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Background: Placenta accreta syndrome (PAS) may led to heavy blood loss and maternal death. Here we analyzed the main risk factors of PAS+ pregnancies and its complications in a referral hospital in the north of Iran. Methods: In a case control study, all pregnant women with PAS referred to our department during 2016 till 2021 were enrolled and divided in two groups case (PAS+) and control (PAS−) based on preoperative imaging, intraoperative findings, and pathological reports. The sociodemographic features and neonatal‐maternal outcomes also were recorded. Results: The most frequent reason for cesarean (C/S) was repeated C/S (62.9%, 56/89). A significant difference showed up in the time lag between previous C/S and the present delivery (p < 0.001) which shows that when the time distance is longer, the risk of PAS rises (OR: 1.01 [95% CI: 1.003−1.017]). Also, a positive history of prior abortion and elective type of previous C/S were related to PAS+ pregnancies. Our other finding showed that PAS+ pregnancies will end in lower gestational age and have a longer duration of operation and hospitalization, heavy blood transfusion, and hysterectomy. Also, PAS+ pregnancies were not related to poor neonatal outcomes. Conclusions: It seems that, in addition to repeated C/S as a strong risk factor, previous abortion is a forgotten key which leads to incomplete evacuation or damage the endometrial‐myometrial layers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Placenta accreta spectrum (PAS) disorders are placental conditions associated with significant maternal morbidity and mortality. While antenatal vaginal bleeding in the setting of PAS is common, the implications of this on overall outcomes remain unknown. Our primary objective was to identify the implications of antenatal vaginal bleeding in the setting of suspected PAS on both maternal and fetal outcomes. Materials and Methods: We performed a case-control study of patients referred to our PAS center of excellence delivered by cesarean hysterectomy from 2012 to 2022. Subsequently, antenatal vaginal bleeding episodes were quantified, and components of maternal morbidity were assessed. A maternal composite of surgical morbidity was utilized, comprised of blood loss ≥ 2 L, transfusion ≥ 4 units of blood, intensive care unit (ICU) admission, and post-operative length of stay ≥ 4 days. Results: During the time period, 135 cases of confirmed PAS were managed by cesarean hysterectomy. A total of 61/135 (45.2%) had at least one episode of bleeding antenatally, and 36 (59%) of these had two or more bleeding episodes. Increasing episodes of antenatal vaginal bleeding were associated with emergent delivery (p < 0.01), delivery at an earlier gestational age (35 vs. 34 vs. 33 weeks, p < 0.01), and increased composite maternal morbidity (76, 84, and 94%, p = 0.03). Conclusions: Antenatal vaginal bleeding in the setting of PAS is associated with increased emergent deliveries, earlier gestational ages, and maternal composite morbidity. This important antenatal event may aid in not only counseling patients but also in the coordination of multidisciplinary teams caring for these complex patients. [ABSTRACT FROM AUTHOR]

This article discusses the clinical application of intraoperative ultrasound for the management of placenta accreta spectrum (PAS) disorders. The study aimed to determine if intraoperative ultrasound, combined with preoperative and surgical findings, could provide evidence for conservative management with safe placental removal in suspected PAS cases. The researchers conducted a prospective study and evaluated nine suspected cases at three stages: preoperative, intraoperative, and postoperative. Intraoperative ultrasound images were found to be clearer than preoperative images, and the identification of a retroplacental myometrial layer was associated with complete placental separation. The authors conclude that intraoperative ultrasound can provide additional information for surgical staging and safe placental removal, but further studies are needed. [Extracted from the article]

A study published in the journal Paediatric & Perinatal Epidemiology examined the accuracy of ICD-10 codes for placenta accreta spectrum (PAS) in a single referral center from 2015 to 2020. Out of 22,345 deliveries, only 51 cases had a histopathologic diagnosis of PAS, indicating a high rate of false positive cases. Inaccurate data on PAS incidence can make it difficult to understand the true scope of the problem and identify risk factors. False positive results can lead to suboptimal screening and treatment, while misclassification can dilute the magnitude of risk factors and lead to unnecessary referrals and increased costs. The study suggests the need for a standardized and objective definition of PAS and efforts to improve the accuracy of ICD-10 coding. [Extracted from the article]

Background and purpose: Cesarean hemorrhage is a common but preventable cause of maternal death and placenta invasion is a major cause of cesarean hemorrhage. This study aimed to compare inhalation anesthesia with isoflurane and Propofol anesthesia in cesarean bleeding in these patients. Materials and methods: This study was conducted as a randomized clinical trial with 15 placental adhesion patients who were candidates for cesarean section. Five patients were excluded by applying the exclusion criteria, and out of the other 10 patients, 5 underwent cesarean section with isoflurane and 5 with Propofol. Results: The comparison indicated that the volume of suctioned blood, the number of gasses used, the volume of serum received, packed-cell received and urinary output were significantly lower in the Propofol group (P≤0.05). Systolic and diastolic blood pressures were significantly close to basic figures in the Propofol group (P≤0.05), Heart rate, respiratory rate, temperature, and O2 saturation were not significantly different between the two groups (P≥0.05). Conclusion: The findings of this study recommended propofol anesthesia for the cesarian section in placenta adhesion. However, further studies with more cases are needed. (Clinical Trials Registry Number: IRCT20110213005825N3)

Background The spectrum of placental adhesive disorders (PAD) forms an important cause for emergency cesarean hysterectomy, requiring an accurate prenatal diagnosis for optimal obstetric management.

