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Abstract Background Placenta accreta spectrum (PAS) is a rare, life-threatening complication of pregnancy. Predicting PAS severity is critical to individualise care planning for the birth. We aim to explore whether radiomic analysis of T2-weighted magnetic resonance imaging (MRI) can predict severe cases by distinguishing between histopathological subtypes antenatally. Methods This was a bi-centre retrospective analysis of a prospective cohort study conducted between 2018 and 2022. Women who underwent MRI during pregnancy and had histological confirmation of PAS were included. Radiomic features were extracted from T2-weighted images. Univariate regression and multivariate analyses were performed to build predictive models to differentiate between non-invasive (International Federation of Gynecology and Obstetrics [FIGO] grade 1 or 2) and invasive (FIGO grade 3) PAS using R software. Prediction performance was assessed based on several metrics including sensitivity, specificity, accuracy and area under the curve (AUC) at receiver operating characteristic analysis. Results Forty-one women met the inclusion criteria. At univariate analysis, 0.64 sensitivity (95% confidence interval [CI] 0.0−1.00), specificity 0.93 (0.38−1.0), 0.58 accuracy (0.37−0.78) and 0.77 AUC (0.56−.097) was achieved for predicting severe FIGO grade 3 PAS. Using a multivariate approach, a support vector machine model yielded 0.30 sensitivity (95% CI 0.18−1.0]), 0.74 specificity (0.38−1.00), 0.58 accuracy (0.40−0.82), and 0.53 AUC (0.40−0.85). Conclusion Our results demonstrate a predictive potential of this machine learning pipeline for classifying severe PAS cases. Relevance statement This study demonstrates the potential use of radiomics from MR images to identify severe cases of placenta accreta spectrum antenatally. Key points • Identifying severe cases of placenta accreta spectrum from imaging is challenging. • We present a methodological approach for radiomics-based prediction of placenta accreta. • We report certain radiomic features are able to predict severe PAS subtypes. • Identifying severe PAS subtypes ensures safe and individualised care planning for birth. Graphical Abstract

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy. [ABSTRACT FROM AUTHOR]

To surgically demonstrate preconceptional laparoscopic repair of a chronic myometrial defect with mesh reinforcement, resulting in a successful pregnancy outcome. Video case report. The Institutional Ethical Committee was consulted, and the requirement for approval was waived because the video describes a modified surgical technique. The patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, and others), and other applicable sites. A referral advanced gynecological endoscopy center. A 27-year-old woman (P 0 A 1) was diagnosed with myomas during pregnancy, resulting in miscarriage at 22 weeks. Laparotomy and myomectomy were performed 2 months later, and three 8-cm myomas were removed. The endometrial cavity opened posteriorly during surgery, and retained products of conceptions were removed. Periconceptional imaging done after two years showed few intramural myomas and a deficient myometrium in the posterior fundal region. Laparoscopy revealed a defect in the posterior fundal aspect of the uterus with leakage of dye, which was converted to laparotomy and myomectomy with the repair of the myometrial defect. After 1 year, follow-up magnetic resonance imaging showed thinned-out posterior myometrium with a focal area of absent myometrium in the midline and endometrial prolapse. The patient was advised on surrogacy, but she wanted to repair the defect again and try for pregnancy, so she was referred to our center. With the background of a few case reports using mesh to reinforce myometrial repair (1, 2), we counseled the patient about the myometrial repair with the additional use of mesh as an off-label use. The risk of uterine rupture after myomectomy is rare (<1%) (3), but it is a severe complication. High-risk cases, like significant myometrial defects or previous ruptures, may require surgical correction. Native repair may not achieve optimal results in all cases. Alternative approaches, like the additional use of mesh or biological materials, have been reported (4). In this case, we demonstrate the use of dual mesh for scar repair. Synthetic mesh over the uterus is used in laparoscopic procedures like sacrohysteropexy and cerclage. We used Parietex (Covidien, New Haven, CT, USA) mesh, a composite macroporous polyester mesh usually used for ventral hernia repair. It has an outer hydrophilic, absorbable collagen barrier that reduces adhesion formation. Laparoscopically, after adhesiolysis, a significant defect was demonstrated on the posterior wall of the uterus (Fig. 1). A complete resection of the fibrotic tissue along the edges of the scar defect was done to expose healthy myometrium. Myometrium was repaired in two layers, excluding the endometrium, with a V-Loc (Covidien, Dublin, Ireland) No. 1–0 suture. Parietex mesh was sutured over the repaired posterior myometrium to reinforce it (Fig. 2). The postoperative myometrial thickness on imaging and pregnancy outcome. Postoperative ultrasound scan after 6 weeks demonstrated restoration of posterior wall myometrial thickness of 14 mm. The patient was conceived through in vitro fertilization techniques 4 months after surgery. Antenatal follow-up was uneventful except for suspicion of posterior placenta accreta. She underwent an elective cesarean section with uterine artery embolization at 34 weeks and delivered a healthy infant weighing 1,950 g. Placental removal was uneventful. On inspection, the posterior surface of the uterus was intact without dehiscence, meshing in situ with minimal adhesions (Fig. 3). Myometrial scar defects can cause potential obstetric complications. Native repair of scar defects may not achieve optimal results, as in our case. Mesh repair of myomectomy scar defects can be used as an alternative approach, as exemplified in this case. However, further studies are required to establish the safety and efficacy of this approach. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) is a high-risk obstetrical condition associated with significant morbidity and mortality. Current clinical screening modalities for PAS are not always conclusive. Here, we report a nanostructure-embedded microchip that efficiently enriches both single and clustered circulating trophoblasts (cTBs) from maternal blood for detecting PAS. We discover a uniquely high prevalence of cTB-clusters in PAS and subsequently optimize the device to preserve the intactness of these clusters. Our feasibility study on the enumeration of cTBs and cTB-clusters from 168 pregnant women demonstrates excellent diagnostic performance for distinguishing PAS from non-PAS. A logistic regression model is constructed using a training cohort and then cross-validated and tested using an independent cohort. The combined cTB assay achieves an Area Under ROC Curve of 0.942 (throughout gestation) and 0.924 (early gestation) for distinguishing PAS from non-PAS. Our assay holds the potential to improve current diagnostic modalities for the early detection of PAS.

Abstract Objective To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). Data sources Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. Study eligibility criteria All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. Study appraisal and synthesis methods Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. Results The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. Conclusions The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. Trial registration Number CRD42021267501.

