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1.
Am J Obstet Gynecol ; 222(4): 293.e1-293.e52, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31917139

RESUMO

OBJECTIVE: To assess the efficacy, effectiveness, and safety of uterine balloon tamponade for treating postpartum hemorrhage. STUDY DESIGN: We searched electronic databases (from their inception to August 2019) and bibliographies. We included randomized controlled trials, nonrandomized studies, and case series that reported on the efficacy, effectiveness, and/or safety of uterine balloon tamponade in women with postpartum hemorrhage. The primary outcome was the success rate of uterine balloon tamponade for treating postpartum hemorrhage (number of uterine balloon tamponade success cases/total number of women treated with uterine balloon tamponade). For meta-analyses, we calculated pooled success rate for all studies, and relative risk with 95% confidence intervals for studies that included a comparative arm. RESULTS: Ninety-one studies, including 4729 women, met inclusion criteria (6 randomized trials, 1 cluster randomized trial, 15 nonrandomized studies, and 69 case series). The overall pooled uterine balloon tamponade success rate was 85.9% (95% confidence interval, 83.9-87.9%). The highest success rates corresponded to uterine atony (87.1%) and placenta previa (86.8%), and the lowest to placenta accreta spectrum (66.7%) and retained products of conception (76.8%). The uterine balloon tamponade success rate was lower in cesarean deliveries (81.7%) than in vaginal deliveries (87.0%). A meta-analysis of 2 randomized trials that compared uterine balloon tamponade vs no uterine balloon tamponade in postpartum hemorrhage due to uterine atony after vaginal delivery showed no significant differences between the study groups in the risk of surgical interventions or maternal death (relative risk, 0.59; 95% confidence interval, 0.02-16.69). A meta-analysis of 2 nonrandomized before-and-after studies showed that introduction of uterine balloon tamponade in protocols for managing severe postpartum hemorrhage significantly decreased the use of arterial embolization (relative risk, 0.29; 95% confidence interval, 0.14-0.63). A nonrandomized cluster study reported that use of invasive procedures was significantly lower in the perinatal network that routinely used uterine balloon tamponade than that which did not use uterine balloon tamponade (3.0/1000 vs 5.1/1000; P < .01). A cluster randomized trial reported that the frequency of postpartum hemorrhage-related invasive procedures and/or maternal death was significantly higher after uterine balloon tamponade introduction than before uterine balloon tamponade introduction (11.6/10,000 vs 6.7/10,000; P = .04). Overall, the frequency of complications attributed to uterine balloon tamponade use was low (≤6.5%). CONCLUSION: Uterine balloon tamponade has a high success rate for treating severe postpartum hemorrhage and appears to be safe. The evidence on uterine balloon tamponade efficacy and effectiveness from randomized and nonrandomized studies is conflicting, with experimental studies suggesting no beneficial effect, in contrast with observational studies. Further research is needed to determine the most effective programmatic and healthcare delivery strategies on uterine balloon tamponade introduction and use.


Assuntos
Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/terapia , Tamponamento com Balão Uterino , Cesárea/estatística & dados numéricos , Feminino , Humanos , Mortalidade Materna , Parto , Placenta Acreta/etiologia , Placenta Prévia/etiologia , Placenta Retida/etiologia , Gravidez , Embolização da Artéria Uterina/estatística & dados numéricos , Tamponamento com Balão Uterino/efeitos adversos , Inércia Uterina/etiologia
3.
Artigo em Alemão | MEDLINE | ID: mdl-31810084

RESUMO

OBJECTIVE: The aim of this study was to analyze data concerning history, clinical course, and prognosis of retained fetal membranes in mares. MATERIAL UND METHODS: Patient records of 121 hospitalized mares with retained placenta were evaluated. In 82 cases, additional blood examinations were performed and analyzed. RESULTS: There was no significant correlation between age, parity or course of parturition and retained placenta. Eighty-one mares (66.9 %) were presented solely with retained fetal membranes, 40 mares (33.1 %) had additional diseases at presentation, most commonly injuries of the labia, followed by perineal tears and lochiometra. During hospitalization 50 mares (41.3 %) developed one or more diseases, most frequently lochiometra (23 mares, 19 %), laminitis (17 mares, 14 %) and thrombophlebitis (11 mares, 9.1 %). Eight mares (6.6 %) were euthanized due to the course of their diesease. Blood examinations revealed a mean leucocyte concentration of 9.8 ± 3.9 G/l at presentation. Mean concentration of serum ionized calcium amounted to 1.5 ± 0.2 mmol/l. There was no statistically significant influence of blood parameters on clinical course or development of additional diseases. CONCLUSION AND CLINICAL RELEVANCE: Retained placenta is a common disorder in the puerperium of the mare. In the presented study, most cases developed additional diseases and in 10 % of the mares, the clinical course led to euthanasia. No risk factors for the occurrence of retained fetal membranes or its clinical course could be identified.


