Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow ...Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.展开更多
Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conduct...Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.展开更多
Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the bene...Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.展开更多
Objectives: To describe a novel procedure to treat hemorrhage of placenta accreta spectrum disorders (PAS) or cesarean-scar pregnancy (CSP). Methods: This was a retrospective study of women under cesarean delivery wit...Objectives: To describe a novel procedure to treat hemorrhage of placenta accreta spectrum disorders (PAS) or cesarean-scar pregnancy (CSP). Methods: This was a retrospective study of women under cesarean delivery with PAS or placenta previa. Patients’ information was acquired from hospital records. A novel procedure of surgery is developed with seven major steps, including avoiding placenta incised, elevating upward the uterine, clamping the uterine arteries with sponge forceps, removing the placenta, opening the vesicouterine space and suture techniques. Results: A total of 38 patients were reviewed. Twenty-one patients diagnosed with placenta accrete syndrome and 3 patients with CSP were underwent surgery with the novel procedure of surgery and all severe hemorrhage was controlled without hysterectomy. There were 2 women with bladder injuries needing primary repair. Fourteen patients with placenta previa underwent cesarean delivery and there was no intraoperative complication of the total 14 patients. Conclusion: The seven-step approach is more secure and effective to control severe hemorrhage without other invasive procedures in cesarean delivery with PAS. It is technically easier to maintain and improve surgical skills.展开更多
The recent increase in placenta accreta spectrum has been correlated with a rise in the rate of cesarean sections.A recent study provides evidence that hampered wound healing results in cesarean scar defects that lead...The recent increase in placenta accreta spectrum has been correlated with a rise in the rate of cesarean sections.A recent study provides evidence that hampered wound healing results in cesarean scar defects that lead to a failure in the normal process of decidualization and deeper adherence of trophoblasts.Matrix metalloproteinase(MMP)is crucial in every step of wound healing as it alters the wound matrix,facilitating cell migration,as well as tissue remodeling.MMP-9 expression is higher in placental and decidual tissue in cases of placenta accreta.Based on these findings,assessment of MMP-9 expression can shed new light on the etiopathology of placenta accreta spectrum disorder and can be a potential diagnostic marker.展开更多
Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the b...Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the burden on the blood bank caused by excessive use of blood and blood products. Methodology: This is a retrospective study conducted at King Saud Medical City Maternity Hospital in Riyadh, Kingdom of Saudi Arabia, from January 2019-September 2020. It includes 170 cases diagnosed with abnormal placentation (low-lying placenta or placenta previa, accreta, increta, or percreta). The primary purpose was to measure consumption of blood and blood products in cases of placental abnormalities and to investigate how much this affects blood bank capacity. A secondary aim was to report rates of admission to the ICU and maternal mortality. Results: This study included 170 women with placental abnormalities. Placental previa had occurred in 96 cases, followed by placenta accreta in 46 cases, placenta increta in 13 cases, placenta percreta in 8 cases, and low-lying placenta in 7 cases. Most patients (93) were treated with a Bakri balloon to prevent hemorrhage, but 38 patients had a hysterectomy. The average estimation of blood loss was 2210 ml, with no maternal mortality. An average of 3.39 units of packed red blood cells (PRBC) with a maximum of 20 units, 2.12 units of fresh frozen plasma (FFP) with a maximum of 20 units, and 0.7 units of packed platelets (PP) with maximum of 12 units consumed per patient. Eighty-seven patients (51.2%) were admitted to the ICU and 83 others (48.8%) were admitted to the high dependency unit. Conclusion:<span style="font-family: "> Blood and blood product volumes had a linear relationship with the severity of placental abnormalities and estimated blood loss. Therefore, blood bank services should be available to save mothers’ life.展开更多
Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple ges...Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.展开更多
Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Bo...Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.展开更多
文摘Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.
基金supported by The Capital health Development Research Project [2020-1-4039]Key Program for Clinical Projects of Hospital [BYSY2018002]。
文摘Objective This study aims to investigate the correlation of an ultrasonic scoring system with intraoperative blood loss(IBL) in placenta accreta spectrum(PAS) disorders.Methods A retrospective cohort study was conducted between January 2015 and November 2019.Clinical data for patients with PAS have been obtained from medical records. Generalized additive models were used to explore the nonlinear relationships between ultrasonic scores and IBL. Logistic regressions were used to determine the differences in the risk of IBL ≥ 1,500 m L among groups with different ultrasonic scores.Results A total of 332 patients participated in the analysis. Generalized additive models showed a significant positive correlation between score and blood loss. The amount of IBL was increased due to the rise in the ultrasonic score. All cases were divided into three groups according to the scores(low score group: ≤ 6 points, n = 147;median score group: 7-9 points, n = 126;and high score group: ≥ 10 points, n = 59). Compared with the low score group, the high score group showed a higher risk of IBL≥ 1,500 m L [odds ratio, 15.09;95% confidence interval(3.85, 59.19);P ≤ 0.001] after a multivariable adjustment.Conclusions The risk of blood loss equal to or greater than 1,500 m L increases further when ultrasonic score greater than or equal to 10 points, the preparation for transfusion and referral mechanism should be considered.
