM and maternal body mass index; and PROM and gestational diabetes mellitus. Ultimately, the 2 subgroups that showed interactions were PE and PROM and chorioamnionitis and PE.The interaction between different factors over the course of preterm birth cannot be ignored. When independent risk factors are combined with other diseases, such as PE combined with PROM or chorioamnionitis in this study, it may more likely result in preterm birth. Thus, this situation deserves particular clinical attention.


Assuntos
Corioamnionite/epidemiologia , Diabetes Gestacional/epidemiologia , Ruptura Prematura de Membranas Fetais/epidemiologia , Placenta Prévia/epidemiologia , Nascimento Prematuro/etiologia , Adulto , China/epidemiologia , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Logísticos , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fatores de Risco
6.
PLoS One ; 15(6): e0233641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525937

RESUMO

OBJECTIVE: To evaluate the effects of changes in risk factors between the first two pregnancies on the occurrence of placental abruption (PA) in the same woman. METHODS: Routinely collected obstetric data from Aberdeen Maternity and Neonatal Databank, the Maltese National Obstetric Information System and the Finnish Medical Birth Register were aggregated. Records of the first two singleton pregnancies from women who had PA in one pregnancy but not the other, were identified from this pooled dataset. A case-crossover study design was used; cases were pregnancies with abruption and matched controls were pregnancies without abruption in the same woman. Conditional logistic regression was used to investigate changes in risk factors for placental abruption in pregnancies with and without abruption. RESULTS: A total of 2,991 women were included in the study. Of these 1,506 (50.4%) had PA in their first pregnancy and 1,485 (49.6%) in a second pregnancy. Pregnancies complicated by preeclampsia {194 (6.5%) versus 115 (3.8%) adj OR 1.69; (95% CI 1.23-2.33)}, antepartum haemorrhage of unknown origin {556 (18.6%) versus 69 (2.3%) adjOR 27.05; 95% CI 16.61-44.03)} and placenta praevia {80 (2.7%) versus 21 (0.7%) (adjOR 3.05; 95% CI 1.74-5.36)} were associated with PA. Compared to 20 to 25 years, maternal age of 35-39 years {365 (12.2) versus 323 (10.8) (adjOR 1.32; 95% CI 1.01-1.73) and single marital status (adjOR 1.36; 95% CI 1.04-1.76) were independently associated with PA. Maternal smoking, BMI and fetal gender were not associated with PA. CONCLUSION: Advanced maternal age, pregnancies complicated with unexplained bleeding in pregnancy, placenta praevia and preeclampsia were independently associated with a higher risk of placental abruption.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Fatores Etários , Estudos Cross-Over , Feminino , Finlândia/epidemiologia , Humanos , Malta/epidemiologia , Idade Materna , Gravidez , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
7.
J Pregnancy ; 2020: 5630296, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32395343

RESUMO

Background: Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective: To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results: Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion: Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.


Assuntos
Placenta Prévia , Fatores Etários , Estudos de Casos e Controles , Cesárea , Etiópia/epidemiologia , Feminino , Humanos , Paridade , Placenta Prévia/epidemiologia , Placenta Prévia/etiologia , Gravidez
8.
Am J Obstet Gynecol ; 223(4): 568.e1-568.e5, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32360847