Assuntos
Doenças dos Cavalos/epidemiologia , Placenta Retida/veterinária , Fatores Etários , Animais , Cálcio/sangue , Eutanásia Animal/estatística & dados numéricos , Feminino , Doenças dos Cavalos/sangue , Doenças dos Cavalos/etiologia , Cavalos , Contagem de Leucócitos/veterinária , Paridade , Placenta Retida/sangue , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Gravidez , Prognóstico
4.
Eur J Obstet Gynecol Reprod Biol ; 236: 160-165, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30933886

RESUMO

OBJECTIVES: To identify risk factors and complications associated with 3rd stage of labor removal of placental fragments (3rd SRPF) by manual uterine revision under a strict protocol. STUDY DESIGN: Ten years retrospective register-based cohort study of vaginal deliveries. Women with 3rd SRPF n = 3297 (exposed) and those without n = 97,888 (non exposed) were compared. MAIN OUTCOMES MEASURES: (1) risk factors for 3rd SRPF aOR (95%CI) (2) early (2a) and late (2b) maternal complications. RESULTS: (1) Risk factors for 3rd SRPF procedure were assisted reproductive technologies 2.20 (1.73-2.34), preterm delivery 2.53 (2.21-2.88), preeclampsia 1.66 (1.25-2.21) Multiple previous early pregnancy loss (>3) 1.40(1.19-1.66), VBAC 1.26(1.13-1.47) and epidural analgesia 1.56 (1.46-1.69). (2a) Early complications: puerperal fever 1.1% vs 0.3%, blood transfusion 9.0% vs. 0.5%, prolonged maternal hospitalization 21.0% vs. 11.4%, all P < 0.0001. Puerperal readmission was 0.819% in the 3rd SRPF vs. 0.315% the control group, P < 0.0001. (2b) Late complications: retained placenta and hysteroscopy / D&C rates were significantly higher among the 3rd SRPF vs. controls: 40.7% vs. 7.1%, 14.8% vs. 3.6% and 48.1% vs. 18.2%, respectively, all P < 0.0001. CONCLUSION: Uterine revision for 3rd SPRF is associated with significant early and late maternal morbidity; should be considered discriminative of a population at risk and postpartum health care planning, beyond being a therapeutic intervention.


Assuntos
Parto Obstétrico/efeitos adversos , Terceira Fase do Trabalho de Parto , Placenta Retida/etiologia , Útero/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Placenta Retida/cirurgia , Gravidez , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Eur J Obstet Gynecol Reprod Biol ; 234: 108-111, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30682599

RESUMO

OBJECTIVE: To compare the prevalence of postpartum retained products of conception (RPOC) among parturients with a history of third stage of labor placental complications and parturients without those complications. STUDY DESIGN: All women operated for postpartum RPOC following vaginal delivery by hysteroscopy or suction curettage between January 2013 and December 2017 were included in the study. Their medical records were reviewed for the occurrence of third stage of labor placental complications (including early postpartum hemorrhage treated with uterotonics, manual separation of the placenta, and revision of the uterine cavity for removal of cotyledons). RESULTS: The study cohort included 172 women operated for postpartum RPOC following vaginal delivery by operative hysteroscopy (143 cases, 83.1%) or by suction curettage (29 cases, 16.9%). Third stage of labor placental complications were reported in 65 (37.8%) cases, while 107 (62.2%) women had an uncomplicated third stage of labor. When considering all vaginal deliveries in our institution during the study period, the risk for RPOC was significantly higher among parturients with third stage of labor placental complications compared to those with an uneventful third stage of labor (3.7% versus 0.3%, p < 0.001, Odds ratio = 12.5, 95% confidence interval 9.0-17.3). CONCLUSION: Postpartum RPOC following vaginal delivery were more common in parturients with third stage of labor placental complications. However, the majority of postpartum RPOC cases were diagnosed in women reported to have an uncomplicated third stage of labor. Thus, focused postpartum ultrasound follow-up of women considered at risk for RPOC will not identify all cases.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Terceira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/patologia , Placenta Retida/etiologia , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Histeroscopia/estatística & dados numéricos , Complicações do Trabalho de Parto/etiologia , Placenta Retida/epidemiologia , Placenta Retida/cirurgia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Curetagem a Vácuo/estatística & dados numéricos , Adulto Jovem
6.
J Matern Fetal Neonatal Med ; 32(3): 384-388, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28891361