This study aimed to investigate assisted reproductive technology (ART) factors associated with placenta accreta spectrum (PAS) after vaginal delivery. This was a registry-based retrospective cohort study using the Japanese national ART registry. Cases of live singleton infants born via vaginal delivery after single embryo transfer (ET) between 2007 and 2020 were included (n = 224,043). PAS was diagnosed in 1412 cases (0.63% of deliveries), including 1360 cases (96.3%) derived from frozen-thawed ET cycles and 52 (3.7%) following fresh ET. Among fresh ET cycles, assisted hatching (AH) (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI] 1.4–4.7) and blastocyst embryo transfer (aOR, 2.2; 95% CI 1.3–3.9) were associated with a significantly increased risk of PAS. For frozen-thawed ET cycles, hormone replacement cycles (HRCs) constituted the greatest risk factor (aOR, 11.4; 95% CI 8.7–15.0), with PAS occurring in 1.4% of all vaginal deliveries following HRC (1258/91,418 deliveries) compared with only 0.11% following natural cycles (55/47,936). AH was also associated with a significantly increased risk of PAS in frozen-thawed cycles (aOR, 1.2; 95% CI 1.02–1.3). Our findings indicate the need for additional care in the management of patients undergoing vaginal delivery following ART with HRC and AH. [ABSTRACT FROM AUTHOR]

Objective To investigate the expression of lncRNA SNHG8 in placenta accrete (PA) and its effect on trophoblast invasion and migration. Methods qRT-PCR was used to detect the expression of lncRNA SNHG8 in placenta tissue of 30 cases in PA group and 30 cases in control group, and the correlation between lncRNA SNHG8 expression and prenatal ultrasound score of 30 cases in PA group was analyzed. Transwell and scratch assay were used to detect the effect of lncRNA SNHG8 interference on the invasion and migration of human chorionic trophoblast cells (HTR8/SVneo cells), and western blot was used to detect the expression of MMP-2 and MMP-9. The downstream targets of lncRNA SNHG8 were predicted by StarBase software, and the expression of lncRNA SNHG8 was detected in placental tissues of the two groups. Dual luciferase reporter assay was used to detect the targeting relationship between lncRNA SNHG8 and miR-542-3p. Results Compared with that of the control group, the expression of lncRNA SNHG8 was up-regulated in the placenta tissue of the PA group(P < 0.05), and it was positively correlated with prenatal ultrasound score. Interference with lncRNA SNHG8 inhibited the invasion and migration of trophoblast cells(P < 0.05); the protein expression of MMP-9 and MMP-2 also decreased significantly (P < 0.05). Biological prediction indicates that miR-542-3p had a binding site with lncRNA SNHG8, and miR-542-3p expression was down-regulated in PA placental tissue(P < 0.05). Dual luciferase reporter assay confirmed that lncRNA SNHG8 could target miR-542-3p. Compared with si-SNHG8+inhibitor-NC, co-transfection of si-SNHG8 and miR-542-3p inhibitor enhanced the invasion and migration ability of trophoblast cells(P < 0.05). Conclusion lncRNA SNHG8 is highly expressed in PA and is related to the severity of PA. LncRNA SNHG8 promotes the invasion and migration of trophoblast by regulating the level of miR-542-3p. The study suggests that lncRNA SNHG8 plays an important role in the invasion and migration of PA trophoblast cells, which is expected to be a clinical diagnostic biomarker and therapeutic target. [ABSTRACT FROM AUTHOR]

Abnormally Invasive Placenta is an obstetric condition resulting in significant physical complications and shown to increase the likelihood of developing Post Traumatic Stress Disorder. Dissatisfaction with the care experienced increases the likelihood of Post Traumatic Stress Disorder. Psychological flexibility has been shown to reduce the severity of Post Traumatic Stress Disorder, but there is no research regarding either of these in women with Abnormally Invasive Placenta. To investigate if there is a relationship between trauma experience in women with a diagnosis of Abnormally Invasive Placenta, psychological flexibility, and birth satisfaction. Using a retrospective questionnaire, 126 participants age range 18–45, comprising the Birth Satisfaction Scale Revised Indicator (BSS-RI), Impact of Events Scale Revised (IES-R) and Acceptance and Action Questionnaire (AAQ-2) was completed. A hierarchical regression assessed the predictive relationship of Psychological Flexibility and Birth Satisfaction on Trauma symptoms The relationship between Birth Satisfaction measured using the BSS-RI and likelihood of Post Traumatic Stress Disorder (IES-R) was not supported (r (124) = −.08, p =.36). Results did show that Psychological Flexibility (AAQ-2) correlated with Trauma Score (IES-R) (r (124) =.68, p <.001) in women who had experienced Abnormally Invasive Placenta and explained 45.3% of the variance. The results suggest that Post Traumatic Stress Disorder in those with Abnormally Invasive Placenta is as high as 1 in 2 and can be mediated by psychological flexibility. In turn, this suggests that interventions to increase Psychological Flexibility in those with the diagnosis may reduce trauma symptom severity.Abbreviations: AAQ-2 - Acceptance and Action QuestionnaireAIP - Abnormally Invasive PlacentaBAME – Black Asian or other Minority EthnicitiesBSS-RI Birth Satisfaction Scale Revised IndicatorEPH – EPH Gestosis (Pre eclampsia/Eclampsia)DSM – Diagnostic Statical ManualIES-R - Impact of Events Scale RevisedPAS - Placenta Accreta SpectrumPTSD – Post Traumatic Stress Disorder [ABSTRACT FROM AUTHOR]

