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The preterm male infant was delivered at 30 3/7 weeks of gestational age by an emergency C-section due to placenta previa, with haemorrhage and fetal distress. The mother, 21 years old, gravida 2 parity 1, had no underlying diseases. The antenatal care was done regularly at a provincial health

Uterine scar dehiscence with underlying placenta is often misdiagnosed as placenta accreta spectrum both prenatally and intraoperatively due to the absence of myometrial tissue in the area. Misdiagnosis generates obstetric anxiety and results in overtreatment which carries a risk of iatrogenic injury. We present a case of the antenatal diagnosis of uterine dehiscence in a 36-year-old woman with a history of two caesarean deliveries and a low-lying placenta. We further describe the sonographic features useful for differentiating this condition from placenta accreta spectrum in instances where the placenta lies under an area of full thickness uterine scar dehiscence.

Placenta accreta spectrum (PAS) disorders is the abnormal invasion of the placenta to the myometrium.[1][1] One of the risk factors of PAS is a previous caesarean section.[2][2] Only few studies described caesarean hysterectomy in patients with PAS with images. We report a case of a caesarean

Objectives: This study aims to investigate whether a significant difference exists in maternal and fetal outcomes between planned cesarean delivery (PCD) compared to emergency cesarean delivery (ECD) in placenta previa (PP) patients without placenta accreata spectrum (PAS) in a tertiary referral hospital. Material and methods: This retrospective cohort study included 237 singleton pregnant women who were diagnosed with PP without PAS at the time of delivery. PP patients who were delivered at the scheduled time were included in the PCD group. Patients with PP delivered in an emergency setting before the scheduled date were assigned to the ECD group. We recorded demographic and clinical characteristics, maternal and neonatal outcomes. Results: Of the 237 patients who met the inclusion criteria, 157 patients (66.8%) underwent PCD, and 80 patients required ECD (33.2%). Patients’ hospitalization and pre-discharge hemoglobin levels were significantly lower in the ECD group (11.25 ± 1.97 g/dL and 9.74 ± 2.09 g/dL, respectively) than in the PCD group (10.77 ± 2.67 g/dL and 9.27 ± 2.70, p = 0.002 and p = 0.004, respectively). While six patients (7.5%) were required intensive care unit (ICU) admission in the ECD group, no patient was required to follow up in ICU in the PCD group (p < 0.001). The hospital length of stay (LOS) was tended to be significantly longer in the ECD group (2.8 ± 0.7 days) than in the PCD group (2.4 ± 0.6 days, p < 0.001). Neonatal outcomes of birth weight, Apgar scores, NICU admission, and neonatal death were significantly better in the PCD group than in the ECD group. Conclusions: The PCD group has better maternal outcomes, including preoperative and discharge hemoglobin levels, ICU admission and hospital LOS, and better neonatal outcomes than the ECD group. Clinicians should pay regard to that scheduling the delivery to advanced pregnancy weeks has a failure possibility, and patients could not reach the scheduled day due to the emergency states.

Background The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study was launched in 2013 to evaluate the complex interactions of genetic and environmental factors in multifactorial diseases. The present study describes the maternal baseline profile and perinatal data of participating mothers and infants. Methods Expectant mothers living in Miyagi prefecture were recruited from obstetric facilities or affiliated centers between 2013 and 2017. Three sets of self-administered questionnaires were collected, and the medical records were reviewed to obtain precise information about each antenatal visit and each delivery. Biospecimens, including blood, urine, umbilical cord blood, and breast milk, were collected for the study biobank. The baseline maternal sociodemographic characteristics, results of screening tests, and obstetric outcomes were analyzed according to the maternal age group. Results A total of 23 406 pregnancies involving 23 730 fetuses resulted in 23 143 live births. Younger maternal participants had a tendency toward a higher incidence of threatened abortion and threatened premature labor, while older age groups exhibited a significantly higher rate of low lying placenta, placenta previa, gestational diabetes and hypertensive disorders of pregnancy. Conclusions The present study clearly shows the distribution of maternal baseline characteristics and the range of perinatal outcomes according to maternal age group. This cohort study can provide strategic information for creating breakthroughs in the pathophysiology of perinatal, developmental, and noncommunicable diseases by collaborative data visiting or sharing.

OBJECTIVE The current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care. MATERIAL AND METHODS We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3. RESULTS The search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD=-3.71 [-4.46, -2.96]; p

AIM The effect of placenta previa on age-specific placental size has not yet been elucidated. This study aimed to examine the effect of placenta previa on the Japanese standardized z-scores of placental size. METHODS This retrospective cohort study included Japanese participants from Ohta Nishinouchi Hospital with single pregnancies who gave birth during 2013-2019. The participants were categorized into two groups based on the presence or absence of placenta previa. Multiple linear regression analyses were used to identify the association of placenta previa with the z-score of placental size, after adjusting for factors, such as maternal smoking status, maternal age, assisted reproductive technology, myoma uteri, uterine anomaly, maternal hypertension at the time of pregnancy, and body mass index before pregnancy. RESULTS A total of 4071 Japanese women (76 with placenta previa and 3995 without placenta previa) were identified. Placenta previa significantly increased the placental weight z-score (partial regression coefficient: 0.44, 95% confidence interval 0.10-0.70, p

OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.

Aim: To determine the diagnostic accuracy and epidemiology of placenta accreta spectrum (PAS) in patients of placenta previa. Design: Systematic review. Methods: PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between January1992 and December 2020. Studies on placenta previa complicated by PAS diagnosed in a defined obstetric population. This research was carried out using standard methods and protocols and keeping in view Newcastle-Ottawa scale for observation and assessment of case study along with the difference approved by consensus. The overall diagnostic accuracy of ultrasonographic findings is the main outcome of this study, whereas the prevalence of placenta accreta in patients of placenta previa and its incidence among different countries all over the world is also described. Results: In this review study, about 300 articles were evaluated. More over about 15 prospective and 14 retrospective case studies incorporated for assessment having complication with placenta previa and PAS. According to the meta-analysis, a significant (p

With a growing number of states legalizing recreational use, cannabis consumption during pregnancy is increasing. Population-based data and rigorous studies examining the association of cannabis use in pregnancy with perinatal outcomes are limited, but trends include preterm prelabor rupture of membranes, placenta previa, and an increased length of hospital stay. Neonates of pregnant persons who used cannabis during their pregnancy can be at increased risk of low birth weight, preterm birth, neonatal intensive care unit admission, neurocognitive deficits, and infectious and neurologic morbidity and mortality. This state of the science review examines the prevalence of cannabis use in pregnancy, its pharmacodynamics and how that is influenced by pregnancy, and associated adverse perinatal and neonatal outcomes. Implications for health care providers caring for pregnant persons using cannabis, especially in legalized states, are discussed.