基金2018 Applied Medicine Research Projects of Health and Family Planning Commission of Hubei(No.WJ2018H0139 and No.WJ2018H0133).
文摘Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.
文摘Objectives: To describe a novel procedure to treat hemorrhage of placenta accreta spectrum disorders (PAS) or cesarean-scar pregnancy (CSP). Methods: This was a retrospective study of women under cesarean delivery with PAS or placenta previa. Patients’ information was acquired from hospital records. A novel procedure of surgery is developed with seven major steps, including avoiding placenta incised, elevating upward the uterine, clamping the uterine arteries with sponge forceps, removing the placenta, opening the vesicouterine space and suture techniques. Results: A total of 38 patients were reviewed. Twenty-one patients diagnosed with placenta accrete syndrome and 3 patients with CSP were underwent surgery with the novel procedure of surgery and all severe hemorrhage was controlled without hysterectomy. There were 2 women with bladder injuries needing primary repair. Fourteen patients with placenta previa underwent cesarean delivery and there was no intraoperative complication of the total 14 patients. Conclusion: The seven-step approach is more secure and effective to control severe hemorrhage without other invasive procedures in cesarean delivery with PAS. It is technically easier to maintain and improve surgical skills.
文摘The recent increase in placenta accreta spectrum has been correlated with a rise in the rate of cesarean sections.A recent study provides evidence that hampered wound healing results in cesarean scar defects that lead to a failure in the normal process of decidualization and deeper adherence of trophoblasts.Matrix metalloproteinase(MMP)is crucial in every step of wound healing as it alters the wound matrix,facilitating cell migration,as well as tissue remodeling.MMP-9 expression is higher in placental and decidual tissue in cases of placenta accreta.Based on these findings,assessment of MMP-9 expression can shed new light on the etiopathology of placenta accreta spectrum disorder and can be a potential diagnostic marker.
文摘Introduction: Hemorrhage is one of the most common causes of maternal morbidity and mortality. This study was conducted to investigate how much abnormal placentation can affect blood bank capacity and to measure the burden on the blood bank caused by excessive use of blood and blood products. Methodology: This is a retrospective study conducted at King Saud Medical City Maternity Hospital in Riyadh, Kingdom of Saudi Arabia, from January 2019-September 2020. It includes 170 cases diagnosed with abnormal placentation (low-lying placenta or placenta previa, accreta, increta, or percreta). The primary purpose was to measure consumption of blood and blood products in cases of placental abnormalities and to investigate how much this affects blood bank capacity. A secondary aim was to report rates of admission to the ICU and maternal mortality. Results: This study included 170 women with placental abnormalities. Placental previa had occurred in 96 cases, followed by placenta accreta in 46 cases, placenta increta in 13 cases, placenta percreta in 8 cases, and low-lying placenta in 7 cases. Most patients (93) were treated with a Bakri balloon to prevent hemorrhage, but 38 patients had a hysterectomy. The average estimation of blood loss was 2210 ml, with no maternal mortality. An average of 3.39 units of packed red blood cells (PRBC) with a maximum of 20 units, 2.12 units of fresh frozen plasma (FFP) with a maximum of 20 units, and 0.7 units of packed platelets (PP) with maximum of 12 units consumed per patient. Eighty-seven patients (51.2%) were admitted to the ICU and 83 others (48.8%) were admitted to the high dependency unit. Conclusion:<span style="font-family: "> Blood and blood product volumes had a linear relationship with the severity of placental abnormalities and estimated blood loss. Therefore, blood bank services should be available to save mothers’ life.
文摘Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.
文摘Placenta percreta is a rare condition,which can lead to significant morbidity and potentially,mortality.This paper discusses two cases of complete placenta previa with placenta percreta invading the urinary bladder.Both patients underwent caesarean hysterectomy and experienced delayed bladder bleeding postoperatively.