Background: The greatest risk for the occurrence of the placenta accreta spectrum (PAS) is represented by uterine scars, which most frequently result after cesarean sections. Uterine rupture is a rare condition and appears mainly in the third trimester of pregnancy. The association between these two conditions is extremely rare in the first trimester of pregnancy. Methods: We performed a systematic review of abnormal placental adhesions and spontaneous uterine ruptures in the first trimester of pregnancy. We also reported a case of spontaneous uterine rupture in a 12-week pregnancy that presented with massive hemoperitoneum and hemorrhagic shock. Results: A 33-year-old patient with two previous cesarean sections, at the twelfth week of pregnancy at the time to this visit to the emergency room, presented with syncope and intense pelvic–abdominal pain. A clinical examination and ultrasound scan established the diagnosis of hemoperitoneum and hemorrhagic shock. Surgical exploration was performed, uterine rupture was identified, and hemostasis hysterectomy was necessary. The histopathological results showed placenta percreta. There have been eight reported cases of spontaneous uterine rupture in the first trimester of pregnancy associated with PAS. In these cases, it was found that 62.5% of the patients had undergone at least one cesarean section in the past; in 75% of the cases, hysterectomy was performed; and, in 87.5% of the cases, the presence of placenta percreta was confirmed. Conclusions: A high rate of cesarean sections determines the increase in the incidence of placenta accreta spectrum disorders. The possible life-threatening complications caused by this pathology can be observed in early pregnancies. [ABSTRACT FROM AUTHOR]

Early diagnosis is essential for the safer perinatal management of placenta accreta spectrum (PAS). We used transcriptome analysis to investigate diagnostic maternal serum biomarkers and the mechanisms of PAS development. We analyzed eight formalin-fixed paraffin-embedded placental specimens from two placenta increta and three placenta percreta cases who underwent cesarean hysterectomy at Sapporo Medical University Hospital between 2013 and 2019. Invaded placental regions were isolated from the uterine myometrium and RNA was extracted. The transcriptome difference between normal placenta and PAS was analyzed by microarray analysis. The PAS group showed markedly decreased expression of placenta-specific genes such as LGALS13 and the pregnancy-specific beta-1-glycoprotein (PSG) family. Term enrichment analysis revealed changes in genes related to cellular protein catabolic process, female pregnancy, autophagy, and metabolism of lipids. From the highly dysregulated genes in the PAS group, we investigated the expression of PSG family members, which are secreted into the intervillous space and can be detected in maternal serum from the early stage of pregnancy. The gene expression level of PSG6 in particular was progressively decreased from placenta increta to percreta. The PSG family, especially PSG6, is a potential biomarker for PAS diagnosis. [ABSTRACT FROM AUTHOR]

Precise extravillous trophoblast (EVT) invasion is crucial for successful placentation and pregnancy. This review focuses on elucidating the mechanisms that promote heightened EVT invasion. We comprehensively summarize the pivotal roles of hormones, angiogenesis, hypoxia, stress, the extracellular matrix microenvironment, epithelial-to-mesenchymal transition (EMT), immunity, inflammation, programmed cell death, epigenetic modifications, and microbiota in facilitating EVT invasion. The molecular mechanisms underlying enhanced EVT invasion may provide valuable insights into potential pathogenic mechanisms associated with diseases characterized by excessive invasion, such as the placenta accreta spectrum (PAS), thereby offering novel perspectives for managing pregnancy complications related to deficient EVT invasion. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Hospital surgical volume–outcome relationship in caesarean hysterectomy for placenta accreta spectrum" published in the BJOG: An International Journal of Obstetrics & Gynaecology. The authors of the article have identified errors in their analysis and have made corrections. The corrected analysis showed that a higher relative hospital surgical volume for caesarean hysterectomy was associated with a lower rate of surgical morbidity in pregnant patients with placenta accreta spectrum. The corrected figures and tables provide updated information on the distribution of patients and patient characteristics based on the revised exposure grouping. The revised Table 2 shows that patients in the high-volume group were 23% less likely to experience surgical morbidity compared to those in the low-volume group (56.7% vs. 62.7%). This association remained when comparing the high-volume group to the mid-volume group (56.7% vs. 64.5%). The results suggest that higher hospital surgical volume is associated with lower surgical morbidity in cesarean hysterectomy. [Extracted from the article]