PURPOSE: To assess whether live birth rates (LBR) and maternal/neonatal complications differed following single fresh and frozen-warmed blastocyst transfer. METHODS: The present retrospective observational study analyzed 4,613 single embryo transfers (SET) (646 fresh and 3,967 frozen) from January 1, 2014, to December 31, 2018. Fresh embryo transfer at blastocyst stage was considered according to the age of the patient and her prognosis. In case of the risk of ovarian hyperstimulation syndrome, premature progesterone rise, non-optimal endometrial growth, or supernumerary embryos, cryopreservation with subsequent frozen embryo transfer (FET) was indicated. RESULTS: No differences in LBR were recorded. Fresh embryo transfers yielded an increase both in neonatal complications OR 2.15 (95% CI 1.20–3.86, p 0.010), with a higher prevalence of singletons weighting below the 5th percentile (p 0.013) and of intrauterine growth retardation (p 0.015), as well as maternal complications, with a higher placenta previa occurrence OR 3.58 (95% CI 1.54–8.28, p 0.003), compared to FET. CONCLUSION: LBR appears not to be affected by the transfer procedure preferred. Fresh embryo transfer is associated with higher risk of neonatal complications (specifically a higher prevalence of singletons weighting below the 5th percentile and of intrauterine growth retardation) and placenta previa. Reflecting on the increased practice of ART procedures, it is imperative to understand whether a transfer procedure yields less complications than the other and if it is time to switch to a “freeze-all” procedure as standard practice. Trial registration: Clinical Trial Registration Number: NCT04310761. Date of registration: March 17, 2020, retrospectively registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10815-021-02362-3.

Placenta Accreta Spectrum (PAS) disorders have become a major iatrogenic obstetric complication worldwide. Data on the accuracy of ultrasound examination diagnosis are limited by incomplete confirmation and variability in the description of the different grades of PAS at delivery. The aim of this study was to compare our prenatal routine sonographic screening and diagnostic scoring system with a standardized clinical grading system at birth in patient at risk of PAS.This is a retrospective cohort study of 607 pregnant patients with at least one prior cesarean delivery between December 2013 and December 2018. All patients were assessed for PAS using our institutional prenatal sonographic scoring system and the corresponding ultrasound findings were compared with those of a standardized clinical intra-operative macroscopic grading system of the degree of accreta placentation at vaginal birth or laparotomy.PAS was diagnosed clinically at birth in 50 (8.2%) cases, 17 of which were confirmed by histopathology. A low (score ≤ 5), medium (score 6-7), high (score ≥ 8) probability for PAS was reported in 502, 61 and 44 cases, respectively. The probability score increased significantly (Both ends of the spectrum of accreta placentation remain difficult to diagnose antenatal and clinically at birth, in particular when no histopathologic confirmation is available. There is a need to develop ultrasound accuracy score systems that can differentiate between the different grades of PAS and which are validated by standardized clinical and pathology protocols.

Objective The training of groups responsible for managing patients with placenta accreta spectrum (PAS) is complex because of the lack of hospitals with a high flow of patients and absence of formal educational programs. We report the results of a virtual training program (VTP) that implement one-step conservative surgery (OSCS). Methods A prospective observation study of OSCS VTP between three expert groups and PAS reference hospitals without experience in OSCS was performed. Accessible or cost-efficient web meeting platforms were used to implement the VTP components: baseline observation of the participant's prior knowledge; instructions about essential PAS surgery topics; base selection and joint planning of surgery; expert group "telepresence" during surgery and postoperative debriefing. Results OSCS was performed successfully at 6 hospitals. All patients had increta/percreta with a median intraoperative bleeding of 1300 mL (IQR 825-2325) and surgical time of 184 minutes (IQR 113-240). All groups considered the VTP very useful (n=33, 97%) or useful (n=1, 3%), they would use it again (definitely: n=27, 81.8%; or probably: n=6, 18.2%), and they would recommend it to other colleagues. Conclusion Tele education and telepresence during PAS surgery facilitates the implementation of OSCS in selected cases.

Pregnancies complicated by the placenta praevia are associated with an increased risk of massive obstetric bleeding and high rates of hysterectomy which are often caused by the placenta accreta.This was a cohort study carried out between 2014 and 2020 in 532 women with abnormal placental localization and attachment. The placental attachment spectrum (PAS) disorder diagnosis was confirmed during the surgery and by the histology results in 164/532 participants. Depending on the surgical approach during the Cesarean delivery, patients were divided into three groups. In Group 1 (PAS was observed in 30.8% of the placenta praevia cases, and in 93.3% was associated with the presence of a uterine scar. Women with the placenta praevia and PAS had a significantly higher number of past deliveries (

Objective To validate the use of placenta accreta risk-antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS). Methods This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001). Results Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06). Conclusion PAR-A score is a novel scoring system of PAS outcomes, which showed external validity based on current data.

Aim To identify a set of scientific, systematic and clinically applicable nursing‐sensitive quality indicators for pernicious placenta previa (PPP). Design A modified Delphi‐Consensus Technique. Methods According to literature retrieval published between 2009–2019, 38 nursing‐sensitive quality indicators were chosen and a questionnaire was designed. An online survey was conducted in 20 hospitals in China, and data of experts’ opinions were collected and analysed by improved Delphi method. Results 38 nursing‐sensitive quality indicators were identified. The response rates in the two rounds of expert consultation were 97.4% and 100%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04–0.28. The nursing‐sensitive quality indicators were successfully constructed based on the modified Delphi technique.

Placental mesenchymal dysplasia (PMD) is a rare placental abnormality that is closely related to severe pregnancy complications. A 27-year-old woman with fetal growth restriction and placenta previa was referred to a university hospital at 22 gestational weeks (GW). She was suspected of having a twin pregnancy with a complete or partial hydatidiform mole and coexisting normal live fetus, because two separate placentas, an enlarged one with multiple cystic lesions and a normal one, were shown on ultrasound examinations. At 27 GW, she experienced a sudden intrauterine fetal death (IUFD) after bleeding due to placenta previa, despite confirmation of fetal well-being at 2 h before bleeding. After delivery, histopathological examination confirmed the diagnosis of PMD. This is the first documented case of a woman with PMD and placenta previa who had a sudden IUFD after bleeding. Patients with both PMD and placenta previa should be considered at extremely high risk for IUFD.