RESUMO

BACKGROUND: Placenta accreta spectrum is well known for its association with catastrophic maternal outcomes. However, its pathophysiology is not well defined. There have been emerging data that in vitro fertilization may be a risk factor for placenta accreta spectrum. OBJECTIVE: We investigated the hypothesis that in vitro fertilization is an independent risk factor for placenta accreta spectrum. STUDY DESIGN: A retrospective analysis of all deliveries in a prospective, population-based cohort (2012-2019) was performed in a tertiary academic center. Primary outcome variable was placenta accreta spectrum. Univariate analysis was performed on potential risk factors for predicting placenta accreta spectrum, and a multivariate model was designed to best fit the prediction of placenta accreta spectrum adjusted for risk factors such as cesarean delivery, placenta previa, age, and parity. History of previous cesarean delivery was known as a risk factor for both placenta previa and placenta accreta spectrum; hence, the interaction between "placenta previa" and "previous cesarean delivery" was included in the final model. Odds ratios were calculated as exponential of beta coefficients from the multivariate regression analysis. RESULTS: A total of 37,461 deliveries were included in this analysis, 5464 (15%) of which had a history of cesarean delivery, 281 (0.7%) had placenta previa in their index pregnancy, and 571 (1.5%) had in vitro fertilization pregnancy. The frequency of placenta accreta spectrum was 230 (0.6%). Independent risk factors for placenta accreta spectrum were in vitro fertilization pregnancy (adjusted odds ratio, 8.7; 95% confidence interval, 3.8-20.3), history of previous cesarean delivery (adjusted odds ratio, 21.1; 95% confidence interval, 11.4-39.2), and presence of placenta previa (adjusted odds ratio, 94.6; 95% confidence interval, 29.3-305.1). After adjustment for number of previous cesarean deliveries, the correlation persisted for in vitro fertilization (adjusted odds ratio, 6.7; 95% confidence interval, 2.9-15.6). CONCLUSION: Our data suggested that in vitro fertilization is an independent risk factor for placenta accreta spectrum, although its relative clinical importance compared with that of the presence of placenta previa and history of cesarean delivery is small. The pathophysiology behind this relationship remains to be investigated.


Assuntos
Cesárea/estatística & dados numéricos , Fertilização In Vitro/estatística & dados numéricos , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Centros Médicos Acadêmicos , Adulto , Estudos de Coortes , Feminino , Humanos , Análise Multivariada , Razão de Chances , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Am J Obstet Gynecol ; 223(2): 226.e1-226.e19, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32109461

RESUMO

BACKGROUND: The use of assisted reproductive technology is increasing worldwide and conception after assisted reproduction currently comprises 3%-6% of birth cohorts in the Nordic countries. The risk of placenta-mediated pregnancy complications is greater after assisted reproductive technology compared with spontaneously conceived pregnancies. Whether the excess risk of placenta-mediated pregnancy complications in pregnancies following assisted reproduction has changed over time, is unknown. OBJECTIVES: To investigate whether time trends in risk of pregnancy complications (hypertensive disorders in pregnancy, placental abruption and placenta previa) differ for pregnancies after assisted reproductive technology compared with spontaneously conceived pregnancies during 3 decades of assisted reproduction treatment in the Nordic countries. STUDY DESIGN: In a population-based cohort study, with data from national health registries in Denmark (1994-2014), Finland (1990-2014), Norway (1988-2015) and Sweden (1988-2015), we included 6,830,578 pregnancies resulting in delivery. Among these, 146,998 (2.2%) were pregnancies after assisted reproduction (125,708 singleton pregnancies, 20,668 twin pregnancies and 622 of higher order plurality) and 6,683,132 (97.8%) pregnancies were conceived spontaneously (6,595,185 singleton pregnancies, 87,106 twin pregnancies and 1,289 of higher order plurality). We used logistic regression with post-estimation to estimate absolute risks and risk differences for each complication. We repeated analyses for singleton and twin pregnancies, separately. In subsamples with available information, we also adjusted for maternal body mass index, smoking during pregnancy, previous cesarean delivery, culture duration, and cryopreservation. RESULTS: The risk of each placental complication was consistently greater in pregnancies following assisted reproductive technology compared with spontaneously conceived pregnancies across the study period, except for hypertensive disorders in twin pregnancies, where risks were similar. Risk of hypertensive disorders increased over time in twin pregnancies for both conception methods, but more strongly for pregnancies following assisted reproductive technology (risk difference, 1.73 percentage points per 5 years; 95% confidence interval, 1.35-2.11) than for spontaneously conceived twins (risk difference, 0.75 percentage points; 95% confidence interval, 0.61-0.89). No clear time trends were found for hypertensive disorders in singleton pregnancies. Risk of placental abruption decreased over time in all groups. Risk differences were -0.16 percentage points (95% confidence interval, -0.19 to -0.12) and -0.06 percentage points (95% confidence interval, -0.06 to -0.05) for pregnancies after assisted reproduction and spontaneously conceived pregnancies, respectively, for singletons and multiple pregnancies combined. Over time, the risk of placenta previa increased in pregnancies after assisted reproduction among both singletons (risk difference, 0.21 percentage points; 95% confidence interval, 0.14-0.27) and twins (risk difference, 0.30 percentage points; 95% confidence interval, 0.16-0.43), but remained stable in spontaneously conceived pregnancies. When adjusting for culture duration, the temporal increase in placenta previa became weaker in all groups of assisted reproductive technology pregnancies, whereas adjustment for cryopreservation moderately attenuated trends in assisted reproductive technology twin pregnancies. CONCLUSIONS: The risk of placenta-mediated pregnancy complications following assisted reproductive technology remains higher compared to spontaneously conceived pregnancies, despite declining rates of multiple pregnancies. For hypertensive disorders in pregnancy and placental abruption, pregnancies after assisted reproduction follow the same time trends as the background population, whereas for placenta previa, risk has increased over time in pregnancies after assisted reproductive technology.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Diabetes Gestacional/epidemiologia , Placenta Prévia/epidemiologia , Complicações na Gravidez/epidemiologia , Técnicas de Reprodução Assistida/efeitos adversos , Descolamento Prematuro da Placenta/etiologia , Adulto , Fatores Etários , Diabetes Gestacional/etiologia , Feminino , Humanos , Incidência , Placenta Prévia/etiologia , Gravidez , Complicações na Gravidez/etiologia , Sistema de Registros , Risco , Países Escandinavos e Nórdicos , Adulto Jovem
10.
Virchows Arch ; 477(1): 65-71, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31965241