Optimal management of placenta accreta spectrum (PAS) requires antenatal diagnosis. We sought to evaluate the sensitivity of ultrasound findings suggestive of PAS in detecting posterior PAS. Cohort study of patients with posterior placentation and pathology-confirmed PAS from 2011 to 2020 at a tertiary center. Patients were excluded if ultrasound images were unavailable. Ultrasounds were reviewed for presence of lacunae, hypervascularity, myometrial thinning, loss of the hypoechoic zone, bridging vessels, abnormal uterine serosa–bladder interface, placental bulge, placental extension into/beyond the myometrium, and an exophytic mass. Risk factors, postpartum outcomes, and ultrasound findings were compared by antepartum suspicion for PAS. Sensitivity was calculated for each ultrasound finding. Thirty-three patients were included. PAS was not suspected antenatally in 70 % (23/33). Patients with unsuspected PAS were more likely to be non-Hispanic, have in vitro fertilization, no prior Cesarean deliveries, no placenta previa, and delivered later in gestation. Depth of invasion and estimated blood loss were less for unsuspected PAS, but there was no difference in hysterectomy between groups. Ultrasound findings were less frequently seen in those who were not suspected antenatally: lacunae 17.4 vs. 100 % (p<0.001), hypervascularity 8.7 vs. 80 % (p<0.001), myometrial thinning 4.4 vs. 70 % (p<0.001), and placental bridging vessels 0 vs. 60 % (p<0.001). There was poor sensitivity (0–42.4 %) for all findings. Posterior PAS is less likely to be detected antenatally due to a lower sensitivity of typical ultrasound findings in the setting of a posterior placenta. Further studies are needed to better identify reliable markers of posterior PAS. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to compare prophylactic common iliac artery (CIA) temporary clamping and preoperative balloon occlusion for managing placenta accreta spectrum (PAS) disorders. Study Design: Between January 2019 and June 2020, 46 patients with PAS disorders were included. Of them, 26 patients were offered CIA balloon occlusion (Group A), while temporary CIA clamping was done for the other 20 patients (Group B). Primary outcomes were procedure‐related complications, and secondary outcomes included intraoperative and postoperative complications, reoperation rates, total procedure time, blood loss, and amount of blood transfusion. Results: Blood loss was statistically non‐significant higher in group B than in group A (p‐value = 0.143). Only one patient in group A and three in group B needed reoperation. The bleeding continued for a mean of 1.6 days in group A and 1.7 days in group B, with non‐significant statistical differences between both groups p value = 0.71. Nine patients in group A (34.6%) and four in group B (20%) required ICU admission. The mean Apgar score was 7 and 6.6 in babies of group A and group B patients, respectively. The median number of allogeneic blood transfusions performed was two in patients in group A and 1 in group B (p‐value = 0.001). Conclusion: Both techniques offer good choices for patients with PAS to decrease mortality and morbidity rates. The selection of a better technique depends on institutional references and physicians' experience. [ABSTRACT FROM AUTHOR]

Objective: Placenta accreta spectrum (PAS) is a high‐risk complication of pregnancy, which often requires complex surgical intervention. There is limited literature on the patient experience during the perioperative period and postpartum pain management for PAS. Therefore, this study aims to explore the patient perspective of anesthesia care. Methods: Ethical approval was granted by the hospital ethics committee (EC02.2023). This was a descriptive survey study, including women with a history of pregnancy complicated by PAS who were members of two patient advocacy groups. The survey, consisting of both open and closed questions, was performed over a 6‐week period between January and March 2023. Content analysis was performed on qualitative data to identify themes, and recommendations for care are suggested. Results: A total of 347 participants responded to the survey; 76% (n = 252) had a cesarean hysterectomy (n = 252), and general anesthesia was the most common primary mode of anesthesia (39%, n = 130). We identified two overarching themes: experiences of anesthesia and experience of postpartum pain management. Under experiences of anesthesia, three subthemes were identified, namely "communication with the anesthesiologist", "deferring to the expertise of the team", and "consequences of decision around the mode of anesthesia." Under postpartum pain management, two subthemes emerged: "support of specialist PAS team" and "poor pain management following PAS surgery". Conclusions: Women want to be involved in decisions around their care, but do not always understand the consequences of their decision‐making, such as missing the birth of their child. An antenatal anesthesiology consultation is important to provide women with information, explore preferences, and develop a plan of care for the birth. Synopsis: Women with placenta accreta spectrum valued being informed and involved in decision making around the mode of anesthesia for birth. [ABSTRACT FROM AUTHOR]

Objective: To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS). Methods: This descriptive survey study was carried out over a 6‐week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis. Results: In all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety‐nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were "variation in approach to primary mode of anesthesia", "perspectives of patient preferences", and "importance of multidisciplinary team care". These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision. Conclusions: Approach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient. Synopsis: Healthcare providers have varying approaches and preferences for anesthesia care in placenta accreta spectrum. [ABSTRACT FROM AUTHOR]