Objective In order to create a comprehensive scoring system based on maternal characteristics and ultrasonographic features for predicting placenta accreta spectrum (PAS). Materials and methods This was a retrospective review of pregnant women who underwent routine ultrasound examination in the third trimester of pregnancy from January 2014 to November 2018 were used as a training set to establish the scoring system for PAS prediction while those who underwent examination from January 2019 to December 2019 served as a validation set.. Maternal characteristics including maternal age, parity, previous vaginal deliveries, previous curettage, previous cesarean section (CS), history of hypertension and diabetes mellitus, prenatal body mass index (BMI) were recorded. Ultrasonographic features including abnormal placental lacunae, subplacental hypervascularity, myometrial thinning, placental bulge, bladder wall interruption, location of placenta, placenta previa (yes or not) were recorded. Multivariate analysis was applied to analyze independent risk factors and assess the predictive power of selected parameters predicting PAS. Receiver operating characteristics (ROC) curve was used to evaluate the diagnosis power. Results Parity, previous curettage and CS were independent risk factors. The best comprehensive scoring system was established as follow: the number of abnormal lacunae ≥3, 2 points; lacuna maximum dimension ≥2 cm, 5 points; subplacental hypervascularity (rich), 1 point; subplacental hypervascularity (extremely rich and disordered), 3 points; bladder wall interruption, 9 points; placental bulge, 9 points; placenta previa, 8 points; anterior placenta, 1 point; previous CS ≥ 1, 1 point; parity ≥ 4, 3 point; previous abortions ≥ 2, 1 point. The area under the ROC curve of the scoring system diagnosing PAS was 0.925. Sensitivity and specificity were 83.3% and 85.7%, respectively. Cross-validation for our model showed that sensitivity, specificity, positive predictive value and negative predictive value of the model in diagnosis of PAS were 82.6%, 81.8%, 82.6% and 81.8%, respectively. Diagnosis of 37 cases were consistent with the “gold standard”, and the coincidence rate was 82.2% (37/45). Conclusion The comprehensive scoring system established in this study can effectively diagnose PAS.

Placenta accreta spectrum (PAS) refers to the range of pathologic adherence of the placenta to the uterine myometrium, including the placenta accreta, increta, and percreta. The incidence of PAS is rising primarily because of an increase in related risk factors, such as the rate of cesarean deliveries and pregnancies resulting from assisted reproductive technology. The maternal risks associated with PAS are significant, including hemorrhage, hysterectomy, and death. Fetal and neonatal risks are primarily the result of premature delivery. Antenatal diagnosis via ultrasonography and magnetic resonance imaging remains imperfect. Management of PAS varies, however, and there is a clear improvement in maternal outcomes with an antenatal diagnosis compared with unexpected diagnosis at the time of delivery. Studies that evaluate the balance between maternal and fetal/neonatal risks of expectant management versus preterm delivery have found that planned delivery between 34 and 35 weeks’ gestation optimizes outcomes. Multidisciplinary PAS care teams have become the norm and recommended approach to management, given the complexity of caring for this obstetrical condition. Although significant advances have been made over the years, large knowledge gaps remain in understanding the pathophysiology, diagnosis, and clinical management.

Placenta accreta spectrum (PAS) refers to the spectrum of diagnoses involving abnormally and morbidly adherent trophoblastic tissue to the gravid uterus. These disorders are associated with significant maternal morbidity and mortality. While race/ethnicity is known to impact pregnancy outcomes, racial disparities have not been previously examined in women with PAS. The objective of current study was to compare patient characteristics and perioperative outcomes of women with PAS who underwent cesarean delivery across race/ethnicity. This is a comparative study that retrospectively queried the National Inpatient Sample, a hospital-based inpatient database in the USA. The study cohort was women diagnosed with PAS who underwent cesarean delivery from 10/2015 to 12/2018. The exposure group was race/ethnicity. Main outcomes were (i) patient/pregnancy characteristics and (ii) surgical morbidity for cesarean delivery, assessed in multivariable analysis. A total of 10,535 women comprised the study cohort (White n = 5,230 [49.6%], Black n = 2,045 [19.4%], Hispanic n = 2,540 [24.1%], and Asian n = 720 [6.8%]). Patient demographics, pregnancy characteristics, and hospital factors for the non-White groups significantly differed compared to the White group. Older age, obesity, diabetes, placenta previa, percreta, non-elective surgery, lower median household income, and Medicaid particularly represented the non-White groups. When perioperative outcomes were compared, non-White women were more likely to have any measured complications, hemorrhage/transfusion, and shock/coagulopathy compared to White women. Various sensitivity analyses redemonstrated the main cohort results. In conclusion, this study suggests that there were significant disparities in patient characteristics and outcomes of women with PAS across race/ethnicity.

The consequence of each cesarean section is the uterine scar formation. In some patients, uterine scar after cesarean section heals incompletely and as a result, the uterine niche is formed. Most of the small niches are asymptomatic, but the large cesarean scar niches in nonpregnant women may cause a cesarean scar syndrome, which manifest itself as abnormal uterine bleeding, dysmenorrhea and secondary infertility. Among pregnant women, the presence of large niches may be associated with potentially life-threatening consequences, such as cesarean scar dehiscence and uterine rupture, placenta accreta spectrum disorders, placenta previa, cesarean scar pregnancy. Due to the possibility of dangerous consequences related to the occurrence of a uterine niche, in recent years many studies have focused on the term of cesarean scar niche, its risk factors, diagnostic methods and treatment options. Uterine niche can be examined using two- or three-dimensional transvaginal ultrasonography, as well as two- and three-dimensional sonohysterography, hysterosalpingography, hysteroscopy or magnetic resonance imaging. However, neither of the above diagnostic method is considered as the "gold standard". There are no unambiguous guidelines on some aspect concerning the diagnosis of cesarean scar niche. The aim of this study is to analyze and describe the diagnostic methods of cesarean section niche.

To assess maternal and neonatal outcomes in women with or without preexisting diabetes mellitus (DM) undergoing assisted reproduction technology (ART) treatment. Prospective or retrospective controlled trials reporting on women with or without preexisting DM undergoing ART treatment were considered eligible. Twelve electronic databases were systematically searched up to December 2020. The risk of bias was assessed by the Cochrane Risk OF Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Each primary outcome was extracted and pooled as maternal- or neonatal-related. Two studies were included in the systematic review, reporting on both maternal- and neonatal-related parameters after ART treatment. Due to the limited data, no meta-analysis was conducted. Preterm birth, placenta previa, and excessive bleeding during pregnancy were observed more often in pregnancies complicated by preexisting DM conceived by ART compared with pregnancies without DM. There was no difference in the risk for placental abruption between the groups. Regarding the neonatal outcomes, large-for-gestational-age (LGA) embryos and neonatal intensive care unit (NICU) admission were more commonly reported for women with preexisting DM. In one study, preexisting DM was marginally associated with infant mortality. Despite the scarce data, preexisting DM in pregnancies conceived by ART is associated with increased risk for maternal and neonatal complications. Registered in PROSPERO (registration number: 143187).