Background and purpose: Mizaj (temperament) is an important concept in Persian medicine that has many applications in the diagnosis, prevention, care, and treatment of many diseases. This study aimed to determine the relationship between placenta accreta and the state of the general and uterine temperament and Apgar score of newborns in mothers candidates for cesarean section. Materials and methods: A case-control study was performed in mothers who were candidates for caesarean section. The subjects included expectant mothers with placenta accreta (n= 33) and a control group (n= 66). Current general and uterine temperament were measured using Mojahedi and Tansas questionnaire. Demographic variables and Apgar score of newborns was measured using the Apgar International Standard Checklist Score. T-test and Chi-square were used to compare the data. Results: Demographic characteristics were similar between the two groups. In pregnant mothers with placenta accreta the mean scores for total warm-cold and wet-dry temperaments were 14.81±1.55 and 3.72±1.23, respectively. In the control group, these scores were 16.81±4.38 and 3.39±0.65, respectively (P

Background: Placenta accreta spectrum (PAS) disorders are increasing in incidence and represent a significant contributor to severe maternal morbidity in the US. Prior uterine surgeries other than cesarean section are important, yet less common, risk factors for PAS. Case: This is a case of a 43-year-old woman with a prior history of cervical cancer necessitating radical trachelectomy. She was subsequently diagnosed with a complete placenta previa with a high degree of suspicion for PAS. Multidisciplinary teams convened to plan for delivery. A cesarean hysterectomy was performed at 32 weeks. Final surgical pathology confirmed the presence of morbidly adherent placenta invading the vaginal cuff. Conclusion: Patients who are diagnosed with early-stage cervical cancers have the option of fertility-preserving surgical management. Serial ultrasound evaluations, specifically looking for PAS, might be warranted in post-trachelectomy pregnancies.

Placenta accreta is a high-risk condition causing obstetric crisis and hemorrhage; however, its pathogenesis remains unknown. We aimed to identify the factors contributing to trophoblast invasiveness and angiogenic potential, which in turn drive the pathogenesis of placenta accreta. We focused on the transforming growth factor (TGF)-β1-Smad pathway and investigated the intrinsic relationship between the time- and dose-dependent inhibition of the ubiquitinating enzyme UCHL5 using bAP15, a deubiquitinase inhibitor, after TGF-β1 stimulation and the invasive and angiogenic potential of two cell lines, gestational choriocarcinoma cell line JEG-3 and trophoblast cell line HTR-8/SVneo. UCHL5 inhibition negatively regulated TGF-β1-induced Smad2 activation, decreasing extravillous trophoblast invasiveness. Smad1/5/9 and extracellular signal-regulated kinase (ERK) were simultaneously activated, and vascular endothelial growth factor was secreted into the trophoblast medium. However, extravillous trophoblast culture supernatant severely impaired the vasculogenic potential of human umbilical vein endothelial cells. These results suggest that the downstream ERK pathway and Smad1/5/9 potentially regulate the TGF-β1-Smad pathway in extravillous trophoblasts, whereas Smad2 contributes to their invasiveness. The abnormal invasive and angiogenic capacities of extravillous cells, likely driven by the interaction between TGF-β1-Smad and ERK pathways, underlie the pathogenesis of placenta accreta. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to correlate fetal main pulmonary artery (PA) Doppler indices with the neonatal outcome in the late preterm and early term pregnancies in placenta accreta spectrum (PAS) patients Methods: A prospective cross-sectional study was conducted on 71 patients with PAS disorders singleton pregnancies undergoing elective or emergency termination of pregnancy under general anesthesia at or after 34 weeks. A full obstetrics ultrasound scan was performed within 24 hours before delivery and after corticosteroids administration to confirm the eligibility criteria and to measure PA Doppler indices in the main PA (pulsatility index (PI), resistance index (RI), systolic to diastolic (S/D) ratio, peak systolic velocity (PSV) and acceleration to ejection time (At/Et) ratio). Results: Twenty-three neonates needed respiratory support and neonatal intensive care unit (NICU) admission. Fetuses that needed respiratory support had a significantly lower gestational age at delivery (36±1.2 versus 36.8±0.5), lower estimated fetal weight (EFW) (2770±475 versus 3096±328), lower birth weight (2782±595 versus 3152±337) and also lower Apgar score than those who did not need. None of the PA Doppler parameters correlated with the neonatal need for respiratory support. The need for respiratory support was more in the neonates who were terminated on emergency basis (39.1% versus 60.9%). The depth of placental invasion correlated with maternal morbidity. Conclusions: PA Doppler parameters do not correlate with the need for respiratory support in patient with PAS disorders. [ABSTRACT FROM AUTHOR]

Objective: Cesarean scar pregnancy (CSP) is a potentially life-threatening disease that has been steadily increasing in prevalence. Pregnancy termination is usually recommended given the risk of life-threatening complications. In some cases, patients refuse to terminate viable CSPs, even after counseling. Recent studies report that, even with a high burden of possible complications and maternal morbidity, many CSPs progress to live, close to term births. The aim of this study is to further demonstrate the natural history of viable cesarean scar pregnancies. Methods: We conducted a systematic review of original studies reporting cases of expectant management of CSPs with positive fetal heartbeats. Results: After selection, 28 studies were included in the review, with a total of 398 cases of CSP, 136 managed expectantly and 117 with positive fetal heartbeat managed expectantly. This study confirmed that the majority of patients experience live births, as 78% of patients selected for expectant management experienced live births at or close to term, with 79% developing morbidly adherent placenta, 55% requiring hysterectomy, and 40% having severe bleeding. Discussion: The optimal management protocol for CSP is still to be defined and more studies are needed to further elucidate this rare but rising disease. Our study provides information on the natural history of untreated CSPs and suggests that termination may not be the only option offered to the patient. [ABSTRACT FROM AUTHOR]