RESUMO

PURPOSE: The purpose of this study is to assess risk factors and complications of manual placental removal. MATERIALS AND METHODS: An historical prospective study of all parturients undergoing manual placental removal between 2012 and 2014. Parturients were matched by time of delivery with parturients delivering vaginally with spontaneous placental separation. Multiple gestations, preterm deliveries, incomplete placental separation and uterine malformations were excluded. Delivery characteristics and short-term complications were studied. Telephone questionnaires were conducted to assess the likelihood of invasive procedures performed for retained products of conception (RPOC) up to 12 weeks postpartum. RESULTS: Overall 293 (1.5% of all vaginal deliveries) were complicated by manual placental removal. Independent risk factors included advanced maternal age (odds ratio (OR) 1.08, 95% CI 1.03-1.12), previous manual removal (OR 9.27, 95% CI 3.15-27.31), regional anesthesia (OR 3.49, 95% CI 2.14-5.70), and labor induction (OR 1.80, 95% CI 1.12-2.88). Short-term complications included blood product transfusions (OR 18.26 95% CI 5.37-62.13) and prolonged hospitalization (OR 1.51 95% CI 1.06-2.16). Invasive procedures for removal of RPOC occurred in 12.2% of women in the study groups and in none of the women in the control group (p < .001). CONCLUSIONS: Manual placental removal harbors short- and long-term complications, including a high likelihood of RPOC necessitating further invasive procedures.


Assuntos
Parto Obstétrico/efeitos adversos , Procedimentos Cirúrgicos em Ginecologia , Complicações do Trabalho de Parto/etiologia , Placenta Retida , Placenta/patologia , Período Pós-Parto , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Mãos , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/cirurgia , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Placenta Retida/cirurgia , Gravidez , Fatores de Risco
8.
Anim Sci J ; 89(9): 1371-1378, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29956439

RESUMO

In dairy cows, retained fetal membranes (RFM) affect reproductive performance. The aim of this study was to examine the leukocyte counts and the gene expression of tumour necrosis factor α (TNFα), interleukin 1ß (IL-1ß), IL-8, and IL-10 in polymorphonuclear leukocytes (PMNs) and peripheral blood mononuclear cells (PBMCs) in cows with (n = 5) or without (n = 5) RFM during the peripartum period. The lymphocyte counts in RFM cows were higher than those in control cows throughout the experiment (p < .05). The expression of IL-8 in PMNs of control cows was higher (p < .05) compared with that of RFM cows postpartum. In cows with RFM, IL-1ß expression was higher (p < .05) in PMNs at 6 weeks postpartum whereas the expression of IL-1ß was lower (p < .05) in PBMCs at 4 weeks postpartum. The expression of IL-10 in PBMCs of control cows was higher (p < .05) than that of RFM cows at 2 weeks prepartum and 4 weeks postpartum. Taken together, our data indicate that changes of gene expression of pro- and anti-inflammatory cytokines in RFM cows might be associated with the delayed placental separation and development of uterine inflammation in RFM cows.


Assuntos
Doenças dos Bovinos/etiologia , Citocinas/sangue , Membranas Extraembrionárias , Expressão Gênica , Mediadores da Inflamação/sangue , Contagem de Leucócitos , Leucócitos/imunologia , Leucócitos/metabolismo , Período Periparto/sangue , Período Periparto/imunologia , Placenta Retida/etiologia , Placenta Retida/veterinária , Complicações na Gravidez/etiologia , Complicações na Gravidez/veterinária , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Doenças Uterinas/etiologia , Doenças Uterinas/veterinária , Animais , Bovinos , Feminino , Inflamação/etiologia , Inflamação/veterinária , Gravidez , Fatores de Tempo
9.
Am J Perinatol ; 35(10): 931-935, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29528466

RESUMO

OBJECTIVE: The objective of this study was to determine the incidence of morbidly adherent placenta in pregnancies after endometrial ablation. STUDY DESIGN: We performed a retrospective cohort analysis using a large, multiinstitutional deidentified clinical database, IBM EPM: Explore (IBM Corporation, Somers, NY). We identified women who underwent endometrial ablation and had a subsequent delivery between 1999 and 2016. Patients with a delivery and no prior ablation were used as controls. The association between morbidly adherent placenta, ablation, and other known risk factors for morbidly adherent placenta was analyzed using multivariable logistic regression. RESULTS: Of 162,100 reproductive-aged women who underwent endometrial ablation, 2,770 women (1.71%) subsequently had a delivery. The rate of morbidly adherent placenta was 1 in 13.9 pregnancies after ablation compared with 1 in 838.7 pregnancies in the control group (adjusted odds ratio [aOR], 20.22, p < 0.0001). CONCLUSION: Pregnancies that occurred after endometrial ablation were associated with increased rates of morbidly adherent placenta.