RESUMO

Pathologically diagnosed placenta accreta is defined as villi adjacent to the myometrium without decidua. It is classified into the superficial (placental accreta vera [PAV]) and deep invasive (placenta increta [PI] and placenta percreta [PP]) types. Data on the clinicopathological characteristics of PAV are limited. Basal plate myometrium (BPMYO) is found in PAV or placentas in asymptomatic women, but its significance is still controversial. This retrospective study aimed to determine the clinicopathological characteristics of pathologically diagnosed PAV and the significance of BPMYO. We reviewed 84 cases of pathologically diagnosed placenta accreta (PAV, 54; PI, 16; and PP, 14), and compared them with controls (i.e., not pathologically diagnosed of any type of placenta accreta, n = 51). Among the PAV cases, the incidence of in vitro fertilization was high, while that of previous cesarean section or placenta previa was low. The incidence of maternal complications was also high in pathologically diagnosed PAV cases, but some PAV were asymptomatic. The rate of prenatal diagnosis of PAV was low, and a high proportion of patients required emergency transportation to central hospitals. Histologically, BPMYO was found in 7 (14%) of controls and 54 (100%) of PAV cases. PAV cases had a higher rate of advanced stages of BPMYO, larger muscle tissue, and more foci than controls. In conclusion, almost PAV is a clinically symptomatic condition but has distinct risk factors and clinical findings from advanced type placenta accreta. Histological evaluation of BPMYO is useful for the diagnosis of PAV.


Assuntos
Miométrio/patologia , Placenta Acreta/patologia , Placenta Prévia/patologia , Placenta/patologia , Adulto , Estudos de Casos e Controles , Cesárea/efeitos adversos , Feminino , Humanos , Incidência , Miométrio/diagnóstico por imagem , Placenta Acreta/diagnóstico , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Placenta Prévia/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
11.
Medicina (Kaunas) ; 56(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31952287

RESUMO

BACKGROUND: To evaluate maternal and neonatal outcomes of assisted reproductive technology (ART). MATERIALS AND METHODS: Pregnant women registered from 2015 through 2017 (n = 6994) at five perinatal centers that managed high-risk pregnancies in Mie, Japan, retrospectively. Rates of preterm birth (<37 gestational weeks), early onset preeclampsia (<34 gestational weeks), late onset preeclampsia (≥34 gestational weeks), low-lying placenta, placenta previa, placenta accreta, placental abruption, atonic bleeding, uterine rupture, and amniotic fluid embolism after ART were evaluated. ART was defined as in vitro fertilization and micro-fertilization. Fisher's exact test, Mann-Whitney's U test, and logistic regression analysis were used to analyze the data. RESULTS: Rates of obstetrical complications including low-lying placenta, placenta previa, placenta accreta, and atonic bleeding were increased with ART compared to those with the control. Particularly, ART was associated with a significantly increased rate of placenta accreta (adjusted odds ratio: 7.35, 95% confidence interval (CI): 3.20-16.6) and significantly decreased rate of placental abruption (adjusted odds ratio: 0.24, 95% CI: 0.07-0.61). CONCLUSIONS: This study showed that ART may reduce placental abruption and increase placenta previa. There is a possibility that the placenta attaches deeper in the myometrium because of ART.


