Value of ultrasound scoring system for assessing risk of pernicious placenta previa with accreta spectrum disorders and poor pregnancy outcomes

AbstractPurposeTo evaluate a system for assessing the risk of pernicious placenta previa (PPP) with placenta accreta spectrum (PAS) disorders and poor pregnancy outcomes.MethodsThis prospective study focused on PPP women at  ≥ 28 weeks’ pregnancy. Transabdominal or transvaginal ultrasonography was used to assess PAS and poor pregnancy outcomes with a system involving uteroplacental demarcation, number and size of lacunae, bladder line, and placental basal and lacunae flow. Every item was assigned 0–2 points, and the sum yielded the final score. Diagnosis of PAS was based on surgery or pathology. One or more of postpartum hemorrhage (PPH) ≥ 1000 ml, hysterectomy, and organ invasion were regarded as a poor pregnancy outcome. Receiver operating characteristic (ROC) curves were generated.ResultsFifty-one PPP women were included, with 70.6% having PAS and 75.0% of PAS women having a poor pregnancy outcome. The incidence of PAS diagnosis was 36.4% for those with a score  
Source: Journal of Medical Ultrasonics - Category: Radiology Source Type: research

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Am J Perinatol DOI: 10.1055/s-0040-1714676 Objective Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. Study Design Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal mo...
Source: American Journal of Perinatology - Category: Perinatology & Neonatology Authors: Tags: Original Article Source Type: research
Discussion –— Cesarean scar ectopic pregnancy (CSEP) or Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy resulting from implantation of a blastocyst within myometrial scar tissue (old uterine scars) in the anterior lower uterine segment (LUS) at the site of prior Cesarean section.— It is considered amongst the rarest type of ectopic pregnancy, although some do not include it in the category of ectopic pregnancy as implantation occurs within the uterus itself.— Incidence is on rise due to increasing numbers of elective Cesarean sections as well as improved detection with tr...
Source: Sumer's Radiology Site - Category: Radiology Authors: Source Type: blogs
We report the case of a 44-year-old woman who had undergone a clandestine abortion six weeks before admission. One week later, she had abnormal vaginal discharge. Three weeks prior to admission, headache, hyperpyrexia and mental alteration were added. At admission, a transvaginal ultrasound showed abnormalities of the uterine cavity. Sepsis and endometritis were diagnosed, and a hysterectomy was scheduled. During preoperative evaluation, meningeal signs were found. The first lumbar puncture (LP) showed a lymphomononuclear pleocytosis, hypoglycorrhachia and hyperproteinorrachia. After five days treatment with ceftriaxone, v...
Source: Infezioni in Medicina - Category: Infectious Diseases Tags: Infez Med Source Type: research
CONCLUSIONS: In 42 cases of angular pregnancy diagnosed by first-trimester ultrasound examination, outcomes were largely positive, with an 80% live-birth rate and a 20% early pregnancy loss rate. Early diagnosis of angular pregnancy using the described criteria may represent an entity that more closely resembles a normal, noneccentric intrauterine pregnancy rather than an ectopic pregnancy. Therefore, most cases can be closely observed and efforts made to expectantly manage pregnancies while awaiting viability. PMID: 31809430 [PubMed - as supplied by publisher]
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
Authors: Elias KM, Berkowitz RS, Horowitz NS Abstract Gestational trophoblastic disease refers to a series of interrelated tumors arising from the placenta, including benign molar pregnancies as well as the malignant conditions termed gestational trophoblastic neoplasia (GTN). GTN most commonly follows a molar pregnancy but may develop after any gestation. The wide availability of first trimester ultrasound and serum human chorionic gonadotropin (hCG) measurement has changed the presentation of molar pregnancy in recent decades from a second trimester to a first trimester disease, such that most patients have few s...
Source: Journal of the National Comprehensive Cancer Network : JNCCN - Category: Cancer & Oncology Tags: J Natl Compr Canc Netw Source Type: research
Conclusions: Uterine arteries POPB is a promising technique that may be adopted in women with placenta praevia to prevent hemorrhagic complications. PMID: 31642721 [PubMed - as supplied by publisher]
Source: Minimally Invasive Therapy and Allied Technologies - Category: Surgery Tags: Minim Invasive Ther Allied Technol Source Type: research
Conclusions: Surgical treatment of anomalous placement of the placenta in third-level hospitals can prevent adverse perinatal outcomes. Expectant management is possible in selected patients. PMID: 31631190 [PubMed - in process]
Source: Cirugia y Cirujanos - Category: Surgery Authors: Tags: Cir Cir Source Type: research
A 30-year-old gravida 4, para 2 with two prior cesarean sections presented with persistent abnormal uterine bleeding one month following a surgical abortion at 7-weeks-gestation. 3D ultrasonography demonstrated a 6 cm vascular heterogenous mass at the prior uterine incision with lateral extension beyond the cesarean section scar concerning for placental increta (Fig 1). An ultrasound-guided dilation and curettage was performed by the family planning division to rule out a new pregnancy or placental tumor in light of abnormal beta-HCG levels (56-114 mIU/mL), but pathological examination only yielded necrotic placental tissue.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Images in Gynecological Surgery Source Type: research
ConclusionSCEM followed by SC appears to be an effective treatment option for CSP. The method seems to be safe in short-term follow-up. However, complications were observed in long-term follow-up. Therefore, patients should be informed about the risk of complications interfering with future fertility, such as intrauterine adhesions and/or amenorrhea.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
CONCLUSION: Given the myometrial defects and placenta increta observed in a pregnancy after uterine artery embolization without documented fibroids or uterine surgery, consideration should be given to antenatal myometrial thickness surveillance. PMID: 31285167 [PubMed - as supplied by publisher]
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
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