Objective: The authors conducted a large‐scale cohort study using the Japan Society of Obstetrics and Gynecology's perinatal registry database to determine the effect of myomectomy on perinatal outcomes. Methods: This retrospective cohort study enrolled 203 745 women who gave birth between January and December 2020 in Japan. The participants were classified into two groups based on their history of myomectomy (open/laparoscopic) to investigate fertility treatment, delivery information, obstetric complications, maternal treatment, infant information, fetal appendages, obstetric history, underlying disease, infectious disease, drugs used, and case information regarding maternal and infant death. Results: In total, 1161 pregnant women had a history of myomectomy and 202 584 did not. Compared with the nonmyomectomy group, the myomectomy group had a higher occurrence rate of uterine rupture (0.9% vs 0.06%, P < 0.01) and placenta accreta (1.5% vs 0.5%, P < 0.01). In addition, history of myomectomy (odds ratio [OR], 2.62 [95% confidence interval (CI), 1.500–4.226]; P < 0.001) was found to be an independent factor for placenta accrete and uterine rupture (OR, 14.4 [95% CI, 6.75–27.02]; P < 0.001). Furthermore, myomectomy increased the risk of uterine rupture by 14 times. Conclusion: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. Synopsis: Postmyomectomy pregnancy may increase the risk of placenta accreta and uterine rupture. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to determine the l evel of attitudes of medical students towards scientific researches. In the study, it was also examined whether there was a significant difference between students' attitudes towards researches according to their gender and grade levels. Materials and Methods: In this study, 110 placenta percreta patients who were delivered between January 2021 and January 2022 in the gynecology and obstetrics clinic of Harran University were included in the study. The patients were grouped according to the number of previous cesarean sections; Pregnant women's age, weeks of delivery, prepartum and postpartum blood transfusion needs, 1st and 5th minute APGAR scores of their babies, intraoperative and postoperative complications, length of hospital stay, and peripartum invasion status according to the status of performing preventive surgery/hysterectomy were retrospectively analyzed from the file records. Results: As the number of previous cesarean section increased, the hysterectomy status of the groups formed based on the number of cesarean sections was found to be statistically significant. However, it was determined that there was no significant difference between the groups in terms of age, weeks of birth, prepartum and postpartum blood transfusion needs, 1st and 5th minute APGAR scores of infants, intraoperative and postoperative complications, and hospital stay. Conclusions: The incidence of hysterectomy increases as the number of previous cesarean sections increases in patients with placenta percreta.This situation increases the morbidity of the patients.Surgeons experienced in peripartum hysterectomy and uterine devascularization maneuvers are needed to achieve optimal results when the diagnosis of placenta percreta is made [ABSTRACT FROM AUTHOR]

Uterine scarring is risky for the pregnancy and is closely associated with adverse pregnancy outcomes. Here, we investigated risk factors and associated perinatal outcomes in singleton pregnant women with uterine scars.Methods: This retrospective cohort study was conducted on singleton pregnant women who delivered at the West China Second University Hospital between January 1, 2021, and December 31, 2021.Results: The control group included 13,433 cases without uterine scars. The study group involved 2397 cases with one previous cesarean delivery (PCD), 163 cases with two PCDs, 12 cases with three PCDs, and 184 cases with non-cesarean uterine scars. The study group had a significantly higher incidence of placenta previa (6.4%), placenta percreta (5.3%), preterm delivery (10.3%), postpartum hemorrhage (3.4%), uterine rupture (9.4%), hysterectomy (0.18%), and bladder injury (0.4%) when compared with the control group (P < 0.05). The scarred uterus cases with 1, 2, or 3 PCDs had significantly different complications, with the higher PCD frequency correlating with increased rates of placenta previa, placenta percreta, postpartum hemorrhage, uterine rupture, and uterine resection. Moreover, the hospitalization time, cesarean operation time, and intrapartum bleeding in the current pregnancy significantly increased with increasing PCD frequency (P < 0.05). Analysis of the association between the duration of the interval between PCD and re-pregnancy and pregnancy complication revealed that the incidence of pernicious placenta previa was statistically higher in cases with intervals of < 2 years or ≥ 5 years (4.7%) than in cases with 2 years ≤ interval time < 5 years (2.5%) (P < 0.05).Conclusion: Pregnancies with uterine scars may experience higher rates of adverse perinatal outcomes. This calls for increased observation during pregnancy and delivery to reduce maternal and fetal complications. [ABSTRACT FROM AUTHOR]

Background: MRI features may be associated with adverse maternal outcome in patients with placenta accreta spectrum (PAS) disorders even with abdominal aortic balloon occlusion (AABO). Purpose: This study aimed to identify risk factors of MRI for association with adverse maternal outcome in patients with PAS disorders after AABO. Study Type: Retrospective. Population: Clinical and MRI features of 80 patients were retrospectively reviewed from October 2016 to August 2021. A total of 40 patients had adverse maternal outcomes including intrapartum/peripartum bleeding >1000 mL and/or emergency hysterectomy after AABO. Sequence: Half‐Fourier acquisition single‐shot turbo spin echo and gradient echo imaging True fast imaging with steady‐state precession (True‐FISP) at 1.5T MR scanner. Assessment: MRI features were evaluated by three radiologists and were tested for any association with adverse maternal outcome. Statistical Tests: Interobserver agreement was calculated with kappa (k) statistics. Association between MRI features and adverse maternal outcomes were evaluated by univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. Results: The interobserver agreement ranged from fair to substantial (k = 0.379–0.783). Multivariate analyses revealed that short cervical length (OR: 4.344), abnormal intraplacental vascularity (OR: 6.005), placental bulge (OR: 9.085), and myometrial interruption (OR: 9.550) were independent risk factors for adverse maternal outcomes. The combination of four risk factors together demonstrated the highest AUC of 0.851 (95% CI 0.769–0.933) with a sensitivity and specificity of 77.5% and 72.5%, respectively and then a nomogram composed of the above four risk factors was constructed to represent the probability of adverse maternal outcome. Data Conclusion: The nomogram demonstrated the association between MRI features and patient's poor outcome after undergoing AABO and C‐section delivery for PAS. Evidence Level: 4 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Objective: A placenta accreta spectrum (PAS) refers to a condition in which there is an abnormal penetration of the placenta, within the walls of the uterus. This study was designed to assess the overall diagnostic accuracy of sonography in detecting myometrium invasion of the placenta, in pregnant women with placenta previa (PP). Materials and Methods: In this study, 70 participants were placed into groups with either an anterior placenta (APL) or a posterior placenta (PPL). An experienced radiologist examined the participants. At least two well-known diagnostic sonographic signs were considered, as the diagnostic criteria of PAS. Results: Sonography diagnosed 30 cases of PAS out of 43 confirmed cases, with a sensitivity of 70%, specificity of 77%, positive predictive value (PPV) of 83% and negative predictive value (NPV) of 61%, accuracy of 72.8%, precision of 69.1%, diagnostic odd ratio (DOR) of 21.06, and an F measure of 0.71. Detection rates were higher in cases of the APL (sensitivity: 78%, specificity: 91%, PPV: 94%, NPV: 68%, accuracy: 82.8%, precision: 78.2%, DOR: 39.12, and an F measure: 0.78). The review of sonograms allowed for the detection of seven cases (10%) of PAS appropriately. Conclusion: The sonographic results seem to be more accurate among individuals with APL than PPL. A replication of this study, with multicenter participation is recommended, especially in cases of PPL. [ABSTRACT FROM AUTHOR]

