Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.463
Filtrar
1.
Wiad Lek ; 74(1): 28-34, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851582

RESUMO

OBJECTIVE: The aim: Improving perinatal outcomes in pregnant women at high risk of intrauterine infection by developing diagnostic criteria and algorithms for managing pregnancy and childbirth. PATIENTS AND METHODS: Materials and methods: The study of pregnancy and childbirth was conducted in 72 patients at high risk of IUI, which formed the main group. The control group consisted of 64 patients with a low infectious risk of IUI. Culture, bacterioscopic and biochemical methods were used to identify microorganisms. Peculiarities of infection in the examined women were investigated by determining the concentration of Ig M and IgG in the blood serum and performed polymerase chain reaction for measles virus, cytomegalovirus, parvovirus B19. Serum for the presence of specific immune globulins to these pathogens was examined by ELISA. Comprehensive ultrasound examination in B-mode was performed to determine the feto metry of the fetus and assess its development with the determination of the estimated mass, location, size and structure of the placenta, the amount of amniotic fluid. To determine the condition of the fetus, a Doppler study of blood flow in the uterine arteries, umbilical artery, middle cerebral artery of the fetus and venous duct. RESULTS: Results: Analyzing the course of this pregnancy in women of the studied groups threatened miscarriage and the threat of premature birth occurred in 24 (33.3%) cases, with signs of isthmic-cervical insufficiency were diagnosed in 13 (18.1%) patients. In the control group of patients, the threat of abortion was diagnosed in 15 (23.4%) patients. According to ultrasound examination, patients in the main group in 12 (16.7%) cases were diagnosed with fetal growth retardation, in 25 (34.7%) patients at high risk of IUI there were changes in the placenta, namely, hyper echogenic inclusions in the placenta occurred in 7 (9.7%) cases, dilation of the intervillous space in 8 (11.1%) cases, placental hyperplasia in 7 (9.7%) cases, polyhydramnios was diagnosed in only 5 (6), 9%) cases, with 1 (1.4%) acute polyhydramnios in patients with signs of acute respiratory viral infection during pregnancy. CONCLUSION: Conclusions: Women at high risk for IUI require close monitoring of the fetus due to the increased frequency of hemodynamic changes in uteroplacental-fetal circulation, including fetal-placental - 22.2% and the occurrence of intrauterine growth retardation. Women with suspected cytomegalovirus infection require determination of seroconversion; in case of immunologically confirmed infection, it is desirable to recognize PCR for cytomegalovirus in the amniotic fluid in order to determine further management and monitoring of this pregnancy.


Assuntos
Doenças Transmissíveis , Complicações Infecciosas na Gravidez , Viroses , Feminino , Feto , Humanos , Recém-Nascido , Placenta/diagnóstico por imagem , Gravidez
2.
Medicine (Baltimore) ; 100(16): e24097, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879654

RESUMO

RATIONALE: Hysteroscopic morcellation is an alternative approach for the removal of placental remnants, given its advantages of safety, efficiency and good reproductive outcomes. This superiority can be even more obvious for removing persistent placental remnants in the lateral angle of the uterine cavity after repeated dilation and curettage (D&C) of an angular pregnancy, which is rarely reported. PATIENT CONCERNS: Two patients who were both initially misdiagnosed as having missed intrauterine miscarriages underwent repeated suction-assisted D&C procedures and were found to have persistent placental remnants in the lateral angles of the uterine cavity. DIAGNOSES: Ultrasound and hysteroscopy evaluations showed that placental remnants in both cases were in the lateral uterine angles and protruding to the interstitial myometrium around the fallopian tube. We corrected the diagnosis to that of angular pregnancy according to a comprehensive consideration of the ultrasound, hysteroscopy and pathology results. INTERVENTIONS: We performed MyoSure hysteroscopic morcellation for both patients and the placental remnants were removed completely without any complication. OUTCOMES: The patients were both scheduled for a second-look hysteroscopy 1 to 3 months after surgery, which revealed normal morphology of the uterine cavities and tubal ostia. The patients both achieved normal intrauterine pregnancies several months after surgery. LESSONS: Hysteroscopic morcellation is a good alternative approach for the removal of placental remnants and should be considered in cases in which there might be a high risk of incomplete evacuation or a high risk of uterine perforation, especially in cases of angular pregnancy.