Assuntos
Técnicas de Ablação Endometrial/efeitos adversos , Miométrio/patologia , Placenta Acreta/epidemiologia , Placenta Retida/epidemiologia , Placenta/patologia , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Ohio/epidemiologia , Placenta/fisiopatologia , Placenta Acreta/etiologia , Placenta Retida/etiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Hemorragia Uterina/cirurgia , Adulto Jovem
10.
J Dairy Sci ; 101(1): 547-555, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29103725

RESUMO

The objective of this study was to evaluate the association of postpartum plasma Ca concentration with early-lactation disease outcomes, culling within 60 d in milk, pregnancy to first service, and milk production. A total of 1,453 cows from 5 commercial dairy farms in New York State were enrolled in a prospective cohort study from February to November 2015. Blood samples were collected within 12 h of parturition, and plasma was submitted to a diagnostic laboratory for total Ca measurement. Early-lactation disease, reproductive performance, and milk production from Dairy Herd Improvement Association (DHIA) test-day data were compiled from each farm's management software. Multivariable Poisson regression models were built to evaluate the association of plasma Ca with the risks of retained placenta (RP), metritis, displaced abomasum (DA), clinical mastitis, culling within 60 d in milk, and pregnancy to first service. Repeated-measures ANOVA were used to evaluate the association of Ca at parturition with milk production across the first 9 DHIA tests. Herd was considered a random effect in all models. Primiparous cows were modeled separately from multiparous cows if differential responses were observed. Calcium was not associated with the risk of RP, metritis, clinical mastitis, or pregnancy to first service in primiparous or multiparous cows. For multiparous cows only, higher Ca concentration tended to be associated with increased culling within the first 60 d in milk. Multiparous cows with Ca ≤1.85 mmol/L had an increased risk of being diagnosed with a DA compared with cows with Ca >1.85 mmol/L. For the milk production models, Ca was not associated with the amount of milk produced within the first 9 DHIA tests in primiparous cows; however, multiparous cows with Ca ≤1.95 mmol/L produced, on average, 1.1 kg more milk per day across the 9 DHIA tests than their multiparous counterparts with Ca >1.95 mmol/L. Our results indicate that plasma Ca concentration measured within 12 h of parturition is a poor predictor of early-lactation health outcomes. Reduced Ca concentration in the immediate postpartum period was associated with higher milk production in multiparous cows. From these results, we caution that studies attempting to categorize subclinical hypocalcemia based on a single sample in the immediate postpartum period could misclassify the disorder.


Assuntos
Cálcio/sangue , Doenças dos Bovinos/etiologia , Hipocalcemia/veterinária , Mastite Bovina/etiologia , Leite/metabolismo , Placenta Retida/veterinária , Reprodução , Animais , Bovinos , Estudos de Coortes , Feminino , Hipocalcemia/complicações , Lactação , New York , Paridade , Placenta Retida/etiologia , Período Pós-Parto , Gravidez , Estudos Prospectivos
11.
Animal ; 12(5): 1050-1059, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29032783

RESUMO

A targeted quantitative metabolomics approach was used to study temporal changes of serum metabolites in cows that normally released their fetal membranes and those that retained the placenta. We identified and measured serum concentrations of 128 metabolites including amino acids, acylcarnitines, biogenic amines, glycerophospholipids, sphingolipids and hexose at -8 and -4 weeks before parturition, during the week of retained placenta (RP) diagnosis, and at +4 and +8 weeks after parturition. In addition, we aimed at identifying metabolite signatures of pre-RP in the serum that might be used as predictive biomarkers for risk of developing RP in dairy cows. Results revealed major alterations in the metabolite fingerprints of pre-RP cows starting as early as -8 weeks before parturition and continuing as far as +8 weeks after calving. Biomarker candidates found in this study are mainly biomarkers of inflammation which might not be specific to RP. Therefore, the relevance of serum Lys, Orn, acetylornithine, lysophophatidylcholine LysoPC a C28:0, Asp, Leu and Ile as potential serum biomarkers for prediction of risk of RP in dairy cows will have to be tested in the future. In addition, lower concentrations of LysoPCs, Trp, and higher kynurenine in the serum during prepartum and the week of occurrence of RP suggest involvement of inflammation in the pathobiology of RP.