Assuntos
Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/efeitos adversos , Descolamento Prematuro da Placenta/epidemiologia , Descolamento Prematuro da Placenta/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Modelos Logísticos , Razão de Chances , Placenta Prévia/epidemiologia , Placenta Prévia/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
J Gynecol Obstet Hum Reprod ; 49(1): 101623, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31446168

RESUMO

OBJECTIVE: To evaluate the obstetrical outcome of pregnancies obtained after assisted reproductive technology (ART).in women with unexplained infertility. MATERIALS AND METHODS: We conducted a retrospective observational case - control cohort study between January 2011 and May 2017. All pregnancies obtained after ART (Intra uterine insemination, In Vitro Fertilization, Intra Cytoplasmic Sperm Injection) were included. The ART pregnancy outcome of women with unexplained infertility was compared to ART pregnancies obtained in a context of male infertility. Cases were matched to controls (1:2) for age, Body Mass Index (BMI), and smoking status. RESULTS: After exclusion of twins, we studied 67 singleton pregnancies in the case group, matched with 129 singleton pregnancies in the control group. The first-trimester complications (miscarriage before 12 weeks gestation (WG), ectopic pregnancy) were similar in the two groups. Concerning the 2nd and the 3rd trimester, the incidence of gestational diabetes mellitus, pre-eclampsia, placenta previa, preterm labor was comparable between the two groups. In singletons, we found a non-significant increase of post-partum hemorrhage (OR=5.5, IC 0.5-50, p=0.13) and small for gestational age new-borns (OR=3.45, IC 0.65-18.1, p=0.14) in women with unexplained infertility. CONCLUSION: More adverse obstetrical outcome are commonly reported after ART, even in singleton pregnancies. Little is known for explaining it and to distingue the own contributions of ART techniques and of the infertility etiology. In our study, we didn't observe a significant negative impact of a history of unexplained infertility on pregnancy. However, further large studies are needed to evaluate more accurately the possible liabilities of the infertility etiology on obstetrical and perinatal outcome.


Assuntos
Infertilidade Feminina/terapia , Resultado da Gravidez , Técnicas de Reprodução Assistida , Aborto Espontâneo/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Diabetes Gestacional/epidemiologia , Feminino , Fertilização In Vitro , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Masculina , Masculino , Trabalho de Parto Prematuro/epidemiologia , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez Ectópica/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Fumar , Estatísticas não Paramétricas , Adulto Jovem
14.
BMC Pregnancy Childbirth ; 19(1): 447, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775687

RESUMO

BACKGROUND: Placenta accreta spectrum (PAS) is a life-threating complication in the field of obstetrics. Sometimes we face with unexpected PAS cases which is potentially higher maternal mortality and morbidity compared with expected cases. The present study was conducted to examine the prevalence of PAS and to elucidate its risk factors using a large Japanese birth cohort study. METHODS: We reviewed the results of a nationwide prospective birth cohort study in Japan, and identified 90,554 participants treated from 2011 to 2014 in 15 regional centers. Multiple regression models were created to identify the risk factors for PAS. These data were obtained from self-reported questionnaires or patient medical records. RESULTS: This analysis consisted of 202 cases of PAS (18 with placenta previa and 184 without placenta previa) and 90,352 cases without PAS. The multiple logistic regression analysis showed that placenta previa (adjusted odds ratio [aOR]: 12.86, 95% confidence interval [CI] 7.70-21.45, P < 0.001), assisted reproductive technology-related pregnancies (aOR: 6.78, 95% CI 4.54-10.14, P < 0.001), smoking during pregnancy (aOR: 1.95, 95% CI 1.15-3.31, P = 0.013), more than two previous cesarean sections (aOR: 2.51, 95% CI 1.35-4.67, P = 0.004), and uterine anomalies (aOR: 3.97, 95% CI 1.24-12.68, P = 0.020) increased the risk of PAS. CONCLUSION: In general population, placenta previa, assisted reproductive technology-related pregnancy, smoking during pregnancy, repeated cesarean sections, and uterine anomalies were risk factors for PAS in the Japanese population.