Background: The two-child policy implemented in China resulted in a surge of high-risk pregnancies among advanced maternal aged women and presented a window of opportunity to identify a large number of placenta accreta spectrum (PAS) cases, which often invoke severe blood loss and hysterectomy. We thus had an opportunity to evaluate the surgical outcomes of a unique conservative PAS management strategy for uterus preservation, and the impacts of magnetic resonance imaging (MRI) in PAS surgical planning. Methods: Cross-sectional study, comparing the outcomes of a new uterine artery ligation combined with clover suturing technique (UAL + CST) with the existing conservative surgical approaches in a maternal public hospital with an annual birth of more than 20,000 neonates among all placenta previa cases suspecting of PAS between January 1, 2015 and December 31, 2018. Results: From a total of 89,397 live births, we identified 210 PAS cases from 400 singleton pregnancies with placenta previa. Aside from 2 self-requested natural births (low-lying placenta), all PAS cases had safe cesarean deliveries without any total hysterectomy. Compared with the existing approaches, the evaluated UAL + CST had a significant reduction in intraoperative blood loss (β=-312 ml, P <.001), RBC transfusion (β=-1.08 unit, P =.001), but required more surgery time (β = 16.43 min, P =.01). MRI-measured placenta thickness, when above 50 mm, can increase blood loss (β = 315 ml, P =.01), RBC transfusion (β = 1.28 unit, P =.01), surgery time (β = 48.84 min, P <.001) and hospital stay (β = 2.58 day, P <.001). A majority of percreta patients resumed normal menstrual cycle within 12 months with normal menstrual fluid volume, without abnormal urination or defecation. Conclusions: A conservative surgical management approach of UAL + CST for PAS is safe and effective with a low complication rate. MRI might be useful for planning PAS surgery. Clinical trial registration number: : ChiCTR2000035202. [ABSTRACT FROM AUTHOR]

Aim: Pouch of Douglas obliteration, which prevents exteriorization of the uterus, increases surgical morbidity in patients with placenta previa. We aimed to identify magnetic resonance imaging features that can predict pouch of Douglas obliteration preoperatively. Methods: We retrospectively assessed 39 women with posterior placenta previa who underwent magnetic resonance imaging for the preoperative assessment of placenta accreta spectrum. We defined the angle formed by the anatomical conjugate line (based on pelvimetry) and the cervical canal as the cervical inclination angle, which was measured on sagittal T2-weighted magnetic resonance imaging. Subsequently, we analyzed the correlation between the cervical inclination angle and pouch of Douglas obliteration. Results: The median maternal age was 34 years (range, 22–44 years) and 26 (66.7%) women delivered at term. The median cervical inclination angle was 98° (range, 71–128). Pouch of Douglas obliteration was confirmed in six patients (15.4%). The cut-off value of the cervical inclination angle for the prediction of pouch of Douglas obliteration was 102° with a sensitivity of 66.7%, specificity of 78.8%, positive predictive value of 36.4%, and negative predictive value of 92.9% (area under the curve, 0.83). Conclusions: Measuring the cervical inclination angle may help in ruling out an obliteration of the pouch of Douglas. It may also be useful in the operative management of women with posterior placenta previa. However, caution should be exercised when generalizing the results of this study because of the small sample size, which makes the results prone to bias. [ABSTRACT FROM AUTHOR]

Background: Most treatments for postpartum haemorrhage (PPH) lack evidence of effectiveness. New innovations are ubiquitous but have not been synthesized for ready access. Narrative review: Pubmed 2020 to 2021 was searched on 'postpartum haemorrhage treatment', and novel reports among 755 citations were catalogued. New health care strategies included early diagnosis with a bundled first response and home-based treatment of PPH. A calibrated postpartum blood monitoring tray has been described. Oxytocin is more effective than misoprostol; addition of misoprostol to oxytocin does not improve treatment. Heat stable carbetocin has not been assessed for treatment. A thermostable microneedle oxytocin patch has been developed. Intravenous tranexamic acid reduces mortality but deaths have been reported from inadvertent intrathecal injection. New transvaginal uterine artery clamps have been described. Novel approaches to uterine balloon tamponade include improvised and purpose-designed free-flow (as opposed to fixed volume) devices and vaginal balloon tamponade. Uterine suction tamponade methods include purpose-designed and improvised devices. Restrictive fluid resuscitation, massive transfusion protocols, fibrinogen use, early cryopreciptate transfusion and point-of-care viscoelastic haemostatic assay-guided blood product transfusion have been reported. Pelvic artery embolization and endovascular balloon occlusion of the aorta and pelvic arteries are used where available. External aortic compression and direct compression of the aorta during laparotomy or aortic clamping (such as with the Paily clamp) are alternatives. Transvaginal haemostatic ligation and compression sutures, placental site sutures and a variety of novel compression sutures have been reported. These include Esike's technique, three vertical compression sutures, vertical plus horizontal compression sutures, parallel loop binding compression sutures, uterine isthmus vertical compression sutures, isthmic circumferential suture, circumferential compression sutures with intrauterine balloon, King's combined uterine suture and removable retropubic uterine compression suture. Innovative measures for placenta accreta spectrum include a lower uterine folding suture, a modified cervical inversion technique, bilateral uterine artery ligation with myometrial excision of the adherent placenta and cervico-isthmic sutures or a T-shaped lower segment repair. Technological advances include cell salvage, high frequency focussed ultrasound for placenta increta and extra-corporeal membrane oxygenation. Conclusions: Knowledge of innovative methods can equip clinicians with last-resort options when faced with haemorrhage unresponsive to conventional methods. Plain language summary: Unborn babies are nourished by the mother's blood supply to the afterbirth (placenta). After a baby's birth, contractions of the muscles of the womb (uterus) shear the placenta from its attachment and clamp off the mother's blood vessels. This process is assisted by giving an injection which contracts the womb, and pulling gently on the cord to remove the afterbirth. Usually, blood loss is minimal. Occasionally the womb fails to contract effectively or there is bleeding from tears of the birth canal. Bleeding in excess of 500 ml is called postpartum haemorrhage, which can be life-threatening. Excessive bleeding may be treated with medicines to contract the womb or help the blood to clot, rubbing or squeezing the womb, a 'drip' with fluids or blood replacement, placing a balloon or suction device in the womb, and operations to stop the bleeding or remove of the womb (hysterectomy). There is very little hard evidence for the effectiveness of each method. This review highlights recent innovations including approaches to quick diagnosis and rapid treatment, suturing the lower part of the womb via the vagina, improvements in balloon and suction methods, new designs of clamps to apply through the vagina and to clamp the aorta (the main artery of the body), new approaches to giving blood clotting factors, many new types of stitches to compress the uterus, and advanced technology such as ultrasound treatment and artificial oxygenation of the mother's blood. We call for more research to show which methods really work. [ABSTRACT FROM AUTHOR]