Assuntos
Histeroscopia/métodos , Morcelação/métodos , Placenta/cirurgia , Gravidez Angular/cirurgia , Útero/cirurgia , Adulto , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez , Gravidez Angular/diagnóstico , Ultrassonografia Pré-Natal , Útero/patologia
3.
Am J Obstet Gynecol ; 224(1): B2-B14, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33386103

RESUMO

Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.


Assuntos
Placenta Acreta/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/normas , Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Feminino , Idade Gestacional , Ginecologia , Humanos , Obstetrícia , Placenta/diagnóstico por imagem , Placenta Acreta/epidemiologia , Gravidez , Sensibilidade e Especificidade , Sociedades Médicas , Estados Unidos , Útero/diagnóstico por imagem
4.
Hum Reprod ; 36(4): 899-906, 2021 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-33346816

RESUMO

Coronavirus disease 2019 (COVID-19) is caused by infection of the respiratory tract by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which survives in the tissues during the clinical course of infection but there is limited evidence on placental infection and vertical transmission of SARS-CoV-2. The impact of COVID-19 in first trimester pregnancy remains poorly understood. Moreover, how long SARS-CoV-2 can survive in placenta is unknown. Herein, we report a case of a pregnant woman in the first trimester who tested positive for SARS-CoV-2 at 8 weeks of gestation, although her clinical course was asymptomatic. At 13 weeks of gestation, her throat swab tested negative for SARS-CoV-2 but viral RNA was detected in the placenta, and the Spike (S) proteins (S1 and S2) were immunolocalized in cytotrophoblast and syncytiotrophoblast cells of the placental villi. Histologically, the villi were generally avascular with peri-villus fibrin deposition and in some areas the syncytiotrophoblast layer appeared lysed. The decidua also had fibrin deposition with extensive leukocyte infiltration suggestive of inflammation. The SARS-CoV-2 crossed the placental barrier, as the viral RNA was detected in the amniotic fluid and the S proteins were detected in the fetal membrane. Ultrasonography revealed extensively subcutaneous edema with pleural effusion suggestive of hydrops fetalis and the absence of cardiac activity indicated fetal demise. This is the first study to provide concrete evidence of persistent placental infection of SARS-CoV-2 and its congenital transmission is associated with hydrops fetalis and intrauterine fetal demise in early pregnancy.


Assuntos
/diagnóstico , Morte Fetal , Placenta/virologia , Complicações Infecciosas na Gravidez/virologia , /isolamento & purificação , Infecções Assintomáticas , Evolução Fatal , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa , Mães , Placenta/diagnóstico por imagem , Gravidez , Primeiro Trimestre da Gravidez
5.
J Physiol ; 599(6): 1901-1915, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33369732

RESUMO

KEY POINTS: Maternal supine sleep position in late pregnancy is associated with an increased risk of stillbirth. Maternal supine position in late pregnancy reduces maternal cardiac output and uterine blood flow. Using MRI, this study shows that compared to the left lateral position, maternal supine position in late pregnancy is associated with reduced utero-placental blood flow and oxygen transfer across the placenta with an average 6.2% reduction in oxygen delivery to the fetus and an average 11% reduction in fetal umbilical venous blood flow. ABSTRACT: Maternal sleep position in late gestation is associated with an increased risk of stillbirth, though the pathophysiological reasons for this are unclear. Studies using magnetic resonance imaging (MRI) have shown that compared with lateral positions, lying supine causes a reduction in cardiac output, reduced abdominal aortic blood flow and reduced vena caval flow which is only partially compensated for by increased flow in the azygos venous system. Using functional MRI techniques, including an acquisition termed diffusion-relaxation combined imaging of the placenta (DECIDE), which combines diffusion weighted imaging and T2 relaxometry, blood flow and oxygen transfer were estimated in the maternal, fetal and placental compartments when subjects were scanned both supine and in left lateral positions. In late gestation pregnancy, lying supine caused a 23.7% (P < 0.0001) reduction in total internal iliac arterial blood flow to the uterus. In addition, lying in the supine position caused a 6.2% (P = 0.038) reduction in oxygen movement across the placenta. The reductions in oxygen transfer to the fetus, termed delivery flux, of 11.2% (P = 0.0597) and in fetal oxygen saturation of 4.4% (P = 0.0793) did not reach statistical significance. It is concluded that even in healthy late gestation pregnancy, maternal position significantly affects oxygen transfer across the placenta and may in part provide an explanation for late stillbirth in vulnerable fetuses.