Assuntos
Biomarcadores/sangue , Doenças dos Bovinos/etiologia , Metabolômica , Placenta Retida/veterinária , Animais , Análise Química do Sangue/veterinária , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/diagnóstico , Feminino , Inflamação/veterinária , Parto , Placenta Retida/sangue , Placenta Retida/diagnóstico , Placenta Retida/etiologia , Gravidez , Fatores de Risco
12.
BMC Pregnancy Childbirth ; 17(1): 298, 2017 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-28886702

RESUMO

BACKGROUND: Oral misoprostol as an induction of labour (IOL) agent is rapidly gaining popularity in resource-limited settings because it is cheap, stable at ambient temperatures, and logistically easier to administer compared to dinoprostone and oxytocin. We aim to investigate the safety and effectiveness of a regimen of oral misoprostol in Papua New Guinean women undergoing IOL. METHODS: As part of a prospective dose escalation study conducted at Modilon Hospital in Papua New Guinea, women with a singleton pregnancy in cephalic presentation and an unfavourable cervix who gave written informed consent were administered oral misoprostol, commencing at 25mcg once every 2 h for 4 doses and increased to 50mcg once every 2 h for 8 doses within 24 h. The primary outcomes studied were i) the proportion of women delivering within 24 h of oral misoprostol administration, and ii) rates of maternal and perinatal severe adverse events. RESULTS: Of 6167 labour ward screened admissions, 209 women (3%) fulfilled the study inclusion criteria and underwent IOL. Overall, 74% (155/209 [95% confidence interval 67.6-79.9]) delivered within 24 h. Most women (90%; 188/209; 95% CI [84.9-93.5]) delivered vaginally with 86% (180/209) having a good outcome for both the mother and baby. Of the 10% (21/209) who failed IOL and underwent caesarean section, a significant proportion of their babies were admitted to special-care nursery compared to babies delivered vaginally (20/21 [95%] versus 8/188 [4%]; Fisher Exact test P < 0.001), but their perinatal mortality rate was not significantly higher (1/21 [5%] versus 2/188 [1%]; P = 0.30). The only maternal death was not study related and occurred in a patient with post-partum haemorrhage, 15 h post-delivery. CONCLUSION: The oral misoprostol regimen for IOL described in the present study is safe, effective and logistically feasible to administer in a resource-limited setting.


Assuntos
Países em Desenvolvimento , Trabalho de Parto Induzido/métodos , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Complicações na Gravidez/terapia , Adulto , Índice de Apgar , Cesárea , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Trabalho de Parto Induzido/efeitos adversos , Misoprostol/efeitos adversos , Ocitócicos/efeitos adversos , Papua Nova Guiné , Admissão do Paciente , Placenta Retida/etiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
13.
Eur J Obstet Gynecol Reprod Biol ; 216: 12-17, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28692888

RESUMO

OBJECTIVE: To determine risk factors for retained placenta, and to identify supporting epidemiologic evidence for the three previously-proposed mechanisms: (i) invasive placentation, (ii) placental hypo-perfusion, and (iii) inadequate uterine contractility. DESIGN: A retrospective population-based cohort study. SETTING AND POPULATION: Israeli population in the southern district. METHODS: Data were analyzed from a tertiary hospital database, between 1989 and 2014, using univariate tests and generalized estimating equation (GEE) multivariable models. MAIN OUTCOME MEASURES: Prevalence of retained placenta. RESULTS: The study population included 205,522 vaginal deliveries of which 4.8% (n=9870) were complicated with retained placenta. Previous intra-uterine procedures and placenta-related pregnancy complications were found to be significant risk factors for retained placenta (history of cesarean section aOR=8.82, 95%CI 8.35-9.31; history of curettage aOR=12.80, 95%CI 10.57-15.50; pre-eclampsia aOR=1.25, 95%CI 1.14-1.38; delivery of a small for gestational age neonate aOR=1.08, 95%CI 1.01-1.16; stillbirth aOR=2.34, 95%CI 1.98-2.77). During labour, the risk for retained placenta was increased in presence of arrest of dilatation (aOR=2.03, 95%CI 1.08-3.82) or arrest of descent (aOR=1.55, 95%CI 1.22-1.96). Infections of the uterine cavity during labour were also found to be strongly associated with increased risk of retained placenta (endometritis aOR=2.21, 95%CI 1.64-2.97; chorioamnionitis aOR=3.35, 95% CI 2.78-4.04). CONCLUSIONS: Supporting epidemiologic evidence were found for all three underlying mechanisms. In addition, there is evidence to suggest that intrauterine infection and inflammation may also be a possible pathology associated with retained placenta. TWEETABLE ABSTRACT: Risk factors for retained placenta support previously proposed mechanisms in a large cohort study.


