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
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.
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.
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]
ConclusionAny reproductive-aged woman with at least one ovary and a means for sperm to meet egg should be screened for pregnancy if she presents with an acute abdomen or abdominal or pelvic pain.
Dominique E. Martin1,2, Amanda K. Jones1,3, Sambhu M. Pillai1,4, Maria L. Hoffman1,5, Katelyn K. McFadden1,6, Steven A. Zinn1, Kristen E. Govoni1 and Sarah A. Reed1* 1Department of Animal Science, University of Connecticut, Storrs, CT, United States 2Department of Psychology, Providence College, Providence, RI, United States 3Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Aurora, CO, United States 4School of Medicine, Georgetown University, Washington, DC, United States 5Department of Fisheries, Animal and Veterinary Sciences, The University of Rhode Island, Kingston, RI, United St...
ConclusionsCaesarean scar pregnancies are uncommon. Multiple treatment strategies have been employed, with variable degrees of success. Further research into risk stratification and management are needed to guide clinician and patient decision making.
CONCLUSION: A GnRH agonist in combination with transient aromatase inhibitor and tranexamic acid is an effective management strategy to treat and maintain reproduction in women with AVMs associated with AUB. PMID: 30413336 [PubMed - as supplied by publisher]
Rationale: Placental site trophoblastic tumor (PSTT) is a very rare malignant tumor, belonging to a family of pregnancy-related illnesses, called gestational trophoblastic diseases (GTD). Less than 300 cases of PSTT have been reported in literature, with an incidence of ≈ 1/50,000–100,000 pregnancies representing only 0.23% to 3.00% of all GTDs. Patient concerns: Our report describes 2 additional cases of PSTT outlining their main diagnostic features and the subsequent management. The first case presented contemporary to a persistent hydatidiform mole in a 37-year-old woman, para 2042; whereas the second...
Cesarean delivery can change the angle of a woman's uterus from an anteflexed...Read more on AuntMinnie.comRelated Reading: Can ultrasound screen for fetal growth restriction? US body fat measure predicts obstetric complications Fewer women are getting hysterectomies Under scrutiny: Pregnancy after uterine fibroid embolization How interventional radiologists can make childbirth safer
Conclusions Recent research supports any method that removes the pregnancy and scar to reduce morbidity and promote future fertility. Laparoscopic and transvaginal approaches are options for CSEP treatment, although continued research is required to identify the optimal approach. Relevance As cesarean delivery numbers rise, a subsequent increase in CSEPs can be anticipated. The ability to accurately diagnose and treat this morbid condition is vital to the practice of any specialist in general obstetrics and gynecology. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After ...