Assuntos
Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Humanos , Japão/epidemiologia , Gravidez , Prevalência , Técnicas de Reprodução Assistida/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Doenças Uterinas/epidemiologia , Adulto Jovem
15.
BMJ Open ; 9(11): e031193, 2019 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-31722942

RESUMO

OBJECTIVE: To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018. ELIGIBILITY CRITERIA: Studies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth. RESULTS: A total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39-1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05-0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65-17.35). CONCLUSIONS: The high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness. PROSPERO REGISTRATION NUMBER: CRD42017068589.


Assuntos
Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Incidência , Período Periparto , Placenta Acreta/terapia , Placenta Prévia/terapia , Gravidez , Prevalência , Ultrassonografia Pré-Natal
16.
Arch Gynecol Obstet ; 300(6): 1601-1606, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31691015

RESUMO

PURPOSE: The incidence of placenta accreta spectrum (PAS; pathologic diagnosis of placenta accreta, increta or percreta) continues to rise in the USA. The purpose of this study is to compare the hemorrhagic morbidity associated with PAS with and without a placenta previa. METHODS: This was a retrospective cohort study of 105 deliveries from 1997 to 2017 with histologically confirmed PAS comparing outcomes in women with and without a coexisting placenta previa. We used the Wilcoxon rank sum test to compare continuous data and Chi-square or Fisher's exact test for categorical data. We also performed log-binomial regression to calculate risk ratios adjusted for depth of invasion (aRR) and 95% confidence intervals (CI). RESULTS: We identified 105 pregnancies with PAS. Antenatal diagnosis of PAS was higher in women with coexisting placenta previa (72.3%) than those without (6.9%, p < 0.001). Women with coexisting placenta previa had greater median estimated blood loss and more units of packed red blood cells transfused (both p ≤ 0.03). Women with placenta previa were more likely to undergo a hysterectomy (RR 2.7; 95% CI 1.8-3.8) and be admitted to the intensive care unit (aRR 3.3; 95% CI 1.1-9.6). CONCLUSIONS: Among women with PAS, those with a coexisting placenta previa experienced greater hemorrhagic morbidity compared to those without. In addition, PAS without placenta previa typically was not diagnosed prior to delivery. This study further supports the recommendation for multi-disciplinary planning and assurance of resources for pregnancies complicated by PAS. In addition, our results highlight the need for mobilization of resources for those pregnancies where PAS is not diagnosed until delivery.


Assuntos
Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Adulto , Feminino , Humanos , Histerectomia , Morbidade , Gravidez , Estudos Retrospectivos
17.
Ginekol Pol ; 90(9): 539-543, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31588552

RESUMO

OBJECTIVES: This study was carried out to evaluate outcomes of pregnancies with complete placenta previa diagnosedin mid-pregnancy, and evaluate whether a history of caesarean section and placenta location effect the resolution ofplacenta previa. MATERIAL AND METHODS: A prospective observational study was conducted on patients diagnosed with complete placentaprevia by ultrasound examination between 20+0 weeks and 25+6 weeks of gestation. Patients were grouped in terms ofplacenta location (anteriorly or posteriorly located) and presence/absence of prior caesarean section. Maternal demographics,ultrasound findings and pregnancy outcomes were subsequently compared between these groups. Statistical analysiswas performed by using SPSS version 16.0. RESULTS: 70 patients with the above characteristics were recruited in our study. Of the 70 patients, 21 (30%) had prior caesareansection, and 41 (58.6%) had an anteriorly located placenta. Patients with prior cesarean delivery delivered earlier(36.9 ± 2.2 weeks versus 38.0 ± 1.8 weeks, P = 0.039). Furthermore, 74.3% of the placenta previa resolved by delivery. Priorcaesarean section (RR 2.941, 95% CI 0.938-9.216, P 0.024) and anterior placenta (RR 3.805, 95% CI 1.126-12.855, P 0.031)were related to greater risk of persistence of placenta previa to term. CONCLUSIONS: Prior caesarean section and anteriorly located placenta are important factors that modify the risk that previawill complicate delivery. Our findings may be useful for patient counselling and future management of the condition.