INTRODUCTION This study examined national-level trends, characteristics, and perioperative outcomes of women who had intra-arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS This was a population-based retrospective observational study that queried the National Inpatient Sample from October 2015 to December 2018. Study population was women who underwent hysterectomy at cesarean delivery for PAS (n = 6440 in 806 centers). Exposure allocation was the use of intra-arterial balloon occlusion. Main outcome measures were (a) characteristics associated with intra-arterial balloon occlusion use, and (b) perioperative outcome including hemorrhage, blood transfusion, coagulopathy, shock, urinary tract injury, intra-arterial balloon occlusion-related complication (arterial injury, arterial thrombosis, and lower extremities ischemia), and death, assessed in multivariable analysis. RESULTS Intra-arterial balloon occlusion was used in 420 (6.5%) women in 64 (7.9%) centers. Utilization of intra-arterial balloon occlusion during cesarean hysterectomy for placenta accreta decreased significantly over time (from 6.3% to 3.1%, p

BACKGROUND: Preterm birth (PTB) rates have been increased significantly in recent years, mostly due to obstetric intervention. This study presents the incidence of PTB in community hospitals by assessing the association between pregnancy complications and iatrogenic PTB. METHODS: A total of 6,693 pregnancies were enrolled in the Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University. They were divided into two groups (

The article presents the analysis of the causes of massive obstetric hemorrhages, treatment features, possible errors made during conservative and surgical treatment. The main causes of massive obstetric hemorrhage were postpartum uterine atony, abruption of a normally located placenta and placenta previa. The amount of lost blood averaged 2,410.45 ± 520.55 ml. The errors made during the clinical examination, surgical, conservative treatment and organizational issues led to 5 cases of maternal mortality and deterioration in the quality of life of women in the study group., В статье приводятся анализ причин массивных акушерских кровотечений, особенности лечения, возможные допущенные ошибки консервативного и оперативного лечения в ретроспективной группе исследуемых пациентов на базе областного перинатального центра в г. Ургенче Хорезмской области в Республике Узбекистан., У статті наводяться аналіз причин масивних акушерських кровотеч, особливості лікування, можливі допущені помилки консервативного і оперативного лікування в ретроспективній групі досліджуваних пацієнтів на базі обласного перинатального центру в м. Ургенчі Хорезмськой області в Республіці Узбекистан.

Objective:to describe a new method of organ-preserving surgery for combined placenta previa and placenta accreta into the uterine scar after a previous cesarean section – the CLAP method. Materials and methods.During 2015–2020, 29 women with placenta praevia and placenta accreta vera into the uterine scar after a previous cesarean section were operated. 15 women (control group) gave birth using the traditional method – cesarean section followed by hysterectomy; in 14 pregnant women (main group) the new method CLAP was used. CLAP consists of the following stages: stage I – C – cesarean section; stage II – L – ligation of internal iliac arteries; stage III – A – adherent placenta's area excision; stage IV – P – pressure, applied to the lower uterine segment, during which the technique of COLUS was performed. Patients were operated at 34–35 weeks of pregnancy after fetal respiratory distress syndrome prophylactics with a course of betamethasone. Results.Statistically significant difference in the age of patients (p = 0.968), status and weight of newborns (p = 0.058) was not found. But significant statistical difference was found in the amount of maternal blood loss during surgical delivery. In the control group, where pregnant women underwent hysterectomy, it was 3652 ± 293 ml, and in the main group, where delivery was performed using the new CLAP technique, blood loss was 2253 ± 153 ml (p Conclusions.CLAP procedure is an effective alternative to previously used organ-preserving operations. It helps to avoid hysterectomy and does not require special equipment during a cesarean section. The CLAP technique has proven to be an effective way to prevent and cease blood loss, as well as to preserve reproductive function of woman.

Objective To describe a stepwise surgical approach for conservative management of placenta previa accreta to preserve the uterus and to evaluate the efficacy and safety of this approach in controlling postpartum hemorrhage including intrapartum hemorrhage. Methods A prospective case series study conducted on 62 pregnant women with one or more cesarean deliveries diagnosed with placenta previa accreta between January 2018 and June 2019 at Ain Shams University Maternity Hospital. All participants underwent a conservative stepwise surgical approach through Pfannenstiel skin incision with fetal delivery through a uterine incision just above the upper border of the placenta, followed by bilateral uterine artery ligation with myometrial excision of the remaining adherent placenta and cervico-isthmic sutures by MMG (the main surgeon) and MS. Results Among 62 women, the surgical approach was successful in controlling postpartum hemorrhage and preserving the uterus in 50 (80.64%) participants. Three women (4.83%) had urinary bladder injuries, all were managed intraoperatively during the cesarean section. Five women (8%) had postpartum pyrexia and five women (8%) had postpartum endometritis, all were managed conservatively with broad-spectrum antibiotics. Conclusion The stepwise surgical approach can be applied to the conservative management of placenta previa accreta to avoid unnecessary cesarean hysterectomy.

Antenatal diagnosis of placenta accreta spectrum (PAS) can ensure multidisciplinary management at center of excellence which can reduce maternal and fetal complications. This can be established by a scoring system which provides a standardized criterion for the diagnosis and management. The objective of our study was to assess the placenta accreta index (PAI) and its individual parameters for diagnosis of PAS in high-risk patients. A prospective study was conducted on 71 pregnant women with placenta previa and previous cesarean section. After informed consent, history was taken and ultrasonography was used to calculate the PAI for each patient. Definitive diagnosis was made clinically during cesarean section or by histopathology for those requiring hysterectomy. The data were evaluated using the latest version of Statistical Package for the Social Sciences software. All ultrasound parameters of placenta accreta index were statistically significant for predicting PAS (p value

Objective Comprehensive comparison of maternal and neonatal outcomes between placenta previa with and without a history of caesarean delivery is sparse in the literature. The objective of this study was to conduct such an analysis. Methods We conducted a retrospective cohort study involving all cases of placenta previa among 56 070 singleton births at two tertiary care hospitals in Guangdong, China, between January 2014 and December 2018. Placenta previa cases were divided into two groups: those with a history of caesarean delivery and those without. We first compared baseline characteristics and then compared maternal and neonatal outcomes between the two groups. Multiple log binomial regression and multiple linear regression analyses were performed to estimate independent association between a history of caesarean delivery and adverse maternal and neonatal outcomes. Results A total of 773 placenta previa cases were included in the final analysis. Of them, 546 had a history of cesarean delivery and 227 did not. Compared with placenta previa cases without a history of cesarean delivery, placenta previa cases with a history of caesarean delivery were at increased risks of placenta accrete and increta, uterine rapture, shock, severe anemia, hysterectomy, and increased bleeding and hospital costs. No differences in neonatal outcomes between the two groups were observed. Conclusions History of caesarean delivery is associated with an increased risk of adverse maternal outcomes but not with neonatal outcomes with placenta previa.

Cesarean section for placenta previa accreta spectrum carries a significant risk of massive hemorrhage. Hence, it is necessary to understand the various hemostatic procedures, damage control surgery and resuscitation for massive hemorrhage, and systemic management against hypovolemic shock and coagulopathy. In cases of placenta previa with previous cesarean section, the operation should be performed in a tertiary medical facility with well-trained staff and blood availability for transfusion. Preoperative placement of an intra-arterial balloon occlusion catheter in the common iliac artery or aorta is useful for preventing massive hemorrhage.