Objective: Placenta accreta spectrum (PAS) is a continuum of placental conditions characterized by significant maternal and neonatal morbidity. Tools to accurately predict postoperative morbidity have been lacking due to the hemodynamic changes of pregnancy. The surgical Apgar score (SAS) is a 10‐point scale that assesses heart rate, mean arterial pressure, and estimated blood loss. The SAS has been validated to predict morbidity such as blood transfusion and reoperation. Methods: We created an obstetric‐specific SAS (ObSAS) scale for physiologic changes of pregnancy (two‐fold increase in blood loss, 10% increased heart rate, and 5% decreased mean arterial pressure) and analyzed 110 cases of PAS who underwent cesarean hysterectomy. Results: An ObSAS of 0–4 (poorest score) was significantly associated with increased risk of intensive care unit (ICU) admission (odds ratio [OR] 40.6, 95% confidence interval [CI] 7.9–742.9), transfusion >4 units (26/26 patients), and greater surgical morbidity (OR 22.7, 95% CI 4.4–415.0). ObSAS of 9–10 resulted in no ICU admissions (0/12), fewer blood transfusions (OR 0.1, 95% CI 0.1–0.4). and less surgical morbidity (OR 0.09, 95% CI 0.01–0.37). Conclusion: Given the overall surgical morbidity associated with PAS cesarean hysterectomy, the ObSAS score is a powerful tool with excellent predictive capabilities for ICU admission, blood transfusion, and surgical morbidity, allowing for resource allocation, prophylactic interventions, and optimal patient outcomes. Synopsis: An obstetric‐specific SAS (ObSAS) accurately predicts maternal morbidity after cesarean hysterectomy for placenta accreta spectrum disorders. [ABSTRACT FROM AUTHOR]

To evaluate assisted reproductive technology-associated risk factors for retained products of conception among live births. Registry-based retrospective cohort study. Not applicable. Cycle-specific data for a total of 369,608 singleton live births after fresh and frozen-thawed embryo transfers (FETs) between 2007 and 2017 were obtained from the Japanese assisted reproductive technology registry. None. Retained products of conception after delivery. Odds ratios and 95% confidence intervals for risk factors associated with retained products of conception during fresh and frozen cycles. In total, 132 deliveries (0.04% of eligible assisted reproductive technology registry deliveries) had retained products of conception; 122 (92.4%) of these deliveries occurred after FET transfer cycles. Cases with retained products of conception were significantly more likely to have undergone vaginal delivery than cases without retained products of conception (78.0% vs. 61.1%); they were also more likely to have been complicated with the placenta accreta spectrum (24.2% vs. 0.45%). Among patients undergoing FETs, factors associated with a significantly increased risk of retained products of conception were embryo stage at transfer, use of hormone replacement cycles, and assisted hatching. Use of hormone replacement cycles represented the largest risk factor (adjusted odds ratio, 4.9; 95% confidence interval, 2.0–12.4), such that retained products of conception occurred in 0.05% (51 of 97,958) of deliveries after hormone replacement cycles but only 0.01% (5 of 47,079) of deliveries after natural cycles. Subgroup analysis showed that hormone replacement cycles and assisted hatching remained significant risk factors for retained products of conception in cases without polycystic ovary syndrome and anovulation and cases with vaginal delivery, but not cases with cesarean section. Among fresh embryo transfers, an increased number of retrieved oocytes was the only significant risk factor for retained products of conception. Our analyses demonstrated that most of the cases involving retained products of conception were derived from FETs, and we identified the use of hormone replacement cycles as the largest risk factor for retained products of conception within this group. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum disorder (PASD) encompasses various types of abnormal placentation in which chorionic villi directly adhere to or invade the myometrium. The incidence of PASD has dramatically risen in the US over the past 3 decades owing to the increased rates of patients undergoing cesarean sections. While PASD remains a significant cause of maternal morbidity and mortality, accurate prenatal identification and characterization of PASD is associated with improved outcomes. Although ultrasound is the first-line imaging modality in the evaluation of PASD, with MRI serving as an adjunct, computed tomography angiography (CTA) may also offer unique diagnostic advantages in cases of advanced PASD by providing superior visualization of placental and abdominopelvic vasculature and enabling the creation of comprehensive vascular maps to roadmap complex surgical interventions. This paper represents the first evaluation of CTA as a diagnostic tool and operative planning aid in this context. Appropriate indications and diagnostic advantages of CTA in this setting are reviewed, and key multimodal imaging features of normal and abnormal placentation are highlighted. [ABSTRACT FROM AUTHOR]