Assuntos
Placenta Prévia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Número de Gestações , Humanos , Placenta Prévia/diagnóstico , Placenta Prévia/epidemiologia , Placenta Prévia/patologia , Gravidez , Resultado da Gravidez/epidemiologia , Segundo Trimestre da Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
18.
Orv Hetil ; 160(41): 1633-1638, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587576

RESUMO

Introduction: Bowel endometriosis is when endometrial-like tissue penetrates the bowel serosa, or it reaches the subserous neurovascular plexus. The effect of surgery for colorectal endometriosis on infertility and pregnancy is not fully proven. Aim: The aim of the present study was to analyse the pregnancy outcome and mode of delivery of patients who underwent 'nerve sparing' anterior resection of the colon. Method: Between 2009 and 2017, we operated 121 patients with bowel endometriosis, and built up a prospective database where we assessed their wish of pregnancy, the way of the conception, pathologies during pregnancy and mode of delivery. Statistical analysis: The relationship between endometriosis and pregnancy pathologies was tested by a χ2 probe and Fisher's exact test, additionally the odds ratio (OR) and 95% confidence interval (CI) were determined. For p<0.05, the result was considered significant. Results: Out of 121 bowel endometriosis patients, 48 (39.6%) women got pregnant, 37 (30.5%) of them with in vitro fertilisation. The control group was built from patients who underwent in vitro fertilisation because of andrological factors. We found that women with endometriosis have a significantly higher risk for praeeclampsia (p = 0.023) and placenta praevia (p = 0.045) during pregnancy. Conclusions: Our study is a unique description of pregnancy outcome and mode of delivery after surgery for bowel endometriosis, which, despite the small number of cases, has yielded similar results to the previous multicentric studies. Orv Hetil. 2019; 160(41): 1633-1638.


Assuntos
Endometriose/cirurgia , Fertilidade/fisiologia , Fertilização In Vitro/métodos , Infertilidade Feminina/complicações , Endometriose/fisiopatologia , Feminino , Humanos , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Taxa de Gravidez , Estudos Prospectivos
19.
BMC Pregnancy Childbirth ; 19(1): 373, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640604

RESUMO

BACKGROUND: Endometriosis is a common disease occurring in 1-2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes. METHODS: This case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31). RESULTS: In the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p <  0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56-6.50, p <  0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66-1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11-10.10, p <  0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19-6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups. CONCLUSION: Women who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.


Assuntos
Endometriose/epidemiologia , Placenta Prévia/etiologia , Hemorragia Pós-Parto/etiologia , Complicações na Gravidez , Medição de Risco/métodos , Adulto , Estudos de Casos e Controles , Endometriose/complicações , Feminino , Humanos , Incidência , Recém-Nascido , Japão/epidemiologia , Masculino , Placenta Prévia/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Gravidez , Resultado da Gravidez , Fatores de Risco
20.
Arch Gynecol Obstet ; 300(6): 1541-1549, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31655886

RESUMO

PURPOSE: Placenta previa is abnormal localization of the placenta, associated with high rates of maternal-fetal morbidity and mortality. This abnormal implantation may also be in the form of invasion to surroundings defined as placenta accreta spectrum (PAS). The increasing rates of cesarean section raise the frequency of placenta previa and PAS in recent years. Although there are some recommendations, the optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear. The aim of this study is to compare maternal, surgical and perinatal outcomes of placenta previa cases who underwent emergency or planned surgery. METHODS: The women who underwent cesarean section for placenta previa between October 2013 and February 2019 at a tertiary care center were retrospectively analyzed. They were divided into two main groups as planned and urgent, and into two subgroups as complicated (PAS) and uncomplicated (non-PAS). RESULTS: Of the 313 women who met the inclusion criteria, 176 were planned and 137 were urgent cesarean sections. In the urgent group, gestational age, duration of surgery, maternal preoperative and pre-discharge hemoglobin levels, requirement of blood and blood product, additional surgical interventions, length of maternal postoperative intensive care unit and hospital stay, neonatal birthweight, Apgar scores, length of the follow-up in neonatal intensive care unit, invasive and non-invasive mechanical ventilation were significantly different. CONCLUSIONS: Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa. Perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37 weeks.


Assuntos
Placenta Acreta/cirurgia , Placenta Prévia/cirurgia , Adulto , Índice de Apgar , Peso ao Nascer , Cesárea/efeitos adversos , Cesárea/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta Acreta/epidemiologia , Placenta Prévia/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Turquia/epidemiologia
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