Introduction: Placenta accreta spectrum (PAS) is a life-threating obstetric complication, and prenatal prediction of PAS can decrease maternal morbidity and mortality. The aim of this prospective cohort study was to determine the clinical factors associated with PAS. Methods: Pregnant women who delivered at a university hospital were enrolled. Clinical data were collected from medical records, and logistic regression analyses were performed to determine which clinical factors were associated with PAS. Results: Eighty-seven (2.1%) of the 4146 pregnant women experienced PAS. Multivariable analyses revealed that a prior history of cesarean section (CS) (OR 3.3; 95% CI 1.9-5.7; p < 0.01), dilation and curettage (D&C) (OR 2.8; 95% CI 1.7-4.6; p < 0.01), hysteroscopic surgery (OR 5.7; 95% CI 2.3-14.4; p < 0.01), uterine artery embolization (UAE) (OR 44.1; 95% CI 13.8-141.0; p < 0.01), current pregnancy via assisted reproductive technology (ART) (OR 4.1; 95% CI 2.4-7.1; p < 0.01), and the presence of placenta previa in the current pregnancy (OR 13.1; 95% CI 7.9-21.8; p < 0.01) were independently associated with the occurrence of PAS. Conclusion: Pregnant women who have a prior history of CS, D&C, hysteroscopic surgery, UAE, current pregnancy via ART, and the presence of placenta previa in the current pregnancy are high risk for PAS.

There is a higher incidence of infertility, chromosomal aberrations, poor results of in vitro fertilization, ectopic pregnancies, spontaneous abortion, preeclampsia, placenta previa, gestational diabetes mellitus, caesarean section, chronic diseases with higher rates of admission into intensive care units, and a higher rate of maternal mortality among women who delay pregnancy into advanced age. This is mainly due to socioeconomic causes as well as the increased use of contraceptives. Problems due to advanced maternal age arise also with egg donations. Only chromosome aberrations are related to the age of the donor. Paternal age also appears to play a significant role in the outcome of the pregnancy. However, opinions vary in the literature available. Counseling the couples should be addressed.

Background Placenta accreta is known to be associated with significant maternal morbidity and mortality—primarily due to intractable bleeding during abortion or delivery at any level of gestation. The complications could be reduced if placenta accreta is suspected in a patient with a history of previous cesarean delivery and the gestational sac/placenta is located at the lower part of the uterus. Then, a proper management plan can be instituted, and complications can be reduced. The diagnosis of placenta accreta in the first trimester of pregnancy is considered uncommon. Case presentation A 34-year-old Malay, gravida 4, para 3, rhesus-negative woman was referred from a private hospital at 13 weeks owing to accreta suspicion for further management. She has a history of three previous lower-segment cesarean sections. She also had per vaginal bleeding in the early first trimester, which is considered to indicate threatened miscarriage. Transabdominal ultrasound revealed features consistent with placenta accreta spectrum. She was counseled for open laparotomy and hysterectomy because of potential major complication if she continued with the pregnancy. Histopathological examination revealed placenta increta. Conclusion A high index of suspicion of placenta previa accreta must be in practice in a patient with a history of previous cesarean deliveries and low-lying placenta upon ultrasound examination during early gestation.

Introduction: Third trimester bleeding is one of the majorobstetric emergencies, which contribute greatly to maternaland fetal morbidity and mortality. It is defined as bleeding from or into the genital tract prior to delivery of thebaby anytime from 20 weeks gestation, in some developedcountries or 24 weeks gestation, in others or 28 weeks incountries with low resource settings thus lacking adequateneonatal support incubators.The aim of this study: The study aimed to elucidate theoutcomes with the associated morbidities, which will help define the magnitude of the problem posed by antepartumhemorrhage in order to better the management measuresavailable to promptly tackle and alleviate this condition.Patients & Methods: This study was prospective observational study conducted in Department of Obstetrics andGynecology, Faculty of Medicine, Fayoum UniversityHospital and El-Sahel Teaching Hospital. All cases of antepartum hemorrhage admitted to emergency unit at maternity hospital after the age of 28 week of gestation during theperiod from (1st of August 2019 to end of November 2020)were included in this study, meeting the inclusion and exclusion criterion.Results: Total number of patients who were admitted toobstetric department with APH during the study period was120 case of them 25 cases were elective and all of themwere placenta previa cases and 95 cases were emergency.67 cases (55.83%) with placenta previa (25 elective and 42emergency) & 44 (36.636%) with accidental hemorrhage(all are emergency or urgent cases), 9 (7.5%) due to othercauses. Maternal outcome in PP include Increased numbersof CS 67 case (100%), Increased number of units of bloodtransfusion (1-18) unit with mean 4.31 ± 3.27, Hysterectomy 21 case (31.3 %), Shock 29 case (43.3 %), Urinary injury either bladder or ureteric injury 5 cases (7.5 %) (4cases bladder injury and 1 case Ureteric injury) all of themwere placenta percreta, ICU admission 14 case (20.9 %),postpartum hemorrhage occurred in 6 cases and maternalmortality one case (1.5%). While maternal out come in accidental hemorrhage patients was numbers of CS delivery was 35 cases and 9 cases delivered vaginally,number of units of blood transfusion (1-18)unit with mean 3.57 ± 3.08, Hysterectomy 3cases (6.8%), Shock 22 case (50%),Conclusion Previous CS was found to be the mostimportant risk factor for Placenta praeviaand accreta Pre-eclampsia& previous abruption were the most important risk factors forabruption. Fetal morbidities associated withboth placenta previa & abruption were prematurity, low birth weight, low Apgar score,admission to NICU.

Although an infrequent occurrence, the placenta can adhere abnormally to the gravid uterus leading to significantly high maternal morbidity and mortality during cesarean delivery. Contemporary national statistics related to a morbidly adherent placenta, referred to as placenta accreta spectrum, are needed.This study aimed to examine national trends, characteristics, and perioperative outcomes of women who underwent cesarean delivery for placenta accreta spectrum in the United States.This is a population-based retrospective, observational study querying the National Inpatient Sample. The study cohort included women who underwent cesarean delivery from October 2015 to December 2017 and had a diagnosis of placenta accreta spectrum. The main outcome measures were patient characteristics and surgical outcomes related to placenta accreta spectrum assessed by the generalized estimating equation on multivariable analysis. The temporal trend of placenta accreta spectrum was also assessed by linear segmented regression with log transformation.Of 2,727,477 cases who underwent cesarean delivery during the study period, 8030 (0.29%) had the diagnosis of placenta accreta spectrum. Placenta accreta was the most common diagnosis (n=6205, 0.23%), followed by percreta (n=1060, 0.04%) and increta (n=765, 0.03%). The number of placenta accreta spectrum cases increased by 2.1% every quarter year from 0.27% to 0.32% (P=.004). On multivariable analysis, (1) patient demographics (older age, tobacco use, recent diagnosis, higher comorbidity, and use of assisted reproductive technology), (2) pregnancy characteristics (placenta previa, previous cesarean delivery, breech presentation, and grand multiparity), and (3) hospital factors (urban teaching center and large bed capacity hospital) represented the independent characteristics related to placenta accreta spectrum (all, P.05). The median gestational age at cesarean delivery was 36 weeks for placenta accreta and 34 weeks for both placenta increta and percreta vs 39 weeks for non-placenta accreta spectrum cases (P.001). On multivariable analysis, cesarean delivery complicated by placenta accreta spectrum was associated with increased risk of any surgical morbidities (78.3% vs 10.6%), Centers for Disease Control and Prevention-defined severe maternal morbidity (60.3% vs 3.1%), hemorrhage (54.1% vs 3.9%), coagulopathy (5.3% vs 0.3%), shock (5.0% vs 0.1%), urinary tract injury (8.3% vs 0.2%), and death (0.25% vs 0.01%) compared with cesarean delivery without placenta accreta spectrum. When further analyzed by subtype, cesarean delivery for placenta increta and percreta was associated with higher likelihood of hysterectomy (0.4% for non-placenta accreta spectrum, 45.8% for accreta, 82.4% for increta, 78.3% for percreta; P.001) and urinary tract injury (0.2% for non-placenta accreta spectrum, 5.2% for accreta, 11.8% for increta, 24.5% for percreta; P.001). Moreover, women in the placenta increta and percreta groups had markedly increased risks of surgical mortality compared with those without placenta accreta spectrum (increta, odds ratio, 19.9; and percreta, odds ratio, 32.1).Patient characteristics and outcomes differ across the placenta accreta spectrum subtypes, and women with placenta increta and percreta have considerably high surgical morbidity and mortality risks. Notably, 1 in 313 women undergoing cesarean delivery had a diagnosis of placenta accreta spectrum by the end of 2017, and the incidence seems to be higher than reported in previous studies.