Assuntos
Imagem por Ressonância Magnética , Circulação Placentária , Feminino , Feto/diagnóstico por imagem , Hemodinâmica , Humanos , Placenta/diagnóstico por imagem , Gravidez , Terceiro Trimestre da Gravidez
6.
J Clin Ultrasound ; 49(1): 12-19, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32964472

RESUMO

PURPOSE: To investigate the association between placental blood perfusion and the occurrence of macrosomia at birth. METHODS: This was a prospective cohort study including women with singleton pregnancies that aimed to measure placental blood perfusion using three-dimensional (3D) power Doppler ultrasonography in the second and third trimester. We acquired three indices of placental blood flow, including vascularization index (VI), flow index (FI), vascularization flow index (VFI), along with routine two-dimensional (2D) biometric measurements, including abdominal circumference (AC) and estimated fetal weight (EFW). Pregnancy outcomes were divided into two groups: newborns with a normal birth weight and those with macrosomia. We then compared all of the recorded variables between these two groups. We also determined the predictive efficiency of each variable using receiver-operating characteristic (ROC) curves. RESULTS: The placental 3D power Doppler indices, including VI and FI, were significantly higher in the third trimester of pregnancies developing macrosomia, but not during the second trimester, as compared to those with a normal birth weight. ROC curves analysis for third-trimester VI and FI suggested a slight ability to predict macrosomia; this was also the case for AC and EFW. Interestingly, VI showed high sensitivity and low specificity, while FI showed low sensitivity and high specificity; this was also the case for AC and EFW. CONCLUSIONS: Three-dimensional power Doppler ultrasound indices were significantly higher during the third-trimester for pregnancies developing macrosomia. However, these indices had only moderate ability to predict macrosomia.


Assuntos
Macrossomia Fetal/diagnóstico , Imageamento Tridimensional/métodos , Placenta/diagnóstico por imagem , Placenta/fisiopatologia , Circulação Placentária/fisiologia , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Macrossomia Fetal/fisiopatologia , Peso Fetal , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Curva ROC
8.
Sci Rep ; 10(1): 22259, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33335122

RESUMO

Abnormal maternal serum biomarkers (AMSB), identified through the aneuploidy screening programme, are frequent incidental findings in pregnancy. They are associated with fetal growth restriction (FGR), but previous studies have not examined whether this association is with early-onset (< 34 weeks) or late-onset (> 34 weeks) FGR; as a result there is no consensus on management. The aims of this study were to determine the prevalence and phenotype of FGR in women with AMSB and test the predictive value of placental sonographic screening to predict early-onset FGR. 1196 pregnant women with AMSB underwent a 21-24 week "placental screen" comprising fetal and placental size, and uterine artery Doppler. Multivariable regression was used to calculate a predictive model for early-onset FGR (birthweight centile < 3rd/< 10th with absent umbilical end-diastolic flow, < 34 weeks). FGR prevalence was high (10.3%), however early-onset FGR was uncommon (2.3%). Placental screening effectively identified early-onset (area under the curve (AUC) 0.93, 95% confidence interval (CI) 0.87-1.00), but not late-onset FGR (AUC 0.70, 95% CI 0.64-0.75). Internal validation demonstrated robust performance for detection/exclusion of early-onset FGR. In this cohort, utilisation of our proposed algorithm with targeted fetal growth and Doppler surveillance, compared with universal comprehensive surveillance would have avoided 1044 scans, potentiating significant cost-saving for maternity services.