Placenta accreta, one of the morbidly adherent placenta components and currently known as placenta accreta spectrum (PAS), is a condition characterized by abnormal adherence of the placenta to the uterine wall. This can lead to significant blood loss and may lead to high morbidity and mortality rates for the mother. It is a failure of placenta separation during the third stage of labor, which is thought to be high prevalence in those with previous cesarean delivery, especially with the presence of placenta previa. However, PAS is possible in cases of a normally-situated placenta without previous cesarean delivery. We reported an interesting case of a 41-year-old woman, gravida 8 para 7, admitted to the labor room for augmentation of labor, who needed emergency lower segment cesarean section. The incidental finding of PAS was made intraoperatively and was complicated with a hysterectomy. PAS in a normally situated placenta (upper segment) in a virgin abdomen that has been discovered during emergency lower segment cesarean section could cause a nightmare to the obstetrician as it leads to massive postpartum hemorrhage, ureteric injury, and high maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum disorders are associated with substantial maternal morbidity and mortality. Despite a preoperative diagnosis, the rate of complications remains high, and the condition is generally associated with the need for a hysterectomy. This study aimed to evaluate the outcomes of a new uterine-preserving technique (called the combined approach, including surgical hemostasis, bilateral ligation of the descending branches of the uterine arteries, and hemostatic external supraplacental stitch with the use of the Zhukovsky double-balloon tamponade in patients with placenta accreta spectrum disorders) during cesarean delivery in women with placenta accreta spectrum disorders vs the surgical technique used until 2014. This retrospective cohort study included 147 patients with placenta accreta spectrum disorders who were divided into 2 groups: the study group (n=95) is to undergo cesarean delivery using the combined approach, and the control group (n=52) is to undergo the surgical technique used until 2014, which included bilateral uterine artery ligation, which is the transfusion of plasma, red blood cells, platelets, and protease inhibitors. The volume of blood loss was 1.5-fold lower (P =.0010), the number of blood transfusions was 5.1-fold lower (P =.026), and the rate of bladder injuries was 19-fold lower (P =.012) in the study group than that in the control group. The duration of hospital stay after delivery was 4 days lesser (P =.001) and the number of hysterectomies was 4.5-fold lower in the study group than in the control group (P =.023). The study groups did not differ in terms of placenta accreta spectrum type. The combined approach during cesarean delivery proved to be more effective than the surgical technique used until 2014 in reducing the number of hysterectomies, blood loss volume, number of blood transfusions, and duration of hospital stay in patients with placenta accreta spectrum disorders. [ABSTRACT FROM AUTHOR]

Background & Objective: Conservative treatment of placenta accreta spectrum (PAS) become increasingly performed, especially due to acceptance of many obstetricians to preserve the uterus. To evaluate cesarean scar integrity following PAS conservative surgery using Shehata's technique and other conservative techniques because more than one level of pelvic devascularization was used. This cross-sectional study was conducted at Tanta University in the period from June 1, 2019 to October 31, 2022. Materials & Methods: All patients underwent conservative uterine sparing technique (Shehata's technique) were assessed by 2 D ultrasound at 6-18 months later to detect the integrity of the CS scar. Fifty women with a history of other conservative treatment of PAS used as control. Results: Women who were operated with Shehata's technique showed less incidence of scar dehiscence with less size of scar defects and more thickness of the myometrium over the scar site and more vascularity of these scars. Conclusion: Shehata's technique resulted in a more integrated scar with less incidence of dehiscence and more vascularity of the compared to other conservative methods of treatment of PAS. Therefore, it is an effective and safe method in treatment of PAS. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) is a severe obstetric pathology, in which placental tissue invades the myometrium. According to the current classification of FIGO (2019), depending on the depth of placental tissue invasion, PAS is divided into Placenta accreta – about 75% of cases, Placenta increta – 15% and Placenta percreta – up to 10% of all cases. The most severe cases associated with the delivery of pregnant women with Placenta percreta, especially with placental tissue sprouting not only the myometrium of the front wall of the uterus, but also the back wall of the urinary bladder or parametrial and paracervical tissue, which according to the FIGO classification are defined as cases of Placenta percreta with a degree of severity 3b and 3c. These are the most dangerous cases of the development of severe hemorrhagic complications, coagulopathic disorders, and the occurrence of intraoperative complications with damage to adjacent organs, primarily the bladder and intestines due to hysterectomy. This article presents for the general public of obstetricians and gynaecologists the analysis of a clinical case in a pregnant woman with complete presentation and placental ingrowth into the prostatic parametrial tissue and partial adhesion to the posterior bladder wall (Placenta previa/percreta 3c). The use of a modified interiliac incision of the anterior abdominal wall, medical and technical support with the use of modern energies (radio wave scalpel, argon plasma tissue coagulation) to minimize the volume of blood loss were described. The intervention was carried out at the main clinical base of the Department of Obstetrics and Gynaecology No. 1, the Kyiv Regional Perinatal Centre. [ABSTRACT FROM AUTHOR]

Background: Perfusion and diffusion coexist in the placenta and can be altered by pathologies. The two‐perfusion model, where f1 and, f2 are the perfusion‐fraction of the fastest and slowest perfusion compartment, respectively, and D is the diffusion coefficient, may help differentiate between normal and impaired placentas. Purpose: Investigate the potential of the two‐perfusion IVIM model in differentiating between normal and abnormal placentas. Study‐Type: Retrospective, case–control. Population: 43 normal pregnancy, 9 fetal‐growth‐restriction (FGR), 6 small‐for‐gestational‐age (SGA), 4 accreta, 1 increta and 2 percreta placentas. Field Strength/Sequence: Diffusion‐weighted‐echo planar imaging sequence at 1.5 T. Assessment: Voxel‐wise signal‐correction and fitting‐controls were used to avoid overfitting obtaining that two‐perfusion model fitted the observed data better than the IVIM model (Akaike weight: 0.94). The two‐perfusion parametric‐maps were quantified from ROIs in the fetal and maternal placenta and in the accretion zone of accreta placentas. The diffusion coefficient D was evaluated using a b ≥ 200 sec/mm2‐mono‐exponential decay fit. IVIM metrics were quantified to fix f1 + f2 = fIVIM. Statistical‐Tests: ANOVA with Dunn‐Sidák's post‐hoc correction and Cohen's d test were used to compare parameters between groups. Spearman's coefficient was evaluated to study the correlation between variables. A P‐value<0.05 indicated a statistically significant difference. Results: There was a significant difference in f1 between FGR and SGA, and significant differences in f2 and fIVIM between normal and FGR. The percreta + increta group showed the highest f1 values (Cohen's d = −2.66). The f2 between normal and percreta + increta groups showed Cohen's d = 1.12. Conversely, fIVIM had a small effective size (Cohen's d = 0.32). In the accretion zone, a significant correlation was found between f2 and GA (ρ = 0.90) whereas a significant negative correlation was found between fIVIM and D (ρ = −0.37 in fetal and ρ = −0.56 in maternal side) and f2 and D (ρ = −0.38 in fetal and ρ = −0.51 in maternal side) in normal placentas. Conclusion: The two‐perfusion model provides complementary information to IVIM parameters that may be useful in identifying placenta impairment. Level of Evidence: 2 Technical Efficacy Stage: 1 [ABSTRACT FROM AUTHOR]