OBJECTIVE To examine the detection rate of placenta previa and placenta accreta spectrum (PAS) by routine mid-pregnancy obstetric ultrasound and to estimate risk factors and prevalence within this cohort. METHODS This was an observational cohort study with prospectively collected data. Women attending routine mid-pregnancy obstetric ultrasound at the Sahlgrenska University Hospital with a suspected cup-shaped placenta (cohort 1, n = 339) and women diagnosed with placenta previa or PAS (cohort 2, n = 227) were analyzed according to detection rate, risk factors, and prevalence. RESULTS The detection rates of placenta previa and PAS were 49% (98) and 25% (14), respectively. However, 216 (99%) women with placenta previa were diagnosed prenatally, as were 14 (50%) women with PAS. In vitro fertilization was identified as the strongest independent risk factor for placenta previa (odds ratio 6.96; 95% confidence interval 4.77-10.16, P

Background Following the discovery that fetal DNA originates from the trophoblastic cells of the placenta, the contribution of the cell-free DNA test in placenta-related obstetric complications has begun to be investigated. Compared to uncomplicated pregnancies, higher fetal fractions were detected in placenta accreta spectrum and placenta previa, which are among placenta-related obstetric complications. However, this data applies only to advanced gestational weeks. Aim To investigate the possible predictive value of fetal fraction in cell-free DNA tests in pregnancies with placenta previa and placenta accreta spectrum in early gestational ages. Materials and Methods This study was conducted in women who were screened via cell-free DNA tests for common aneuploidies in the first and second trimester and subsequently diagnosed with placenta previa or placenta accreta spectrum. After the diagnosis was confirmed with a C-section, fetal fractions were retrospectively compared to a control group with a history of an uncomplicated C-section who were also previously screened by cell-free DNA test. Results The median and interquartile range (IQR) of fetal fractions for placenta previa (n=19), placenta accreta spectrum (n=7), and control groups (n=85) were 8.1 (6–10), 6.8 (6.7–10.7), and 7.1 (4.7–9.65), respectively. No statistically significant difference was observed among the three groups in terms of fetal fractions (p=0.587). Conclusions According to our data, we did not observe any relationship between placental invasion abnormalities vs. control group or placenta previa vs. control group using the fetal fractions of the cell-free DNA test. Furthermore, we could not confirm a predictive role and/or any additional clinical contribution. We believe that future studies focusing on placental mRNA might be more helpful than cell-free fetal DNA testing.

This study aimed to review the obstetric complications during subsequent pregnancies after uterine artery embolization (UAE) for postpartum hemorrhage (PPH) by exploring the relationship between prior UAE and obstetric complications through a meta-analysis. We conducted a systematic literature review through March 31, 2021, using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials in compliance with the PRISMA guidelines and determined the effect of prior UAE for PPH on the rate of placenta accreta spectrum (PAS), PPH, placenta previa, hysterectomy, fetal growth restriction (FGR), and preterm birth (PTB). Twenty-three retrospective studies (2003–2021) met the inclusion criteria. They included 483 pregnancies with prior UAE and 320,703 pregnancies without prior UAE. The cumulative results of all women with prior UAE indicated that the rates of obstetric complications PAS, hysterectomy, and PPH were 16.3% (34/208), 6.5% (28/432), and 24.0% (115/480), respectively. According to the patient background-matched analysis based on the presence of prior PPH, women with prior UAE were associated with higher rates of PAS (odds ratio [OR] 20.82; 95% confidence interval [CI] 3.27–132.41) and PPH (OR 5.32, 95% CI 1.40–20.16) but not with higher rates of hysterectomy (OR 8.93, 95% CI 0.43–187.06), placenta previa (OR 2.31, 95% CI 0.35–15.22), FGR (OR 7.22, 95% CI 0.28–188.69), or PTB (OR 3.00, 95% CI 0.74–12.14), compared with those who did not undergo prior UAE. Prior UAE for PPH may be a significant risk factor for PAS and PPH during subsequent pregnancies. Therefore, at the time of delivery, clinicians should be more attentive to PAS and PPH when women have undergone prior UAE. Since the number of women included in the patient background-matched study was limited, further investigations are warranted to confirm the results of this study.

Background: Placenta accreta spectrum is a term which describes abnormal invasion of the placenta into the uterine myometrium. The first line in diagnosis is ultrasonography and magnetic resonance imaging may complement the diagnosis. Aim: The aim of the work is to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa.Materials and Methods: This is a prospective cohort study which was conducted in Ain Shams University on 50 women with a diagnosis of anterior placenta previa and history of previous cesarean section who were pregnant at 32 weeks or more and were planned for delivery by elective cesarean section. They were subjected to ultrasonography and elastography study and the diagnosis of placenta accreta spectrum was confirmed/ excluded intraoperatively.Results: Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. elastrgraphy had a sensitivity of 73.7%, specificity of 90.3%, positive predicting value of 82.4% and negative predictive value of 84.8% in diagnosing cases with abnormal placental invasion while sensitivity, specificity positive and negative predictive value of ultrasonography in diagnosing abnormal placental invasion was 89.5%, 96.8%, 94.4% and 93.8% respectively.Conclusion: Elastography is sensitive and specific but inferior to ultrasonography in evaluating women with suspected placenta accreta spectrum but it may be useful in diagnosis of focal invasion.