Background: A previous study investigated the effect of adenomyosis on perinatal outcomes. Some studies have reported varying effect of adenomyosis on pregnancy outcomes in some patients and dependence on the degree and subtype of uterine lesions. To elucidate the impact of adenomyosis on perinatal outcomes. Methods: This large-scale cohort study used the perinatal registry database of the Japan Society of Obstetrics and Gynecology. A dataset of 203,745 mothers who gave birth between January 2020 and December 2020 in Japan was included in the study. The participants were divided into two groups based on the presence or absence of adenomyosis. Information regarding the use of fertility treatment, delivery, obstetric complications, maternal treatments, infant, fetal appendages, obstetric history, underlying diseases, infectious diseases, use of drugs, and maternal and infant death were compared between the groups. Results: In total, 1,204 participants had a history of adenomyosis and 151,105 did not. The adenomyosis group had higher rates of uterine rupture (0.2% vs. 0.01%, P = 0.02) and placenta accreta (2.0% vs. 0.5%, P < 0.001) than the non-adenomyosis group. A history of adenomyosis (odds ratio: 2.26; 95% confidence interval: 1.43–3.27; P < 0.001), uterine rupture (odds ratio: 3.45; 95% confidence interval: 0.89–19.65; P = 0.02), placental abruption (odds ratio: 2.11; 95% confidence interval: 1.27–3.31; P < 0.01), and fetal growth restriction (odds ratio: 2.66; 95% confidence interval: 2.00–3.48; P < 0.01) were independent risk factors for placenta accreta. Conclusion: Adenomyosis in pregnancies is associated with an increased risk of placenta accreta, uterine rupture, placental abruption, and fetal growth restriction. Trial registration: Institutional Review Board of Tottori University Hospital (IRB no. 21A244). [ABSTRACT FROM AUTHOR]

Background: To develop an ultrasound scoring system for placenta accreta spectrum (PAS), evaluate its diagnostic value, and provide a practical approach to prenatal diagnosis of PAS. Methods: A total of 532 pregnant women (n = 184 no PAS, n = 120 placenta accreta, n = 189 placenta increta, n = 39 placenta percreta) at high-risk for placenta accreta who delivered in the Third Affiliated Hospital of Zhengzhou University between January 2021 and December 2022 underwent prenatal ultrasound to evaluate placental invasion. An ultrasound scoring system that included placental and cervical morphology and history of cesarean section was created. Each feature was assigned a score of 0 ~ 2, according to severity. Thresholds for the total ultrasound score that discriminated between no PAS, placenta accreta, placenta increta, and placenta percreta were calculated. Results: Univariate and multivariate regression analysis identified seven indicators of PAS that were included in the ultrasound scoring system, including placental location, placental thickness, presence/absence of the retroplacental space, thickness of the retroplacental myometrium, presence/absence of placental lacunae, retroplacental myometrial blood flow and history of cesarean section. Using the final ultrasound scoring system, no PAS is diagnosed at a total score < 5, placenta accreta or placenta increta is diagnosed at a total score 5–10, and placenta percreta is diagnosed at a total score ≥ 10. Conclusions: This study identified seven indicators of PAS and included them in an ultrasound scoring system that has good diagnostic efficacy and clinical utility. Trial registration: ChiCTR2300069261 (retrospectively registered on 10/03/2023). [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum is increasing in prevalence and poses significant risks to obstetric patients. This article defines characteristics, diagnosis, management, and outcomes of placenta accreta spectrum, highlighting interventional radiology's role in its management as part of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

We investigated a disintegrin and metalloproteinase with thrombospondin type 1 motif-12 (ADAMTS-12) levels in both fetal umbilical cord and maternal blood of pairs diagnosed with placenta accreta spectrum (PAS). We analyzed ADAMTS-12 level by ELISA in 160 samples that included 30 control pairs (30 maternal and 30 umbilical cord serums), 20 pairs in the placenta previa (PP), and 30 pairs in the PAS group (30 maternal and 30 umbilical cord serums). There were increased serum levels of ADAMTS-12 in maternal serum (p = 0.037) and umbilical cord serum level (p = 0.004) of PAS group compared with the PP and healthy control groups. There was a positive correlation between maternal ADAMTS-12 and fetal ADAMTS-12 serum levels (r = 0.53, p = 0.002). Our findings indicate that ADAMTS-12 could be a -diagnostic biomarker for PAS. [ABSTRACT FROM AUTHOR]

The placenta accreta spectrum without previa is difficult to diagnose before delivery and sometimes requires hysterectomy. A fertility preservation procedure is useful when placenta accreta spectrum is unexpectedly encountered. A 38‐year‐old woman, conceived by in vitro fertilization (IVF), was not diagnosed of placenta accreta spectrum until delivery. A cesarean section was performed for fetal breech presentation. The placenta could not be detached from the uterine fundus and marked bleeding started. We conducted the "TURIP" procedure: ensured hemostasis with tourniquet of uterine isthmus, uterus inversion to expose the adhesion site with intra‐venous nitroglycerin administration, placental detachment by sharp dissection under direct visualization. The detached areas were sutured for hemostasis. The patient recovered uneventfully and achieved the second pregnancy by IVF 1 year later. The TURIP procedure is useful to preserve fertility in unpredicted placenta accreta spectrum without previa, even in undiagnosed cases before delivery. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) is a clinical entity significantly increasing the risk of a peripartum hemorrhage. Various surgical methods have been described in the literature, which aim to reduce the risk of bleeding, although they often lack reproducibility and have been performed on low numbers of patients. The aim of this study was to evaluate the use of the Foley catheter as a cervical tourniquet during cesarean sections, in patients with PAS. Methods: All patients who underwent peripartum hysterectomy due to PAS in a large single-center registry were included in the present analysis. The general demographics and clinical characteristics of all participants, including blood loss, and maternal and fetal outcomes, were collected and analyzed. Results: Twelve participants were included. The mean blood loss was 1200 ± 760 ml during operation and the mean ± SD procedural duration was 89 ± 17 min. The median (Q1–Q3) length of hospital stay post-procedurally was 5 (4–6) days. None of the patients required subsequent urgent surgical procedures after hysterectomy. The median (Q1–Q3) packed red blood cell units transfused in our cohort was 2 (0–3). Conclusion: Using the Foley catheter as a tourniquet might be an effective method of excessive bleeding prevention in patients with PAS during peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate surgical outcomes of using a double uterine segment tourniquet in obstetric hysterectomy for bleeding control in patients with placenta accreta spectrum. Methods: Retrospective case–control study conducted at the Central Hospital of San Luis Potosi, Mexico. Patients with the diagnosis of placenta accreta spectrum who underwent obstetric hysterectomy were included. Two groups were formed: in the first, a double uterine segment tourniquet was used; and in the second, the hysterectomy was performed without a tourniquet. Primary surgical outcomes were compared. Results: Forty patients in each group were included. The use of a double uterine segment tourniquet had lower total blood loss compared with the non‐tourniquet group (1054.00 ± 467.02 vs. 1528.75 ± 347.12 mL, P = 0.0171) and a lower drop in hemoglobin (1.74 ± 1.10 vs. 2.60 ± 1.25 mg/dL, P = 0.0486). Ten patients (23.80%) in the double tourniquet group required blood transfusion, compared with 26 (65.00%) in the non‐tourniquet group (P = 0.0003). Surgical time did not show a statistical difference between groups. Conclusion: The use of a uterine segment tourniquet in obstetric hysterectomy may improve surgical outcomes in patients with placenta accreta spectrum with no difference in surgical time and urinary tract lesions. Synopsis: During obstetric hysterectomy in patients with placenta accreta spectrum, the use of a double uterine segment tourniquet may significantly reduce blood loss with no difference in surgical time and urinary tract lesions. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate a clinicoradiomic nomogram based on sagittal T2WI images to predict placenta accreta spectrum (PAS). Methods: Between October 2016 and April 2022, women suspected of PAS by ultrasound were enrolled. After taking into account exclusion criteria, 132 women were retrospectively included in the study. The variance threshold SelectKBest and the least absolute shrinkage and selection operator were applied to select radiomic features, which was further used to calculate the Rad‐score. Multivariable logistic regression was used to screen clinical factor. Results: Based on 13 radiomic features, five radiomic models were constructed. A clinical factor of intraplacental T2‐hypointense bands was obtained by multivariate logistic regression. The area under the curve (AUC) value of the stochastic gradient descent (SGD) radiomic model was 0.82 in the training cohort and 0.78 in the test cohort. After adding clinical factors to the SGD radiomic model, the AUC value of the clinicoradiomic model was significantly increased from 0.82 and 0.78 to 0.84 in both the training and test cohorts. The nomogram of the clinicoradiomic model was constructed, which had good performance verified by calibration and a decision curve. Conclusion: The presented nomogram could be useful for predicting PAS. Synopsis: The nomogram, which incorporated radiomic features with clinical features, could be useful for differentiating placenta accreta spectrum and normal placenta. [ABSTRACT FROM AUTHOR]