Maternal and paternal age at birth is increasing globally. Maternal age may affect perinatal outcomes, but the effect of paternal age and its joint effect with maternal age are not well established. This prospective, multicenter, cohort analysis used data from the University Hospital Advanced Age Pregnant Cohort Study in China from 2016 to 2021, to investigate the separate association of paternal age and joint association of paternal and maternal age with adverse perinatal outcomes. Of 16,114 singleton deliveries, mean paternal and maternal age (± SD) was 38.0 ± 5.3 years and 36.0 ± 4.1 years. In unadjusted analyses, older paternal age was associated with increased risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum disorders, placenta previa, cesarean delivery (CD), and postpartum hemorrhage, preterm birth (PTB), large-for-gestational-age, macrosomia, and congenital anomaly, except for small-for-gestational-age. In multivariable analyses, the associations turned to null for most outcomes, and attenuated but still significant for GDM, CD, PTB, and macrosomia. As compare to paternal age of < 30 years, the risks in older paternal age groups increased by 31–45% for GDM, 17–33% for CD, 32–36% for PTB, and 28–31% for macrosomia. The predicted probabilities of GDM, placenta previa, and CD increased rapidly with paternal age up to thresholds of 36.4–40.3 years, and then plateaued or decelerated. The risks of GDM, CD, and PTB were much greater for pregnancies with younger paternal and older maternal age, despite no statistical interaction between the associations related to paternal and maternal age. Our findings support the advocation that paternal age, besides maternal age, should be considered during preconception counseling. Trial Registration NCT03220750, Registered July 18, 2017—Retrospectively registered, https://classic.clinicaltrials.gov/ct2/show/NCT03220750. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) disorders are a continuum of placental pathologies with increased risk for hemorrhage, blood transfusion and maternal morbidity. Uterine artery embolization (UAE) is a safe approach to the standardization of complex PAS cases. The aim of this study is to analyze anemia and transfusion rate, outcome and anesthesiological management of women who underwent caesarean delivery with subsequent UAE for the management of PAS. Material and Methods: This retrospective observational study included all pregnant women admitted to the University Hospital Frankfurt between January 2012 and September 2023, with a diagnosis of PAS who underwent a two-step surgical approach for delivery and placenta removal. Primary procedure included cesarean delivery with subsequent UAE, secondary procedure included placenta removal after a minim of five weeks via curettage or HE. Maternal characteristics, anesthesiological management, complications, anemia rate, blood loss and administration of blood products were analyzed. Results: In total, 17 women with PAS were included in this study. Of these, 5.9% had placenta increta and 94.1% had placenta percreta. Median blood loss was 300 (200–600) mL during primary procedure and 3600 (450–5500) mL during secondary procedure. In total, 11.8% and 62.5% of women received red blood cell transfusion during the primary and secondary procedures, respectively. After primary procedure, postpartum anemia rate was 76.5%. The HE rate was 64.7%. Regional anesthesia was used in 88.2% during primary procedure. Conclusion: The embolization of the uterine artery for women diagnosed with PAS is safe. Anemia management and the implementation of blood conservation strategies are crucial in women undergoing UAE for the management of PAS. [ABSTRACT FROM AUTHOR]