Background. An advanced abdominal pregnancy (AAP) rarely continues to a live birth, but sometimes, a live birth may occur. In developed countries, women with AAP who have not been diagnosed preoperatively are expected to be diagnosed quickly, and the pregnant woman and the fetus will be saved. After careful examination of the past cases, we sought to derive what is the best diagnosis and treatment choice in the current medical environment. Materials and Methods. We retrospectively studied AAP cases in Japan. We examined diagnosis of AAP before fetal delivery and placental treatment at the time of delivery. AAP was well documented in 10 cases. We contacted the AAP authors, who reported 10 AAP cases in Japan, directly to confirm any unclear points. Results. Two cases were diagnosed with AAP before laparotomy, one was diagnosed after IUFD, and seven were diagnosed at the time of laparotomy. The two most recent cases were diagnosed with AAP preoperatively by ultrasound and MRI. Six cases were described for preoperative diagnosis. There were two cases of placenta previa, one of a bicornuate uterus, one of breech presentation, one of a combination of uterine cervical fibroids and placenta previa, and one of a combination of presentation and placental abnormality with uterine fibroids. In five cases, the placenta was removed at the time of laparotomy. Simultaneous removal of the placenta during laparotomy could not be performed because of intra-amniotic infection with a macerated fetus in an IUFD case. Among eight cases, excluding 20-week and 21-week gestation with no expectation of viable newborns, there were one male and seven female fetuses. The birth weight ranged from 1765 to 3520 g, with a median birth weight of 2241 g. Combined malformations were described in six of the seven live births. Clubfoot, torticollis, joint contracture, and bone deformity were transient because intrauterine compression quickly improved. Conclusion. In recent cases, AAP has been diagnosed by MRI and ultrasound. MRI should be performed if abdominal pregnancy is suspected. Postoperative infections may occur if the placenta is not removed at the time of delivery. We recommend placental resection with the help of an anesthesiologist, a gynecologist, a urologist, and a surgeon in the current medical environment.

Introduction : Placenta accreta is defined as abnormal implantation of placenta villi which invades myometrium without the presence of decidua bacalis resulting in placenta that is difficult to remove. Based on the depth of invasion, placenta accreta is divided into three grades, placenta accreta, placenta increta, and placenta percreta. Placenta accreta developes if chorionic villi attaches to endometrium beyond desidua basalis. Placenta increta develops when chorionic villi invades the whole myometrium. Placenta percreta developes when chorionic villi attaches beyond myometrium reaching serous and abdominal organ. Based on clinical manifestation, placenta accreta is the common term being used. Incident of abnormal placenta invasion varies from 1 : 93.000 up to 1 : 540 pregnancy. PA incidence had increased four times from 1994 to 2002 in line with increased of caesarean section procedure. Other study showed history of caesarean section increased risk of placenta accreta up to 8,7 times. Placenta accreta index (PAI) was developed based on scoring process or various parameters assessment to help diagnose placenta accreta. The parameters including: history of caesarean section ≥ 2 times, lacunae grade, sagittal smallest myometrial thickness, anterior placenta previa and birding vessel. High PAI indicates high risk of abnormal placenta invasion based on histology. Objective : This study aims to investigate modified history of cesarean section score in placenta accreta index in predicting placenta accreta diagnosis in RSUP DR M Djamil Padang. Material and methods : This was analytical study with cross sectional design. Study population was 84 placenta accreta patients in RSUP Dr. M. Djamil Padang from 2016 to 2019. Study sample was recruited using simple random sampling technique after meeting inclusion and exclusion criteria. Statistic analysis was done using Cohen’s Kappa test. Diagnostic test including sensiticivy, specivicity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Result : Strenght of agreement diagnosis placenta accreta based on PAI showed Kappa score of -0,002 (Kappa score < 0,2) which indicated poor strength of agreement. Strenght of agreement diagnosis placenta accreta based on modified PAI showed Kappa score of 0,353 (Kappa score range from 0,21 to 0,40) which indicated fair strength of agreement. PAI diagnostic test yield sensitivity of 97,1%, specificity of 2,8%, positive predictive value of 48,5%, negative predictive value of 50%, and accuracy of 48,6%. Modified PAI diagnostic test yield sensitivity of 97,1%, specificity of 38,9%, positive predictive value of 60%, negative predictive value of 93,3%, and accuracy of 67,1%. Conclusion : PAI has high sensitivity, low specificity, moderate positive predictive value, moderate negative predictive value, and moderate accuration. Modified PAI has high sensitivity, moderate specificity, moderate positive predictive value, high negative predictive value, and high accuracy. PAI diagnosis has poor strength of agreement compared with pathology anatomy. Modified PAI diagnosis has fair strength of agreement compared with pathology anatomy. Modified PAI has identical sensitivity with standard PAI, meanwhile for specificity, positive predictive value, negative predictive value, and accuracy, modified PAI yields higher result compared to PAI. Keywords: Modified score of history caesarean section, placenta accreta index, Modified placenta accreta index, diagnostic test of placenta accreta diagnosis

Acute Polyhydramnios is defined as accumulation of amniotic fluid rapidly complicating approximately 0.2 TO 1.6% of all pregnancies, whereas gestational diabetes (GD) is glucose intolerance in pregnant women, a major health issue in pregnant women. The prevalence rate of glucose intolerance in pregnant women is between 4.6%–14% in well developed areas and 1.7%–13.2% in rural areas. Pregnancies conceived by in vitro fertilisation (IVF) have been associated with higher risk of gestational diabetes mellitus (11.7%), gestational hypertension (9.3%), preeclampsia (4.0%), ICP (11.8%), placenta previa (7.1%), placental abruption (1.6%), PROM (9.9%), placental adherence (7.7%), postpartum haemorrhage (7.3%), and polyhydramnios (2.2%), as compared to spontaneously conceived pregnancies. Case Description: A 35 years primigravida, 33 weeks gestational age with IVF conception with preeclampsia with breech came with pain in abdomen since 2-3days.On clinical examination, polyhydramnios was diagnosed. On admission she presented with deranged sugar level which was abnormal and sudden rise in Glycosylated hemoglobin seen. Patient was managed conservatively by termination of pregnancy and successful outcome of pregnancy was obtained despite of liquor more than adequate and deranged sugar levels. Objectives: We examined the routine antenatal profile, radiological changes as well as doppler changes in IVF conceived pregnancies and further management on the basis of clinical, haematological and radiological investigations will be planned accordingly. Conclusion: Acute polyhydramnios and Gestational diabetes is common in patients conceived through in vitro fertilisation and is associated with poor foe to maternal outcome. Regular antenatal investigations and radiological investigations done to keep her pregnancy in check and reduce the long term effects by modifying treatment modality and by following healthy lifestyles in such patients.