The study included 32 women with PAS and 20 with normally implanted placenta as a control group. Vascular endothelial cell growth factor (VEGF), Soluble FMS Like Tyrosine Kinase (sFLT-1/sVEGFR1), and Endoglin (ENG) were measured in placenta tissue by ELISA. Granzyme B (GrzB) expression in trophoblastic and stromal mesenchymal cells was evaluated by immunohistochemistry. MAIT, NK, and NKT cells were assessed in blood and placenta by flow cytometry. Alterations were observed in levels of MAIT cells, NK cell subsets, and NKT cells in patients compared with controls. Several significant correlations were detected between these cells and GrzB scores, VEGF, ENG, and sFLT-1 levels. This is the first study analysing these cells in PAS patients and correlating their levels with changes in some angiogenic and antiangiogenic factors implicated in trophoblast invasion and with GrzB distribution in trophoblast and stroma. Interrelation between these cells probably plays an important role in pathogenesis of PAS. [ABSTRACT FROM AUTHOR]

Objective: We explore the continuum between the two diagnoses of c-section scar pregnancy (CSP) and early placenta accreta spectrum (PAS), the role of pelvic magnetic resonance imaging (MRI) as a diagnostic aide, interventions to reduce morbidity and mortality, and surgical considerations of a robotic-assisted total laparoscopic hysterectomy for definitive management of an early pregnancy loss impacted by CSP/PAS. Case(s): A thirty-six-year-old pregnant female with seven prior cesarean sections presents with life-threatening vaginal bleeding after an early pregnancy loss at home. In the hospital, pelvic ultrasound demonstrates a retained placenta, and MRI further reveals findings concerning for a new diagnosis of CSP and early PAS. After medical stabilization and multidiscipliary treating planning, she underwent uterine artery embolization followed by robotic-assisted total laparoscopic hysterectomy. She was discharged on postoperative day one and recovered well. Final pathology confirmed placental invasion through the endo-myometrium with uterine serosa only overlying the attached placenta consistent with a diagnosis of an abnormal placentation disorder. Conclusion: Here we describe a severe presentation of early PAS after an early pregnancy loss and the role of MRI and multidisciplinary collaboration in successful management. Discussion between minimally invasive gynecology, maternal-fetal medicine, and radiology specialists is critical in management of a c-section scar pregnancy and placenta accreta spectrum disorder. MRI has an emerging and important independent role in visualizing critical anatomy and surgical planning. [ABSTRACT FROM AUTHOR]

Placenta Accreta Spectrum disorders (PASd) refer to the range of pathologic adherence of placenta associated with high maternal morbidity and mortality due to severe and sometimes life-threatening hemorrhage at the time of delivery. The aim of this study is to describe the surgical technique of extraperitoneal retrograde hysterectomy, which has allowed a reduction of blood transfusions compared to patients who underwent classical post-partum hysterectomy. We collected data from twelve patients with antenatal diagnosis of PASd treated between 2018 and 2021 with an extra-peritoneal hysterectomy using a posterior retrograde approach and we compared them to patients who underwent classical hysterectomy for suspected PASd, treated between 2007 and 2017. The classical hysterectomy group presented a higher frequency of blood and plasma transfusion compared to the extraperitoneal hysterectomy group. In particular, classical hysterectomy resulted in an independent risk factor for transfusion, with an increment of 6.6 times of risk. Even if future studies are required, we think that extraperitoneal hysterectomy could be a safe option in case of PASd, considering that classical hysterectomy compared to this approach increases, in our population, the risk of blood and plasma transfusion. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to report the incidence of lower urinary tract injuries (UTI) during cesarean section (CS) hysterectomy in cases of Placenta Accreta Spectrum (PAS) disorders. Study design Retrospective analysis including all women with a prenatal diagnosis of PAS between January 2010 and December 2020. A dedicated multidisciplinary team was involved to define a tailored management for each patient. All relevant demographic parameters, risk factors, degree of placental adhesion, type of surgery, complications and operative outcomes were reported. One hundred and fifty-six singleton gestations with a prenatal diagnosis PAS were included in the analysis. 32.7% of cases were classified as PAS 1 (grade 1-3a FIGO classification), 20.5% as PAS 2 (grade 3b FIGO classification) and 46.8% as PAS 3 (grade 3c FIGO classification). A CS hysterectomy was performed in all cases. Surgical complication occurred in seventeen cases (0% in PAS 1, 12.5% in PAS 2 cases and in 17.8% in PAS 3). The incidence of UTI in our series was 7.6% in all women with PAS, including 8 cases of bladder and 12 of ureteral lesion, and 13.7 % in those with PAS 3 only. Despite advances in prenatal diagnosis and management, surgical complications, mainly those involving the urinary system, still occur in a significant proportion of women undergoing surgery for PAS. The findings from this study highlight the need for a multidisciplinary management of women with PAS in centers with high expertise in prenatal diagnosis and surgical management of these conditions. [ABSTRACT FROM AUTHOR]

