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Background: Despite the rising incidence of caesarean scar pregnancy (CSP), as yet there are no consensus or evidence‐based guidelines for management. Aims: To review diagnosis, treatment and management of all women with CSP over a 5 year period at Mater Mothers' Hospital, Brisbane, Australia. Materials and methods: Retrospective cohort study of CSP between 2013–2018. Data reviewed included demographics, presenting symptoms, gestational age, ultrasound findings, human chorionic gonadotrophin levels, treatment success, complications, and if available, subsequent pregnancy outcomes. Results: Twenty‐eight women were treated for CSP during the study period. Initial diagnosis was delayed in ten (36%). Overall success rates of initial treatment were 22/28 (79%). Of the six cases of failed treatment, five had been treated with systemic methotrexate alone. All women requiring further intervention had fetal pole present, and 50% had fetal cardiac activity. Failure rate of systemic methotrexate alone was 5/11 (45%). Eleven women deemed appropriate for conservative management did not require further treatment or experience complications. Nine women had data available for subsequent pregnancies, of whom two developed placenta accreta. Conclusion: This study provides data that may assist in guideline development and decision‐making for management of CSP. Conservative management in carefully selected women appeared to be safe. Nearly half of women treated with systemic methotrexate alone required another treatment modality, suggesting a role for intralesional treatment, particularly in the presence of fetal pole ± fetal cardiac activity. More than one in five women with documented subsequent pregnancies were diagnosed with placenta accreta. [ABSTRACT FROM AUTHOR]

Introduction: Placenta accreta spectrum (PAS) covers a spectrum of placental adherence abnormalities: placenta accreta, increta and percreta. PAS is associated with significant maternal morbidity and mortality. Studies have shown the importance of multidisciplinary teamwork in the management of PAS. Aim: This study was designed to describe the maternal and neonatal morbidity and mortality associated with PAS in our centre over a ten‐year period. Methods: A retrospective cohort study was conducted of pregnancies complicated by PAS between February 2006 and January 2016 at Flinders Medical Centre (FMC), South Australia. Electronic and medical records were examined to obtain patient demographics, antenatal and surgical, findings and postnatal outcomes. Results: There were 67 PAS cases with an overall incidence of 2.3 per 1000 deliveries. Three cases were excluded due to incomplete information. Of the remaining 64 cases, 56 women were antenatally diagnosed. Sixty cases were confirmed to be invasive at delivery; 28 accreta (superficial) and 32 increta/percreta (deep) cases. The four cases with no invasion at delivery were suspected antenatally to have PAS. The median (Q1, Q3) number of caesarean sections in this cohort was 2 (1, 3). Deep invasion is significantly associated with increased bleeding, intensive care unit admission, surgical complications and an extended postpartum stay. Conclusion: The incidence of PAS at FMC is high as it is the state's tertiary referral centre. While PAS is associated with increased morbidity, thorough perioperative planning by a multidisciplinary team is crucial for excellent patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergency peripartum hysterectomy (EPH) is a life‐saving obstetric procedure reserved for conditions where medical treatment and conservative surgery have failed. EPH is associated with significant morbidity and mortality. Aim: To examine the incidence, indications, risk factors, maternal and neonatal outcomes of EPH in a tertiary hospital in Western Australia (WA). Methodology: A retrospective case‐note analysis of all cases of EPH performed at King Edward Memorial Hospital in WA between the years 2006 and 2016. The incidence, indications, risk factors, maternal and neonatal outcomes were reviewed. All cases were ascertained via our hospital obstetric database. Results: A total of 72 cases of EPH were identified among 64 999 births. The incidence of EPH in WA was 1.1 per 1000 deliveries. Abnormal placentation was the main indication for EPH accounting for 66.7% of cases. Among women undergoing an EPH, 22.2% had a history of one previous caesarean section and 33.3% had two or more caesarean sections, respectively. Maternal morbidity was significant. There was one cardiac arrest secondary to hypovolaemia, and 84% of the women received blood transfusions with more than half of these women meeting the criteria for massive transfusion protocol (≥4 units of packed red cells). Urinary tract injury and venous thromboembolism were some of the other complications among our cohort of women. Conclusion: EPH is associated with significant morbidity. Our study identifies abnormal placentation as the leading cause of EPH. [ABSTRACT FROM AUTHOR]