Assuntos
Placenta Retida/etiologia , Insuficiência Placentária/fisiopatologia , Placentação/fisiologia , Contração Uterina/fisiologia , Adulto , Corioamnionite/epidemiologia , Corioamnionite/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Placenta Retida/epidemiologia , Placenta Retida/fisiopatologia , Insuficiência Placentária/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
14.
Theriogenology ; 92: 36-44, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28237340

RESUMO

The hypothesis was that a prolonged parturition impairs placenta expulsion and can lead to retained placentas in sows. Furthermore, we hypothesized that application of oxytocin around the time of expulsion of the first placental part improves placenta expulsion. We recorded 142 parturitions of 101 Yorkshire x Large White sows. We determined parity, gestation length, number of liveborn and stillborn piglets, farrowing duration (time between first and last piglet) and the outcome variables: number of expelled placental parts, placenta expulsion duration (time between first and last placental part), first placental part expulsion (time between last piglet and first placental part) and last placental part expulsion (time between last piglet and last placental part). The relationship between farrowing duration and each of the outcome variables was investigated using four distinct multivariable models. Use of oxytocin (used in 44 out of 142 parturitions) increased number of expelled placental parts (3.8 ± 0.2 vs. 2.9 ± 0.3; P = 0.035), decreased the placenta expulsion duration (172 ± 44 vs. 328 ± 26 min; P = 0.011) and time of last placental part expulsion (148 ± 48 vs. 300 ± 24 min; P = 0.025). If oxytocin was not used, farrowing duration obeyed a quadratic relationship with the number of expelled placental parts (P = 0.001), placenta expulsion duration (P = 0.002) and time of last placental part expulsion (P = 0.024). If oxytocin was used, number of expelled placental parts was positively associated with number of liveborn piglets (ß = 0.2 ± 0.1; P = 0.002) and affected by parity. 5th parity sows expelled more placental parts (4.3 ± 0.4) than 4th (3.2 ± 0.3; P = 0.024) and 3rd parity sows (2.7 ± 0.4; P = 0.008). Furthermore, placenta expulsion duration was positively associated with number of liveborn piglets (ß = 18 ± 8 min; P = 0.025). First placental part expulsion was negatively correlated with farrowing duration (ß = 0.3 ± 0.1; P = 0.001). Sows that experienced total (no expulsion of placental parts; n = 4) and partial retained placentas (no expulsion of placental parts after birth of the last piglet; n = 4) had longer farrowing durations (1009 ± 275 and 734 ± 136 min) than sows with no retained placentas (369 ± 202 min; P = 0.021 and P = 0.004). The results show that a prolonged parturition impaired and oxytocin improved placenta expulsion in sows. Furthermore, retained placentas occurred in 3-6% of the sows and was correlated with a prolonged parturition.


Assuntos
Tamanho da Ninhada de Vivíparos/fisiologia , Paridade/fisiologia , Parto/fisiologia , Placenta Retida/veterinária , Doenças dos Suínos/etiologia , Animais , Feminino , Ocitocina , Parto/efeitos dos fármacos , Placenta Retida/etiologia , Gravidez , Fatores de Risco , Suínos , Fatores de Tempo
15.
Acta Obstet Gynecol Scand ; 95(5): 501-4, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26765548

RESUMO

The standard treatment for retained placenta is manual removal whatever its subtype (adherens, trapped or partial accreta). Although medical treatment should reduce the risk of anesthetic and surgical complications, they have not been found to be effective. This may be due to the contrasting uterotonic needs of the different underlying pathologies. In placenta adherens, oxytocics have been used to contract the retro-placental myometrium. However, if injected locally through the umbilical vein, they bypass the myometrium and perfuse directly into the venous system. Intravenous injection is an alternative but exacerbates a trapped placenta. Conversely, for trapped placentas, a relaxant could help by resolving cervical constriction, but would worsen the situation for placenta adherens. This confusion over medical treatment will continue unless we can find a way to diagnose the underlying pathology. This will allow us to stop treating the retained placenta as a single entity and to deliver targeted treatments.