Multiple cesarean deliveries are known to be associated with long-term postoperative consequences because of a permanent defect of the lower uterine segment wall and the development of thick pelvic adhesions. Patients with a history of multiple cesarean deliveries often present with large cesarean scar defects and are at heightened risk in subsequent pregnancies of cesarean scar ectopic pregnancy, uterine rupture, low-lying placenta or placenta previa, and placenta previa accreta. Moreover, large cesarean scar defects will lead to progressive dehiscence of the lower uterine segment with the inability to effectively reapproximate hysterotomy edge and repair at birth. Major remodeling of the lower uterine segment associated with true placenta accreta spectrum at birth, whereby the placenta becomes inseparable from the uterine wall, increases the rates of perinatal morbidity and mortality, especially when undiagnosed before delivery. Ultrasound imaging is currently not routinely used to evaluate the surgical risks of patients with a history of multiple cesarean deliveries, beyond the risk assessment of placenta accreta spectrum. Independent of accreta placentation, a placenta previa under a scarred, thinned partially disrupted lower uterine segment, covered by thick adhesions with the posterior wall of the bladder, poses a surgical risk and requires fine dissection and surgical expertise; however, data on the use of ultrasound to evaluate uterine remodeling and adhesions between the uterus and other pelvic organs are scarce. In particular, transvaginal sonography has been underused, including in patients with a high probability of placenta accreta spectrum at birth. Based on the best available knowledge, we discuss the role of ultrasound imaging in identifying the signs suggestive of major remodeling of the lower uterine segment and in mapping the changes in the uterine wall and pelvis, to enable the surgical team to prepare for all different types of complex cesarean deliveries. The need for postnatal confirmation of the prenatal ultrasound findings for all patients with a history of multiple cesarean deliveries, regardless of the diagnosis of placenta previa and placenta accreta spectrum, is discussed. We propose an ultrasound imaging protocol and a classification of the level of surgical difficulty at elective cesarean delivery to stimulate further research toward the validation of ultrasound signs by which these signs may be applied to improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) is caused by abnormal placental attachment to the uterine wall that can involve invasion into the myometrium, uterine serosa or even surrounding organs. Women with suspected PAS should be referred to centres with appropriate expertise as they are associated with increased maternal morbidity and mortality. Women with PAS are at significant risk of haemorrhage and other surgical complications. Suspicion is raised in the presence of risk factors and the patient assessed with ultrasound scan. Once PAS is suspected skilled surgeons, anaesthetists and interventional radiologists should be involved in patient care and delivery planning. Unfortunately, not all cases are detected antenatally and when the condition is recognized only at the time of delivery the morbidity and mortality rates are higher. Urgent assistance of experienced surgeons should be sought in these cases to optimize the outcome for the patient. [ABSTRACT FROM AUTHOR]

Objective As the awareness of the accompanying morbidity of placenta accreta spectrum (PAS) has increased over recent decades. We sought to analyze the precision and reliability of the currently available content regarding PAS on YouTube. Study Design A YouTube search was performed on June 17, 2019 by using the search terms "placenta accreta," "PAS," and "invasive placentation." Search results were sorted by relevance, and up to 200 videos per search term were systematically evaluated by four independent reviewers. A quality assessment checklist relating to aspects of PAS was developed with a Likert's scale from 0 to 12 points to quantify video content. Videos were classified as poor educational quality (grade 0 to ≤4), moderate quality (grade >4–8), and high quality (grade >8–12). Results Of the 318 videos identified, 99 videos met inclusion criteria. The majority of videos (61.6%) were produced by a professional source, that is, appearing to be from a hospital, university, or educational service. Of the remaining videos, 16.2% were classified as personal, that is, posted from personal YouTube accounts and depicting a personal or family member experience, and 22.2% were classified as other. The majority of the "other" category consisted of news segments and short clips from talk shows. Overall, 60.6% of videos were of poor educational quality, 32.3% were of moderate quality, and 7.1% were deemed high quality. All seven of the high-quality videos were produced by a professional source and intended for an audience of medical professionals. There were neither high-quality videos intended for the general public nor the likely affected and relevant patient population. Conclusion This study suggests that the currently available videos on YouTube regarding PAS are poor educational sources for patients seeking information, and demonstrates a need for high-quality content videos produced by medical professionals specifically focused on meeting the needs of patient population. Key Points Awareness of the accompanying morbidity of placenta accreta spectrum has increased over recent decades. YouTube videos are poor educational sources for patients seeking information regarding PAS. YouTube videos and all social media warrant improvements regarding patient's information. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum (PAS) disorder is a major cause of postpartum hemorrhage-associated maternal and fetal death, and novel methods for PAS screening are urgently needed for clinical application. Methods: The purpose of this study was to develop new methods for PAS screening using serum biomarkers and clinical indicators. A total of 95 PAS cases and 137 controls were enrolled in a case–control study as cohort one, and 44 PAS cases and 35 controls in a prospective nested case–control study were enrolled as cohort two. All subjects were pregnant women of Chinese Han population. Biomarkers for PAS from maternal blood samples were screened based on high-throughput immunoassay and were further validated in three phases of cohort one. Screening models for PAS were generated using maternal serum biomarkers and clinical indicators, and were validated in two cohorts. The expression levels of biomarkers were analyzed using histopathological and immunohistochemical (IHC) techniques, and gene expression was examined by QPCR in the human placenta. Binary logistic regression models were built, and the area under the curve (AUC), sensitivity, specificity, and Youden index were calculated. Statistical analyses and model building were performed in SPSS and graphs were generated in GraphPad Prism. The independent-sample t test was used to compare numerical data between two groups. For nonparametric variables, a Mann–Whitney U test or a X2 test was used. Results: The results demonstrated that the serum levels of matrix metalloproteinase-1 (MMP-1), epidermal growth factor (EGF), and vascular endothelial growth factor-A (VEGF-A) were consistently higher, while the level of tissue-type plasminogen activator (tPA) was significantly lower in PAS patients compared with normal term controls and patients with pre-eclampsia (PE) and placenta previa (PP). IHC and QPCR analysis confirmed that the expression of the identified biomarkers significantly changed during the third trimester in human placenta. The generated screening model combining serum biomarkers and clinical indicators detected 87% of PAS cases with AUC of 0.94. Conclusions: Serum biomarkers can be used for PAS screening with low expense and high clinical performance; therefore, it may help to develop a practicable method for clinical prenatal PAS screening. [ABSTRACT FROM AUTHOR]

