Placenta percreta presenting in the first trimester and resulting in severe consumption coagulopathy and hysterectomy: a case report.

Placenta percreta complicating pregnancy in the first trimester is extremely rare, and only a few cases have been reported in the literature. A patient with risk factors for placenta percreta that presented as first trimester fetal demise, unresponsive to medical management with prostaglandin, is presented. The patient required an emergency hysterectomy to control the bleeding after uterine curettage which was complicated by severe consumption coagulopathy. This rare entity can lead to significant mortality and morbidity, particularly in the background of an increased prevalence of the disease and its associated risk factors, and the large number of spontaneous and induced abortions performed worldwide.

Caesarean deliveries in the Mother-Child (Rhea) cohort in Crete, Greece: almost as frequent as vaginal births and even more common in first-time mothers.

BACKGROUND: Caesarean deliveries are on the increase in Greece and around the world. The objective of the present study was to assess the frequency of planned and emergency caesarean deliveries and their socio-demographic predictors in women with singleton pregnancies followed-up from early pregnancy to delivery. METHODS: The mother-child cohort in Crete examines a population sample of pregnant women recruited during one year beginning in February 2007. A cohort of 1096 women, with singleton pregnancies, was included in the present analyses. Multivariable Poisson regression models with robust error variance were used. RESULTS: Overall, 48% of the women had a caesarean delivery, with a higher percentage observed in women having their first child (52%). Maternal age was a predictor for caesarean deliveries; type of hospital was associated with the risk for an emergency caesarean, whereas women with lower education were at an increased risk of having a planned caesarean delivery among primiparae. Prior caesarean delivery was by far the strongest predictor (RR=7.68, 95% CI 5.71, 10.33) for a subsequent one among multiparae. CONCLUSIONS: Caesarean deliveries are almost as frequent as vaginal births in the study population and even more frequent in first-time mothers. The study findings support that risk factors are indeed mode of delivery and parity status specific. As such, it is becoming clearer which groups of women, especially first-time mothers, need to be targeted in future research and interventions so as to understand better and achieve an appropriate caesarean delivery risk.