Placenta Accreta Spectrum and Postpartum Hemorrhage

Abdelwahab, Mahmoud; Cackovic, Michael

doi:10.1097/grf.0000000000000783

Cited by 3 publications

(2 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Managing postpartum hemorrhage in cases of morbid placental adherence requires a coordinated approach involving obstetricians, anesthesiologists, and urologists if there exists an invasion of the urinary bladder. When considering options for preserving the uterus through medical or conservative surgical therapy, such as uterine artery embolization, it is essential to take this differential diagnosis into account before proceeding with a second surgery [36,37]. In our case, although uterine artery embolization could have been a potential option to control vaginal bleeding, the size of the mass led us to conclude that surgical removal was necessary.…”

Section: Discussionmentioning

confidence: 80%

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

Tîrnovanu,

Toma

et al. 2023

JPM

View full text Add to dashboard Cite

Placental morbid adherence is a known risk factor for postpartum hemorrhage. The incidence of abnormal placental attachment has been increasing over the past few decades, mainly due to rising rates of cesarean deliveries, advanced maternal age, and the use of assisted reproductive technologies. Cesarean section is a significant risk factor for placenta increta, as it disrupts the normal architecture of the uterine wall, making it more difficult for the placenta to detach after delivery. We present the case of a woman who underwent a cesarean section at 28 weeks due to anterior placenta previa, accompanied by hemorrhage and rupture of membranes. Following the delivery, she experienced normal postoperative bleeding and was discharged home after five days. However, six weeks later, she presented with heavy bleeding, leading to the decision to perform a total hysterectomy. The levels of HCG were found to be low. The pathological examination of the specimens confirmed a diagnosis of placenta increta, as it revealed notable placental proliferation, necrotic villi, and placental invasion near the uterine serosa. Notably, we did not find any similar cases documented in the literature. Patients experiencing prolonged vaginal bleeding after childbirth and diagnosed with placenta accreta should be closely monitored through ultrasound examinations; abnormal proliferation of the placenta can occur, and prompt detection is crucial for appropriate management.

show abstract

Section: Discussionmentioning

confidence: 80%

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

Tîrnovanu,

Toma

et al. 2023

JPM

View full text Add to dashboard Cite

show abstract

“…PAS is defined as an abnormal trophoblast invasion into the myometrium, and even to or beyond the serosa [1][2][3]. Multiple morbidities were associated with PAS including intractable postpartum hemorrhage, massive blood transfusion, and even maternal death, with more possibilities of hysterectomy, iatrogenic surgical injury to bowel or bladder [4]. Epidemiological research on PAS identifies a history of prior caesarean delivery as the predominant risk factor for the development of PAS [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Single-cell and spatial transcriptomics reveal alterations in trophoblasts at invasion sites and disturbed myometrial immune microenvironment in placenta accreta spectrum disorders

Ji,

Chen,

Pan

et al. 2024

Biomark Res

View full text Add to dashboard Cite

Background Placenta accreta spectrum disorders (PAS) are a severe complication characterized by abnormal trophoblast invasion into the myometrium. The underlying mechanisms of PAS involve a complex interplay of various cell types and molecular pathways. Despite its significance, both the characteristics and intricate mechanisms of this condition remain poorly understood. Methods Spatial transcriptomics (ST) and single-cell RNA sequencing (scRNA-seq), were performed on the tissue samples from four PAS patients, including invasive tissues (ST, n = 3; scRNA-seq, n = 4), non-invasive normal placenta samples (ST, n = 1; scRNA-seq, n = 2). Three healthy term pregnant women provided normal myometrium samples (ST, n = 1; scRNA-seq, n = 2). ST analysis characterized the spatial expression landscape, and scRNA-seq was used to identify specific cellular components in PAS. Immunofluorescence staining was conducted to validate the findings. Results ST slices distinctly showed the myometrium in PAS was invaded by three subpopulations of trophoblast cells, extravillous trophoblast cells, cytotrophoblasts, and syncytiotrophoblasts, especially extravillous trophoblast cells. The pathways enriched by genes in trophoblasts, smooth muscle cells (SMC), and immune cells of PAS were mainly associated with immune and inflammation. We identified elevated expression of the angiogenesis-stimulating gene PTK2, alongside the cell proliferation-enhancing gene EGFR, within the trophoblasts of PAS group. Trophoblasts mainly contributed the enhancement of HLA-G and EBI3 signaling, which is crucial in establishing immune escape. Meanwhile, SMC regions in PAS exhibited upregulation of immunomodulatory markers such as CD274, HAVCR2, and IDO1, with CD274 expression experimentally verified to be increased in the invasive SMC areas of the PAS group. Conclusions This study provided information of cellular composition and spatial organization in PAS at single-cell and spatial level. The dysregulated expression of genes in PAS revealed a complex interplay between enhanced immune escape in trophoblasts and immune tolerance in SMCs during invasion in PAS. These findings will enhance our understanding of PAS pathogenesis for developing potential therapeutic strategies.

show abstract

Fostering Excellence in Obstetrical Surgery

Wilson

2023

JHL

View full text Add to dashboard Cite

This obstetric surgery review is directed toward the common obstetrical surgeries (caesarean delivery, VBAC/TOLAC, operative vaginal delivery, placenta accreta spectrum) with evidence for quality and safety to allow for obstetrical outcome excellence. Materials and Methods: This focused scoping review has used a structured process for article identification and inclusion for each of the focused surgeries. Results: The review results provide an obstetrical surgery (OS) overview for caesarean delivery, vaginal birth after caesarean delivery and/or trial of labor after caesarean delivery, operative vaginal delivery, placenta accreta spectrum; considerations for quality and safety variance due to non-clinical human factors; quality improvement (QI) tools; OS QI implementation cohorts; implementation considering certain barriers and solutions. Conclusion: Administrative health care systems and obstetrical surgery care providers cannot afford, not to consider and implement, certain evidenced-based "bottom-up/top-down" processes for quality and safety, as the patients will demand the quality and the safety, but the lawyers should not have to enforce it.

show abstract

Placenta Accreta Spectrum and Postpartum Hemorrhage

Cited by 3 publications

References 52 publications

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

Unexpected Dramatic Evolution of Placenta Increta: Case Report and Literature Review

Single-cell and spatial transcriptomics reveal alterations in trophoblasts at invasion sites and disturbed myometrial immune microenvironment in placenta accreta spectrum disorders

Fostering Excellence in Obstetrical Surgery

Contact Info

Product

Resources

About