Objectives-To study effectiveness of temporary aortic clamping as a method of limiting blood loss at in women with placenta accrete spectrum Methods-Data was collected from records of 14 patients with PAS who had Paily's aortic clamp applied after delivery of baby and prior to Caesarean hysterectomy from January 2016 to December 2021 at Government Medical College Hospital, Thrissur, Kerala, India. Results-6(42.9 %) cases were diagnosed intraoperatively. 12 (85.7 %) had a Classical Caesarean and 2(14.3 %) had a lower segment Caesarean followed by total hysterectomy. Mean duration of application of the clamp was 28.21±12.49 min(Range 15-60 min). The mean blood loss was 1.77 ± 0.96 litres(95% CI 1.21-2.33). Mean units of blood transfused was 2.64 (95 % CI 1.67-3.62). None of the patients required ionotropes or critical care. There were 2 cases(14.2 %) of bladder injury, both occurred in FIGO type 3b PAS. There were no cases of vascular injury, organischemia, thrombosis or relaparotomy for bleeding. Mean duration of hospital stay was 11.35 ± 5.38 days. Conclusion-Aortic clamping prior to Caesarean hysterectomy is a safe and effective method to reduce blood loss in Placenta Accreta Spectrum. [ABSTRACT FROM AUTHOR]

Background: Antepartum haemorrhage (APH) is an obstetrical emergency that accounts for 3-5% of pregnancies and is a leading cause of maternal and perinatal morbidity and mortality. Materials And Methods: This retrospective study was conducted in the department of obstetrics and gynaecology,SMGS Hospital, GMC Jammu over a period of 1 year from 1st January 2022 to 31st December 2022.Data was collected from records kept in the hospital .179 cases of APH were studied during the study period. The maternal baseline characteristics, mode of delivery, pregnancy outcome and obstetrical complications were studied. The study was approved by the Institutional Ethics Committee. The objective of this study was to determine the maternal and perinatal effects of APH. Results: Majority of the patients (67) were in the age group of 26-30 years (37.43 %).Majority of the patients (62) were primigravida (34.63 %), 47 patients were gravida 2 (26.25 %),41 patients were gravida 3 (22.90 %),18 patients were gravida 4(10.05 %) and 11 patients were gravida 5 and more (6.14 %). Majority of the patients (87) presented at 33-36.6 weeks of gestation (48.60%) followed by more than 37 weeks (39.10 %). Majority of the patients (72) had previous vaginal delivery (40.22 %) followed by primigravida (27.93 %),previous abortions (18.99 %),previous 1 LSCS (15.64 %) and previous 2 LSCS (7.26 %).130 patients had placenta praevia (72.62 %),abruption (20.67 %),accreta (3.35 %), Percreta (1.67 %) and increta (1.67 %). Majority of the patients underwent LSCS (75.55 %), LSCS WITH B/L UA Ligation (8.88 %),caesarean hysterectomy (10 %),vaginal delivery (4.44 %)and laparotomy with uterine repair (0.55 %). Majority of the babies had birth weight between 1.5 to 2.5 kg (69.27 %), more than 2.5 kg (24.02%)and <1.5 kg (8.37 %). Apgar score at birth >6 in 87.70%, < 6 in 10.05% and IUD in 3.88%. Conclusion: APH cannot reliably be predicted. APH is associated with high maternal and perinatal morbidity and mortality. All the cases diagnosed as APH during antenatal period must be considered high risk and proper antenatal management plan should be formulated. In suspected cases of morbidly adherent placenta, senior obstetrician, paediatrician and anaesthetist must be available during delivery. In such cases, a preoperative planning with multidisciplinary approach should be followed. Patient counselling and proper consent should be taken which include possibility of hysterectomy and interventional radiology. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to assess the utility a scoring system using selected ultrasonographic features to predict placenta accreta spectrum (PAS) and its severity in suspicion of PAS. Materials and Methods: This prospective study was conducted with a total of 27 pregnant women with placenta previa totalis with suspicion of PAS between and 37 weeks gestation between July 2019 and January 2020. PAS score was calculated with the following parameters: loss of clear zone, number, size, and regularity of placental lacunae, turbulent flow in lacunae, uterovesical or subplacental hypervascularity, bridging vessels, and number of previous cesarean section. Patients were divided into groups due to PAS scores and the severity PAS. Receiver operating characteristics curves were performed to assess the performance of the PAS scoring system. Results: In a total of 27 patients, 7 (25.9%) patients not have PAS, 5 (18.5%) patients had accreta, 7 (25.9%) patients had increta, and 8 patients (29.6) had percreta. groups with PAS scores higher than 8, 86% of patients had placenta percreta. PAS score was 2.8±1.4 in the no PAS group, 3.6±1.9 in the accreta group, 5.1±2.4 in the increta group, 9.8±1.6 in the percreta group and statistically higher in the percreta group. The optimal cut-off values of PAS score to predict abnormal placental invasion was (60% sensitivity, 86% specificity), 7.5 for differentiation percreta from increta (87.5% sensitivity, 75% specificity) Conclusion: A PAS scoring system that combines several ultrasound and clinical characteristics may greatly improve prenatal risk assessment and prediction of PAS. [ABSTRACT FROM AUTHOR]

Twin pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF) is an exceedingly rare condition with an incidence of about 1 in 20,000–100,000 pregnancies. It can be detected by prenatal ultrasonography and an elevated maternal serum beta-human chorionic gonadotropin (BhCG) level. Herein, the author reports a case of CHMCF which was incidentally diagnosed through pathologic examination without preoperative knowledge. The 41-year-old woman, transferred due to preterm labor, delivered a female baby by cesarean section at 28 + 5 weeks of gestation. Clinically, the surgeon suspected placenta accreta on the surgical field, and the placental specimen was sent to the pathology department. On gross examination, focal vesicular and cystic lesions were identified separately from the normal-looking placental tissue. The pathologic diagnosis was CHMCF and considering the fact that placenta accreta was originally suspected, invasive hydatidiform mole was not ruled out. After radiologic work-up, metastatic lung lesions were detected, and methotrexate was administered in six cycles at intervals of every two weeks. The author presents the clinicopathological features of this unexpected CHMCF case accompanied by pulmonary metastasis, compares to literature review findings, and emphasizes the meticulous pathologic examination. [ABSTRACT FROM AUTHOR]