Background: The association between an incomplete placenta and postpartum haemorrhage (PPH) is well documented; however, the significance of ragged or incomplete membranes has not been explored as an independent risk factor for PPH. Aims: To explore the association between the completeness of the amniotic and chorionic membranes and the risk of PPH, independent to placental status. Materials and methods: 37 176 birth records were retrospectively extracted from the period 1 July, 2008 to 30 June, 2016 from the databases of two public hospitals in Melbourne, Australia. Following application of specific exclusion and inclusion criteria, including non‐complete placentas, 5718 records were available for analysis. These records were grouped based on membrane status (complete, ragged or incomplete) and outcome (PPH or no PPH). Results: Primary PPH rates were 14.8% in women with complete membranes, 20.2% in women with ragged membranes and 25.8% in women with incomplete membranes. Following statistical adjustment, the risk ratios for PPH were 1.32 (95% CI: 1.15–1.50) and 1.70 (95% CI: 1.41–2.04) in women with ragged and incomplete membranes, respectively. Conclusions: Both ragged and incomplete membranes were found to be independent risk factors for primary PPH. This previously un‐discussed association has the potential to influence clinical practice changes, particularly with regard to the ongoing clinical relevance and use of the terms 'ragged' and 'incomplete' membranes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to provide an in-depth analysis of all stillbirth causation over a period of 10 years in a busy maternity unit located in a socioeconomically disadvantaged urban area, with an emphasis on overlapping pathology.Materials and Methods: A retrospective analysis of all structurally normal stillbirths in singleton pregnancies born during 2002-2012. The PSANZ stillbirth classification was used; per stillbirth subgroup main risk factors were evaluated.Results: Out of 130 cases, 43% showed overlapping pathologies. In the remaining 74 (56%) cases, the following single pathologies were found: IUGR 20 (15%), infection 12 (9%), abruption 8 (6%), placental thrombotic pathology 8 (6%), miscellaneous 6 stillbirths (5%), and 20 cases (15%) unexplained. Smoking was a risk factor for stillbirth associated with abruption (OR 3.639), infection (OR 2.271), and thrombotic pathology (OR 2.168). Drug use had an association with (placental) infection (OR 3.598). Obesity showed a significant association with IUGR (OR 3.782) and abruption (OR 9.040). Thrombophilia risk analysis for the overall group of stillbirths showed significant results for Protein S (OR 8.889) and homocysteine >90th centile (OR 2.087).Conclusions: Overlapping pathology was identified in 43% of stillbirths. Infection, IUGR, and abruption were the most important single cause of stillbirth. [ABSTRACT FROM AUTHOR]

Objective: Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia.Design: A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System.Setting: Australia.Population: 623 cases, 820 controls.Methods: Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile.Main Outcome Measures: Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, eclampsia or pulmonary embolism).Results: SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans).Conclusion: The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome. [ABSTRACT FROM AUTHOR]

Objective To examine maternal morbidity in primary surgical management of placenta accreta. Design Retrospective case series. Setting Quaternary perinatal referral center in Melbourne, Australia. Population Clinically suspected and histologically confirmed cases of placenta accreta, increta and percreta. Methods Women were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records. Main outcome measures Predefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive ( NICU) or special care nurseries ( SCN), respiratory distress syndrome. Results Between 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy ( p = 0.04). Nearly two-thirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products ( p = 0.03), sustain renal tract injury ( p = 0.003) and require intensive care admission ( p = 0.002). Conclusions A primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center. [ABSTRACT FROM AUTHOR]