Placenta Praevia and Placenta Accreta: Diagnosis and Management

Jauniaux, E; Alfirević, Z; Bhide, A.; Belfort, Michael A.; Burton, Graham J.; Collins, Sally; Dornan, Samina; Jurkovic, D.; Kayem, Gilles; Kingdom, John; Silver, Robert M.; Sentilhes, Loïc; Gynaecologists,

doi:10.1111/1471-0528.15306

Cited by 366 publications

(426 citation statements)

References 221 publications

(279 reference statements)

Supporting

Mentioning

390

Contrasting

Unclassified

Order By: Relevance

“…(4) International guidelines and literature reviews suggest that the optimal management of placenta praevia pregnancies is Caesarean section at the proper gestational age in a unit with adequate facilities and available blood supplies. (5)(6)(7)(8)(9) However, there is no definite data on the type or volume of blood that should be used for preoperative preparation. In many hospitals, including our institute, four units of packed red blood cells are cross matched, then two units are delivered to be on standby in the operating room.…”

Section: Introductionmentioning

confidence: 99%

Associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies

Titapant¹,

Chongsomboonsuk²

2019

smedj

View full text Add to dashboard Cite

METHODSThis case-control study was conducted after approval by our institutional review board. We included subjects with placenta praevia who underwent Caesarean delivery at a gestational age of INTRODUCTION This study aimed to evaluate associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies.METHODS A case-control study was conducted among 405 pregnant women with placenta praevia who underwent Caesarean delivery between August 2004 and December 2013. 135 of the women received blood transfusions. Another 270 women who did not receive any blood transfusion were randomly selected and served as controls. Maternal demographic data, reproductive history, antepartum profiles and obstetric outcomes were compared between the two groups.RESULTS Women in the case group were significantly more likely to be multiparous, deliver at a gestational age of less than 37 weeks, have a prior Caesarean delivery, experience preoperative bleeding and anaemia, and have major and anterior placenta praevia (p < 0.05). Multivariate analysis demonstrated that significant, independently associated factors of blood transfusion were: previous Caesarean section (adjusted odds ratio [OR] 2.30, 95% confidence interval [CI] 1.36-3.90), anterior placenta praevia (adjusted OR 2.30, 95% CI 1.15-4.60), major placenta praevia (adjusted OR 2.39, 95% CI 1.34-4.22), preoperative bleeding of more than 250 mL (adjusted OR 6.11, 95% CI 2.35-15.90), preoperative anaemia (adjusted OR 2.31, 95% CI 1.34-4.00) and emergency Caesarean section (adjusted OR 2.14, 95% CI 1.08-4.22).CONCLUSION Previous Caesarean section, anterior placentation, major placenta praevia, preoperative bleeding of more than 250 mL, preoperative anaemia and emergency Caesarean section were independent factors that increased the risk of blood transfusion for Caesarean section in pure placenta praevia pregnancies.

show abstract

Section: Introductionmentioning

confidence: 99%

Associated factors of blood transfusion for Caesarean sections in pure placenta praevia pregnancies

Titapant¹,

Chongsomboonsuk²

2019

smedj

View full text Add to dashboard Cite

show abstract

“…The placenta was defined as placenta previa when it was lying directly over the internal os and as low-lying when it was situated < 20 mm from the internal os 11 . Antenatal diagnosis of PAS disorder was based on the following typical ultrasound signs 18 : loss of the clear zone, defined as loss of the hypoechoic plane between the placenta and the underlying myometrium; presence of placental lacunae, defined as irregular vascular spaces within the placental parenchyma, showing turbulent flow within, on grayscale or color Doppler ultrasound; bladder-wall interruption, defined as loss or interruption of the echogenic bladder border; and uterovesical hypervascularity, defined as the presence of vessels visualized by color Doppler crossing the myometrium and extending from the placenta to the posterior bladder wall or to other organs, often running perpendicular to the myometrium.…”

Section: Methodsmentioning

confidence: 99%

“…Ultrasound represents the gold standard for antenatal evaluation of women at risk for PAS disorder, while magnetic resonance imaging is usually performed to define the depth and topography of placental invasion, particularly in cases of posterior low-lying placenta [5][6][7][8][9][10][11] . However, a significant proportion of cases with PAS disorder still remain undiagnosed before surgery 12 .…”

Section: Introductionmentioning

confidence: 99%

Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low‐lying placenta

Pasquo

Ghi

Calì

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective To evaluate the diagnostic accuracy of a new ultrasound sign, intracervical lakes (ICL), in predicting the presence of placenta accreta spectrum (PAS) disorder and delivery outcome in patients with placenta previa or low‐lying placenta. Methods This was a retrospective multicenter study of women with placenta previa or low‐lying placenta at ≥ 26 weeks' gestation, who were referred to three Italian tertiary units from January 2015 to September 2018. The presence of ICL, defined as tortuous anechoic spaces within the cervix which appeared to be hypervascular on color Doppler, was evaluated on ultrasound images obtained at the time of referral. The primary aim was to explore the diagnostic accuracy of ICL in detecting the presence and depth of PAS disorder. The secondary aim was to explore the accuracy of this sign in predicting total estimated blood loss, antepartum bleeding, major postpartum hemorrhage at the time of Cesarean section and need for Cesarean hysterectomy. The diagnostic accuracy of ICL in combination with typical sonographic signs of PAS disorder, was assessed by computing summary estimates of sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and diagnostic odds ratios (DOR). Results A total of 332 women with placenta previa or low‐lying placenta were included in the analysis, with a median maternal age of 33.0 (interquartile range, 29.0–37.0) years. ICL were noted in 15.1% of patients. On logistic regression analysis, the presence of ICL was associated independently with major postpartum hemorrhage (odds ratio (OR), 3.3 (95% CI, 1.6–6.5); P < 0.001), Cesarean hysterectomy (OR, 7.0 (95% CI, 2.1–23.9); P < 0.001) and placenta percreta (OR, 2.8 (95% CI, 1.3–5.8); P ≤ 0.01), but not with the presence of any PAS disorder (OR, 1.6 (95% CI, 0.7–3.5); P = 0.2). Compared with the group of patients without ultrasound signs of PAS disorder, the presence of at least one typical sonographic sign of PAS disorder in combination with ICL had a DOR of 217.2 (95% CI, 27.7–1703.4; P < 0.001) for placenta percreta and of 687.4 (95% CI, 121.4–3893.0; P < 0.001) for Cesarean hysterectomy. Conclusion ICL may represent a marker of deep villus invasion in women with suspected PAS disorder on antenatal sonography and anticipate the occurrence of severe maternal morbidity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

show abstract

“…The estimated prevalence of CSP is 1 in 1500–2000 women with a previous CS. There is also a wide variation in the reported prevalence of placenta accreta, ranging between 1 in 300 and 1 in 2000 pregnancies. A systematic review of 14 cohort studies including 3889 pregnancies found a pooled incidence of placenta previa accreta of 4.1% in women with one prior CS and 13.3% in those with at least two previous Cesarean deliveries.…”

Section: Pathophysiology Of Cspmentioning

confidence: 99%