Assuntos
Biomarcadores/sangue , Retardo do Crescimento Fetal/sangue , Recém-Nascido Pequeno para a Idade Gestacional/sangue , Placenta/diagnóstico por imagem , Adulto , Área Sob a Curva , Feminino , Retardo do Crescimento Fetal/fisiopatologia , Idade Gestacional , Humanos , Recém-Nascido , Placenta/patologia , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Medição de Risco , Ultrassonografia Doppler , Ultrassonografia Pré-Natal/métodos , Artéria Uterina/diagnóstico por imagem , Artéria Uterina/patologia
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2079-2083, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018415

RESUMO

The placenta is a vital organ for growth and development of the fetus. Shear Wave Absolute Vibro-Elastography (SWAVE) is a new elastography technique proposed to detect placenta disorders. Elastography involves applying a force on the tissue and measuring the resulting tissue deformation. All types of compression cause the tissue to expand in three directions given the biological tissues are nearly incompressible. Hence, 3D displacement estimation should lead to the most accurate elasticity reconstruction compared to the traditional 1D methods. Previous studies estimated 3D displacements over ultrasound volumes mostly for quasi-static compression to generate strain images. However, accurate displacement tracking of dynamic motion continues to be a challenge. In this work, a novel volumetric regularized algorithm, 3D GLobal Ultrasound Elastography (GLUE3D), is presented to estimate the 3D displacement over a volume of ultrasound data, following by a 3D Young's modulus reconstruction. The proposed method outperforms the previous 2D method over a volume and is compared with a 3D technique using phantom data for which the elasticity are provided by the values from magnetic resonance elastography on the same phantom and also the manufacturer reference numbers. We then present Young's modulus reconstruction results obtained from clinical data of placenta which shows more uniform elasticity maps compared to the traditional 1D displacement measurements over a volume of ultrasound data. Furthermore, the dependency of the elasticity values to the frequency is investigated in this study.


Assuntos
Técnicas de Imagem por Elasticidade , Módulo de Elasticidade , Elasticidade , Feminino , Humanos , Imagens de Fantasmas , Placenta/diagnóstico por imagem , Gravidez
10.
Zhonghua Fu Chan Ke Za Zhi ; 55(9): 627-632, 2020 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-32957751

RESUMO

Objective: To investigate the clinical characteristics and outcomes of monochorionic monoamniotic (MCMA) twin pregnancy. Methods: The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected, and the general clinical data, prenatal examination and pregnancy outcomes were analyzed retrospectively. Results: The age of 60 MCMA twin pregnant women was (31.0±4.1) years old, among which 44 cases were primiparas (73%, 44/60) and 16 cases were multiparas (27%, 16/60). Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery. Median ultrasonic diagnosis of gestational age was 12 weeks (range: 8-30 weeks). In the 60 MCMA twin pregnancies, 6 cases were conjoined twins, 5 cases were complicated with twin reversed arterial perfusion sequence (TRAPS), and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination. Among the 60 MCMA twin pregnant women, 19 cases had spontaneous abortion or induced abortion due to fetal malformation, fetal death or other reasons within 28 weeks of pregnancy, 41 cases entered the perinatal period, a total of 70 newborns survived. The main cause of perinatal fetal or neonatal death was fetal dysplasia. Conclusions: There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy. Accurate early diagnosis, enhanced management and monitoring during pregnancy, and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.


Assuntos
Âmnio/diagnóstico por imagem , Placenta/diagnóstico por imagem , Gravidez de Gêmeos , Gêmeos Monozigóticos , Ultrassonografia Pré-Natal/métodos , Adulto , Âmnio/fisiopatologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal , Placenta/fisiopatologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
12.
Arch Gynecol Obstet ; 302(2): 337-343, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32451659

RESUMO

PURPOSE: The objective of this study was to evaluate the feasibility and value of measuring early placental echogenicity to predict fetal intrauterine growth restriction (IUGR). METHODS: This is a single center, retrospective cohort study. Early ultrasound examination (6 + o to 8 + 6 weeks of gestation in singleton pregnancies) was used to measure placental dimensions and placental echogenicity. A ratio between placental echogenicity and myometrial echogenicity (PE/ME-ratio) was calculated for each patient. Study population was assigned to either the IUGR group or the control group based on clinical data. RESULTS: 184 eligible pregnancies were analysed. 49 patients were included in our study. Of those, 9 (18.37%) cases were affected by IUGR and 40 (81.63%) were controls. Measuring the placental echogenicity was feasible in all cases. IUGR neonates had a significant lower placental echogenicity (1.20 (± 0.24) vs. 1.64 (± 0.60), p = 0.033), but no significant differences in the other placental outcomes were observed. CONCLUSION: Our results showed that measuring placental echogenicity is feasible in the early first trimester and demonstrated a significantly lower placental echogenicity in fetuses with subsequent IUGR. Further prospective studies are needed to validate those results.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Placenta/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Estudos de Viabilidade , Feminino , Retardo do Crescimento Fetal/diagnóstico , Humanos , Recém-Nascido , Projetos Piloto , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade
13.
PLoS Biol ; 18(5): e3000676, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32463837