Postpartum haemorrhage (PPH) is a significant cause of maternal mortality globally, necessitating prompt and efficient management. This review provides a comprehensive exploration of endovascular treatment dimensions for both primary and secondary PPH, with a focus on uterine atony, trauma, placenta accreta spectrum (PAS), and retained products of conception (RPOC). Primary PPH, occurring within 24 h, often results from uterine atony in 70% of causes, but also from trauma, or PAS. Uterine atony involves inadequate myometrial contraction, addressed through uterine massage, oxytocin, and, if needed, mechanical modalities like balloon tamponade. Trauma-related PPH may stem from perineal injuries or pseudoaneurysm rupture, while PAS involves abnormal placental adherence. PAS demands early detection due to associated life-threatening bleeding during delivery. Secondary PPH, occurring within 24 h to 6 weeks postpartum, frequently arises from RPOC. Medical management may include uterine contraction drugs and hemostatic agents, but invasive procedures like dilation and curettage (D&C) or hysteroscopic resection may be required. Imaging assessments, particularly through ultrasound (US), play a crucial role in the diagnosis and treatment planning of postpartum haemorrhage (PPH), except for uterine atony, where imaging techniques prove to be of limited utility in its management. Computed tomography play an important role in evaluation of trauma related PPH cases and MRI is essential in diagnosing and treatment planning of PAS and RPOC. Uterine artery embolization (UAE) has become a standard intervention for refractory PPH, offering a rapid, effective, and safe alternative to surgery with a success rate exceeding 85% (Rand T. et al. CVIR Endovasc 3:1-12, 2020). The technical approach involves non-selective uterine artery embolization with resorbable gelatine sponge (GS) in semi-liquid or torpedo presentation as the most extended embolic or calibrated microspheres. Selective embolization is warranted in cases with identifiable bleeding points or RPOC with AVM-like angiographic patterns and liquid embolics could be a good option in this scenario. UAE in PAS requires a tailored approach, considering the degree of placental invasion. A thorough understanding of female pelvis vascular anatomy and collateral pathways is essential for accurate and safe UAE. In conclusion, integrating interventional radiology techniques into clinical guidelines for primary and secondary PPH management and co-working during labour is crucial. [ABSTRACT FROM AUTHOR]

Objective: The study aims to equip both Obstetricians and Gynaecologists with the knowledge of clinical conditions that will benefit from interventional radiology, equipment and materials that are commonly used, benefits, complications and the side effects of these techniques. Methods: It was a single-centre, retrospective cohort study with examples from hospital practice during the period of 2015 to 2021, acquired through computerised database including all obstetrics and gynecological cases in which interventional radiology techniques were used. No statistical analysis of data was applicable as it was a single-centre retrospective analysis of cases. Results: We had a total of 35 cases, including but not limited to placenta accreta spectrum disorders, fibroid, pelvic congestion syndrome and arteriovenous malformation who underwent various interventional radiological procedures ranging from embolization of uterine artery, peripheral angiography, embolization, and internal iliac artery balloon placement to ovarian vein embolization and coil insertion. Conclusion: Increased collaborative efforts between interventional radiology and gynaecology would allow patients to be fully informed on the complete spectrum of surgical and nonsurgical treatment options available to them. [ABSTRACT FROM AUTHOR]

Background: We investigated the association between placental location and pregnancy outcomes in placenta previa. Methods: This multi-center retrospective study enrolled 781 women who delivered between May 1999 and February 2020. We divided the dataset into anterior (n = 209) and posterior (n = 572) groups and compared the baseline characteristics and obstetric and neonatal outcomes. The adverse obstetric outcomes associated with placenta location were evaluated using a multivariate logistic analysis. Results: Gestational age at delivery in the anterior group (253.0 ± 21.6) was significantly lower than that in the posterior group (257.6 ± 19.1) (p = 0.008). The anterior group showed significantly higher parity, rates of previous cesarean section, non-vertex fetal positions, admissions for bleeding, emergency cesarean sections, transfusions, estimated blood loss, and combined placenta accrete spectrum (p < 0.05). In the multivariate analysis, the anterior group had higher rates of transfusion (OR 2.23; 95% CI 1.50–3.30), placenta accreta spectrum (OR 2.16; 95% CI 1.21–3.97), and non-vertex fetal positions (OR 2.47; 95% CI 1.09–5.88). Conclusions: These findings suggest that more caution is required in the treatment of patients with anterior placenta previa. Therefore, if placenta previa is diagnosed prenatally, it is important to determine the location of the body and prepare for massive bleeding in the anterior group. [ABSTRACT FROM AUTHOR]

Purpose: We previously reported that T2 dark bands and placental bulges observed in magnetic resonance imaging (MRI) can predict adverse maternal outcomes in patients with placenta accreta spectrum (PAS) and placenta previa undergoing prophylactic balloon occlusion of the internal iliac artery. On the other hand, the risk factors associated with the use of prophylactic aortic balloon occlusion (PABO) have not been sufficiently investigated. This retrospective study aimed to identify MRI-based risk factors associated with adverse maternal outcomes in the context of PABO during a cesarean section (CS) for PAS and placenta previa. Materials and Methods: Ethical approval was obtained for a data analysis of 40 patients diagnosed with PAS and placenta previa undergoing PABO during a CS. Clinical records, MRI features, and procedural details were examined. The inclusion criteria for the massive bleeding group were as follows: an estimated blood loss (EBL) > 2500 mL, packed red blood cell (pRBC) transfusion (>4 units), and the need for a hysterectomy or transcatheter arterial embolization after delivery. The massive and nonmassive bleeding groups were compared. Results: Among the 22 patients, those in the massive bleeding group showed significantly longer operative durations, a higher EBL (p < 0.001), an increased number of pRBC transfusions (p < 0.001), and prolonged postoperative hospital stays (p < 0.05). T2 dark bands on MRI were significant predictors of adverse outcomes (p < 0.05). Conclusion: T2 dark bands on MRI were crucial predictors of adverse maternal outcomes in patients undergoing PABO for PAS or placenta previa during a CS. Recognizing these MRI features proactively indicates the need for effective management strategies during childbirth and emphasizes the importance of further prospective studies to validate and enhance these findings. [ABSTRACT FROM AUTHOR]