Assuntos
Manipulações Musculoesqueléticas , Miométrio , Ocitócicos , Placenta Retida , Tocolíticos , Tomada de Decisão Clínica , Gerenciamento Clínico , Feminino , Humanos , Manipulações Musculoesqueléticas/efeitos adversos , Manipulações Musculoesqueléticas/métodos , Miométrio/efeitos dos fármacos , Miométrio/fisiopatologia , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos , Placenta Retida/diagnóstico , Placenta Retida/etiologia , Placenta Retida/fisiopatologia , Placenta Retida/terapia , Gravidez , Risco Ajustado , Tocolíticos/administração & dosagem , Tocolíticos/efeitos adversos
16.
Ultrasound Obstet Gynecol ; 47(3): 290-301, 2016 03.
Artigo em Inglês | MEDLINE | ID: mdl-26195324

RESUMO

Although the incidence of morbidly adherent placenta (MAP) has risen progressively in the last two decades, there remains uncertainty about the diagnosis and management of this condition. The aim of this review is to provide up-to-date and evidence-based answers to common clinical questions regarding the diagnosis and management of MAP. Different risk factors have been associated with MAP; however, previous Cesarean section and placenta previa are the most frequently associated. Ultrasound is the primary method for diagnosing MAP and has a good overall diagnostic accuracy for its detection. When considering the different ultrasound signs of MAP, color Doppler seems to provide the best diagnostic performance. Magnetic resonance imaging has the same accuracy in diagnosing MAP as does ultrasound examination; its use should be considered when a resective procedure, such as hysterectomy, is planned as it can provide detailed information about the topography of placental invasion and predict difficulties that may arise in surgery. The optimal gestational age for delivery in pregnancies with MAP is yet to be established; planning surgery between 34 and 36 weeks of gestation provides the best balance between fetal maturity and the risk of unexpected episodes of heavy bleeding, which are more likely to occur with delivery after this timepoint, especially in severe cases of MAP. The optimal surgical approach to MAP depends on multiple factors, including availability of an experienced team, specific surgical skills and hospital resources. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Cesárea/métodos , Aconselhamento/métodos , Diagnóstico por Imagem/métodos , Placenta Prévia/patologia , Placenta Retida/diagnóstico por imagem , Cesárea/efeitos adversos , Gerenciamento Clínico , Medicina Baseada em Evidências , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Placenta Prévia/terapia , Placenta Retida/etiologia , Placenta Retida/terapia , Gravidez , Fatores de Risco , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/métodos
17.
BJOG ; 123(13): 2140-2145, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26265563

RESUMO

OBJECTIVE: Antenatal diagnosis of morbidly adherent placenta has been shown to improve outcomes, but existing predictors lack sensitivity. Our objective was to determine whether the presence of myometrial fibres attached to the placental basal plate (BPMYO) in an antecedent pregnancy is associated with subsequent morbidly adherent placenta. DESIGN: A case-control study. SETTING: Departments of Obstetrics and Gynecology and Pathology, Northwestern University, Chicago, IL, USA. SAMPLE: Women who had at least two pregnancies with placental pathological evaluation. METHODS: Cases were defined as women with evidence of morbidly adherent placenta (both clinically and pathologically) in their most recent pregnancy whereas women without evidence of morbidly adherent placenta served as controls. Pathological specimens of placentas from previous pregnancies were evaluated for BPMYO. The presence of BPMYO on a previous placenta was evaluated to determine whether it could be used to improve the antenatal diagnosis of morbidly adherent placenta. RESULTS: Of the 25 cases of morbidly adherent placenta, 19 (76%) had BPMYO present on their previous placenta compared with 41 (41%) of controls (odds ratio 4.8, 95% CI 1.8-13.0). Adding BPMYO to a regression including other risk factors for morbidly adherent placenta (i.e. maternal age, number of previous caesarean sections, placenta praevia, previous multiple gestation, any previous curettage, and ultrasonographic suspicion of placenta accreta) significantly improved the sensitivity of antenatal diagnosis of morbidly adherent placenta (61% versus 39%, P < 0.001) without a change in specificity (97% versus 97%, P = 1.00). CONCLUSION: BPMYO on previous placental pathology is associated with an increased risk of morbidly adherent placenta in a subsequent pregnancy. These findings may shed light on the pathophysiology of accreta and inform future research on predictors of accreta. TWEETABLE ABSTRACT: Previous basal plate myometrium improves the ability to detect subsequent morbidly adherent placenta.


Assuntos
Placenta Acreta , Placenta Retida , Placenta , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Humanos , Miométrio/patologia , Placenta/patologia , Placenta/fisiopatologia , Placenta Acreta/diagnóstico , Placenta Acreta/epidemiologia , Placenta Acreta/etiologia , Placenta Acreta/fisiopatologia , Placenta Retida/diagnóstico , Placenta Retida/epidemiologia , Placenta Retida/etiologia , Placenta Retida/fisiopatologia , Gravidez , Gravidez Múltipla/estatística & dados numéricos , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/estatística & dados numéricos , Fatores de Risco , Estatística como Assunto , Estados Unidos/epidemiologia
18.
J Perinat Med ; 44(4): 415-9, 2016 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-25741732