RESUMO

We have used magnetic resonance imaging (MRI) to provide important new insights into the function of the human placenta in utero. We have measured slow net flow and high net oxygenation in the placenta in vivo, which are consistent with efficient delivery of oxygen from mother to fetus. Our experimental evidence substantiates previous hypotheses on the effects of spiral artery remodelling in utero and also indicates rapid venous drainage from the placenta, which is important because this outflow has been largely neglected in the past. Furthermore, beyond Braxton Hicks contractions, which involve the entire uterus, we have identified a new physiological phenomenon, the 'utero-placental pump', by which the placenta and underlying uterine wall contract independently of the rest of the uterus, expelling maternal blood from the intervillous space.


Assuntos
Placenta/fisiologia , Circulação Placentária , Adulto , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Feminino , Humanos , Angiografia por Ressonância Magnética , Oxigênio/metabolismo , Placenta/diagnóstico por imagem , Pré-Eclâmpsia/fisiopatologia , Gravidez , Útero/fisiologia , Adulto Jovem
15.
Pregnancy Hypertens ; 20: 27-35, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32145525

RESUMO

OBJECTIVE: To determine the rate of sonographic placental markers and their predictive value for preeclampsia and fetal growth restriction in women with chronic kidney disease (CKD). STUDY DESIGN: A retrospective cohort study of women with CKD followed at a tertiary referral center between 2016 and 2019 (n = 86). All women underwent 2nd trimester sonographic placental examinations that included assessment of placental morphology, umbilical cord, and uterine artery Doppler. Continuous placental markers were converted to multiples on medians (MoM). MAIN OUTCOME MEASURES: Predictive value of sonographic markers for preeclampsia and birthweight < 10th percentile. RESULTS: Women in the cohort had a high rate of preeclampsia (24.4%), birthweight < 10th% (26.7%), and preterm birth (30.2%). The most important markers were placental volume and uterine artery Doppler: the risk of preeclampsia was elevated in women with low placental volume (51.7% vs. 10.9%; OR = 8.79 [2.70-28.59] for preeclampsia; and 40.0% vs. 9.1%; OR = 6.67 [1.85-24.04] for preterm preeclampsia), and in women with bilateral uterine artery notching (62.5% vs. 20.8%; OR = 6.35 [1.37-29.45] for preeclampsia; and 62.5% vs. 10.4%; OR = 14.38 [1.29-71.75] for preterm preeclampsia). The combination of both markers had the strongest predictive value for preeclampsia (positive likelihood ratio = 8.25 [6.84-9.95]). Low placental volume and bilateral uterine notching were also associated with birthweight < 10th percentile. CONCLUSION: A 2nd-trimester sonographic placental study can identify a subgroup of women with CKD who are at most risk of preeclampsia and fetal growth restriction. Such data may inform their subsequent perinatal care and assist care providers in the often challenging distinction between preeclampsia flare of underlying CKD.


Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Placenta/diagnóstico por imagem , Pré-Eclâmpsia/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Adulto , Peso ao Nascer , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Pré-Eclâmpsia/etiologia , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/etiologia , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Cordão Umbilical/diagnóstico por imagem , Artéria Uterina/diagnóstico por imagem
17.
BMC Pregnancy Childbirth ; 20(1): 111, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066401