Introduction With increasing caesarean section (c-section) rates, personalized communication of risk has become paramount. A reliable tool to predict complications would support evidence-based discussions around planned mode of birth. This systematic review aimed to identify, synthesize and quality appraise prognostic models of maternal complications of elective c-section. Methods MEDLINE, Embase, Web of Science, CINAHL and the Cochrane Library were searched on 27 January using terms relating to ‘c-section’, ‘prognostic models’ and complications such as ‘infection’. Any study developing and/or validating a prognostic model for a maternal complication of elective c-section in the English language after January 1995 was selected for analysis. Data were extracted using a predetermined checklist: source of data; participants; outcome to be predicted; candidate predictors; sample size; missing data; model development; model performance; model evaluation; results; and interpretation. Quality was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST) tool. Results In total, 7752 studies were identified; of these, 16 full papers were reviewed and three eligible studies were identified, containing three prognostic models derived from hospitals in Japan, South Africa and the UK. The models predicted risk of blood transfusion, spinal hypotension and postpartum haemorrhage. The study authors deemed their studies to be exploratory, exploratory and confirmatory, respectively. From the three studies, a total of 29 unique candidate predictors were identified, with 15 predictors in the final models. Maternal age (n = 3), previous c-section (n = 2), placenta praevia (n = 2) and pre-operative haemoglobin (n = 2) were found to be common predictors amongst the included studies. None of the studies were externally validated and all had a high risk of bias due to the analysis technique used. Conclusion Few models have been developed to predict complications of elective c-section. Existing models predicting blood transfusion, spinal hypotension and postpartum haemorrhage cannot be recommended for clinical practice. Future research should focus on identifying predictors known before surgery and validating the resulting models.

Background: Placenta accrete is a clinical and diagnostic challenge that is being with increasing frequency and may lead to catastrophic blood loss and related complications. Color doppler ultrasonography and magnetic resonance imaging are considered as specific imaging modalities and have very important role in the prenatal diagnosis of placenta accreta. Objectives: The aim of the current work was to evaluate the diagnostic value of color doppler ultrasonography and magnetic resonance imaging in the prenatal assessment of placenta accreta. Patients and Methods: This study was conducted on 40 pregnant women (from 32 to 40 weeks of pregnancy) with placenta previa and presented with manifestations of suspected placenta accreta. Their age ranged from 19 to 40 years with mean age of 31.8 years. All cases were subjected to ultrasound examination, but MRI was done in 33 cases prior to elective delivery. Results: Cases diagnosed of having placenta accreta were 18 out of 40 cases (45 %). Among those 18 cases; placenta found tobe accreta in 6 patients, increta in 7 patients and percreta in 5 patients. Our study showed high statistical significance between occurrence of Placenta accrete & prior uterine surgeries as a risk factor. Overall accuracy of ultrasound was 88%, while that of MRI was 85%. Ultrasound showed better specificity (86%) than that of MRI (81%), but MRI showed better sensitivity (92%) than that of ultrasound (89%). Conclusion: It could be concluded that both ultrasound and magnetic resonance have fairly good sensitivity and specificity for prenatal diagnosis of placenta accreta. Color doppler ultrasound remains the first primary screening imaging modality used to evaluate suspected placenta accreta and MRI is suggested as an alternative complementary tool to ultrasound in cases with inconclusive criteria.

Background A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia. Methods Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use. Results During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p p p p N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12–0.46, p p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13–0.56, p N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8–3.5), p p Conclusions This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use.

The number of mothers giving birth with sectio caesarae delivery at BLUD R.S H.M Djafar Harun North Kolaka in 2015 was 254 people, then increased in 2016 to 521 people. The purpose of this study was to analyze the risk factors for the incidence of Sectio Caesarea delivery at H.M Djafar Harun Hospital, North Kolaka. This type of research is an analytic observational study with a case-control study approach. The study population was 68 with a sample of 136 people using the Accidental Sampling Technique. Data analysis using the Odds Ratio test. The results of the risk analysis based on narrow pelvic factors showed the value of OR= 9,681; LL= 2,728; UL= 34,355, and then placenta previa factor showed the value of OR= 6,484; LL= 0,759; UL= 55,385. In conclusion, narrow pelvis is a strong risk factor and placenta previa is not a strong risk factor for Sectio Caesarea delivery. It is hoped that the hospital will seek to identify high-risk pregnancies, complications or pregnancy abnormalities so that they can be detected early so that they are able to more optimally handle complications during childbirth.

To report the technique and outcomes of a surgical care bundle, which preemptively and prophylactically reduces intrapartum bleeding during cesarean sections for these conditions and hence reducing the risk for a cesarean hysterectomy. In this report, we present the surgical and clinical outcomes of a case series of 16 patients presenting with a morbidly low or adherent placenta on whom this technique was piloted. Seven of the sixteen patients (44%) required a blood transfusion ranging from 1 to 5 units of packed RBCs. None of the neonates required neonatal unit admissions. One woman had a subsequent pregnancy, with normal placentation and an uncomplicated delivery by cesarean section. None of the patients in our series had a hysterectomy, needed to return to theater after the initial surgery or had secondary postpartum hemorrhage. The ElNoury–Webster Bundle is a stepwise surgical technique for the conservative management of morbidly low or adherent placenta particularly in low and middle-income healthcare settings.

Stillbirth is a major obstetrical complication and devastating experience for parents as well as obstetricians. Identification of causes of stillbirth will be helpful in counselling of parents as well as formulating preventive measures. Objectives of current study were to study the prevalence, causes of stillbirth and associated complications to suggest preventive measures. This retrospective observational study was carried out from July 2018 to June 2019 at a teaching tertiary care hospital. Total number of birth during the study period was 6587 and total number of stillbirth was 109, hence prevalence of stillbirth was 16.5 per 1000 total births. Majority of patients 41(37.6%) belonged to maternal age group of 20-24 years of age. Majority of patients 73(67%) were multigravida. Majority 72(66.0%) were emergency admissions. Majority of stillbirth 88(80.7%) were preterm, less than 37weeks of gestational age. Majority of stillbirth 49(44.9%) were weighted from 1000-1499gram. Majority of stillbirth 65(59.6%) were male. Vaginal delivery occurred in 93(85.3%) and 16(14.7%) required surgical intervention. In 21(19.2%) no identifiable cause of stillbirth was found whereas causes identified in 88(80.8%). Stillbirth occurred in 27(24.8%) cases of hypertensive disorder of pregnancy and 24(22%) patients of anaemia. Other causes of stillbirth were Abruption 9(8.2%), IUGR 9(8.2%), oligohydramnios 5(4.6%) congenital malformation 3(2.8%), fever 3(2.7%), placenta previa 3(2.8%), gestational diabetes 2(1.9%), hypothyroidism 2(1.9%) and uterine rupture in 1(0.9%). DIC occurred in 4(3.6%). Majority of patients were unregistered and had not taken antenatal care or had inadequate antenatal care. Hypertensive disorders during pregnancy were the leading cause for stillbirth followed by anemia and unexplained causes. A significant proportion of stillbirths can be prevented by health education regarding importance of adequate antenatal care, warning signs and institutional deliveries. Emotional support and counseling of patients and her relatives are very much essential in patients having stillbirth.

Accreta placenta spectrum is a complex obstetrical condition of abnormal placental invasion associated with severe maternal morbidity. This study aimed to analyze our therapeutic management and counseling of the cases with placenta accreta spectrum (PAS) associated with placenta previa. We performed a retrospective study of pregnant women with PAS associated with placenta previa at the Filantropia Clinical Hospital between January 2017–April 2021. In these cases, the earlier diagnosis was realized by an ultrasonographic scan and was confirmed by histopathological findings after the surgical treatment. The conservative management was obtained in one case at