RESUMO

OBJECTIVES: To explore the influence of epidural analgesia on the course of the third stage of labor and on the incidence of the complete retained placenta as well as retained parts of the placenta. STUDY DESIGN: This is a population-based cohort study in a tertiary medical center. We collected data from all 4227 spontaneous singleton vaginal deliveries during 6 months and compared the incidence of retained placenta in deliveries with epidural analgesia with those without analgesia. Multivariable logistic regression was used to control for possible confounders. RESULTS: More than two-thirds of the women (69.25%) used epidural analgesia during their delivery. A need for intervention due to placental disorder during the third stage of labor was noted in 4.2% of all deliveries. Epidural analgesia appeared to be significantly (P=0.028) related to placental disorders compared with no analgesia: 4.8% vs. 3%, respectively. Deliveries with manual interventions during the third stage, for either complete retained placenta or suspected retained parts of the placenta, were associated with the use of epidural analgesia (P=0.008), oxytocin (P=0.002) and older age at delivery (P=0.000), but when including all factors in a multivariable analysis, using a stepwise logistic regression, the factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and, marginally, older age. CONCLUSIONS: Complete retained placenta and retained parts of the placenta share the same risk factors. Epidural analgesia does not directly influence the incidence of complete retained placenta or retained parts, though clinically linked through increased oxytocin use. The factors that were independently associated with interventions for placental disruption during the third stage of delivery were previous cesarean section, oxytocin use and older age.


Assuntos
Analgesia Epidural/efeitos adversos , Placenta Retida/etiologia , Adulto , Estudos de Coortes , Parto Obstétrico , Feminino , Humanos , Incidência , Israel/epidemiologia , Terceira Fase do Trabalho de Parto , Modelos Logísticos , Placenta Retida/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco
19.
Gynecol Obstet Invest ; 80(3): 206-10, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26088169

RESUMO

OBJECTIVE: To compare the reproductive outcomes of women with pathologically confirmed retained products of conception (RPOC) following spontaneous vaginal delivery versus first-trimester pregnancy termination. METHODS: We retrospectively reviewed all cases of women who underwent uterine re-evacuation due to pathologically confirmed RPOC between January 1, 2000 and December 31, 2010. Reproductive outcomes were compared between women with RPOC following spontaneous vaginal delivery and those who underwent dilatation and curettage (D&C) due to first-trimester abortion. RESULTS: The study group consisted of 176 patients with pathologically confirmed RPOC. Of those, 83 (47.1%) were admitted after spontaneous vaginal delivery and 93 (52.9%) following D&C due to first-trimester abortion. There were no significant differences in the conception rate, the mean time to conception and the rate of a new infertility problem between women with RPOC after vaginal delivery compared to those following pregnancy termination (p > 0.05). Furthermore, there were no significant differences between the groups in pregnancy outcomes following RPOC. CONCLUSION: Pathologically confirmed RPOC harbors the same reproductive outcomes following spontaneous vaginal delivery and first-trimester pregnancy termination.


Assuntos
Aborto Espontâneo/epidemiologia , Parto Obstétrico , Dilatação e Curetagem/métodos , Placenta Retida/diagnóstico , Complicações na Gravidez/epidemiologia , Taxa de Gravidez , Aborto Induzido/efeitos adversos , Adulto , Dilatação e Curetagem/efeitos adversos , Feminino , Humanos , Placenta Retida/etiologia , Placenta Retida/cirurgia , Gravidez , Complicações na Gravidez/etiologia , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Adulto Jovem
20.
Turk Patoloji Derg ; 31(1): 77-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24585351

RESUMO

Placental polyp is the retained fragment of placental tissue after the parturition or abortion for indefinite period which forms a polypoidal mass in the uterus. It is predominantly composed of necrotic and hyalinized chorionic villi (ghost chorionic villi). We report a case of 26-year-old G2P2 woman presenting with vaginal bleeding. Her last pregnancy had occurred five years ago. Laboratory investigations revealed a positive urine pregnancy test and serum levels of beta-human chorionic gonadotrophin (ß-hCG) was elevated. Ultrasonography revealed hyperechoic mass in uterine cavity. She underwent total abdominal hysterectomy and the pathological diagnosis was of a placental polyp.


Assuntos
Placenta Retida/diagnóstico , Pólipos/diagnóstico , Adulto , Biomarcadores/sangue , Biópsia/efeitos adversos , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Humanos , Histerectomia , Placenta Retida/sangue , Placenta Retida/etiologia , Placenta Retida/cirurgia , Pólipos/sangue , Pólipos/etiologia , Pólipos/cirurgia , Gravidez , Testes de Gravidez , Hemorragia Uterina/etiologia
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