RESUMO

BACKGROUND: For the first time, we aimed to introduce a model for prediction of placenta accreta spectrum (PAS), using existing sonography indices. METHODS: Women with a history of Cesarean sections were included. Participants were categorized "high risk" for PAS if the placenta was previa or low-lying. Sonography indices including abnormal placental lacuna, loss of clear zone, bladder wall interruption, myometrial thinning, placental bulging, exophytic mass, utero-vesical hypervascularity, subplacental hypervascularity, existence of bridging vessels, and lacunar flow, were registered. To investigate simultaneous effects of 15 variables on PAS, Minimax Concave Penalty (MCP) was used. RESULTS: Among 259 participants, 74 (28.5%) were high risk and 43 individuals had PASs. All sonography indices were higher among patient with PAS (p < 0.001) in the high risk group. Our model showed that utero-vesical hypervascularity, bladder interruption and new lacunae have significant contribution in PAS. Optimal cut off point was p = 0.51 in ROC analysis. Probability of PAS for women with lacunae was between 96 and 100% and probability of PAS for women without lacunae was between 0 to 7%, therefore accuracy of the proposed model was equal to 100%. CONCLUSIONS: Using the introduced model based on three factors of abnormal lacuna structures (grades 2 and 3), bladder wall interruption and utero-vesical vascularity, 100% of all cases of PASs are diagnosable. If supported by future studies our model eliminates the need for other imaging assessments for diagnosis of invasive placentation among high risk women with previous history of Cesarean sections.


Assuntos
Modelos Estatísticos , Placenta Acreta/diagnóstico , Placenta/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Cesárea , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Placenta Prévia/diagnóstico , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos
18.
Radiol Clin North Am ; 58(2): 381-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044013

RESUMO

Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta is a key component to evaluate during any imaging performed during pregnancy. The most common disease processes involving the placenta include placenta accreta spectrum disorders and placental masses. Several systemic processes such as infection and fetal hydrops can too affect the placenta; however, their imaging features are nonspecific such as placental thickening, heterogeneity, and calcifications. Ultrasound is the first line of imaging during pregnancy, and MR imaging is reserved for problem solving, when there is need for higher anatomic resolution.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez
19.
Eur Radiol ; 30(5): 2604-2615, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32040730

RESUMO

OBJECTIVES: This study was conducted in order to establish the joint Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) guidelines on placenta accreta spectrum (PAS) disorders and propose strategies to standardize image acquisition, interpretation, and reporting for this condition with MRI. METHODS: The published evidence-based data and the opinion of experts were combined using the RAND-UCLA Appropriateness Method and formed the basis for these consensus guidelines. The responses of the experts to questions regarding the details of patient preparation, MRI protocol, image interpretation, and reporting were collected, analyzed, and classified as "recommended" versus "not recommended" (if at least 80% consensus among experts) or uncertain (if less than 80% consensus among experts). RESULTS: Consensus regarding image acquisition, interpretation, and reporting was determined using the RAND-UCLA Appropriateness Method. The use of a tailored MRI protocol and standardized report was recommended. CONCLUSIONS: A standardized imaging protocol and reporting system ensures recognition of the salient features of PAS disorders. These consensus recommendations should be used as a guide for the evaluation of PAS disorders with MRI. KEY POINTS: • MRI is a powerful adjunct to ultrasound and provides valuable information on the topography and depth of placental invasion. • Consensus statement proposed a common lexicon to allow for uniformity in MRI acquisition, interpretation, and reporting of PAS disorders. • Seven MRI features, namely intraplacental dark T2 bands, uterine/placental bulge, loss of low T2 retroplacental line, myometrial thinning/disruption, bladder wall interruption, focal exophytic placental mass, and abnormal vasculature of the placental bed, reached consensus and are categorized as "recommended" for diagnosing PAS disorders.


Assuntos
Consenso , Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico , Placenta/diagnóstico por imagem , Radiografia Abdominal/métodos , Radiologia , Sociedades Médicas , Feminino , Humanos , Gravidez
20.
Obstet Gynecol Clin North Am ; 47(1): 147-162, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008665

RESUMO

Fetal membranes (FMs) play a role in pregnancy maintenance and promoting parturition at term. The FMs are not just part of the placenta, structurally or functionally. Although attached to the placenta, the amnion has a separate embryologic origin, and the chorion deviates from the placenta by the first month of pregnancy. Other than immune protection, these FM functions are not those of the placenta. FM dysfunction is associated with and may cause adverse pregnancy outcomes. Ongoing research may identify biomarkers for pending preterm premature rupture of the FMs as well as therapeutic agents, to prevent it and resulting preterm birth.


Assuntos
Membranas Extraembrionárias/diagnóstico por imagem , Ruptura Prematura de Membranas Fetais/diagnóstico , Placenta/diagnóstico por imagem , Nascimento Prematuro , Feminino , Humanos , Gravidez
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...