The pathology of placenta accreta, a worldwide epidemic

Khong, T. Y.

doi:10.1136/jcp.2008.055202

Cited by 186 publications

(139 citation statements)

References 45 publications

(45 reference statements)

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“…Placenta accreta, increta or percreta are associated with major pregnancy complications 58 and are thought to be becoming more common 59 owing to a number of factors including rising maternal age at delivery and an increasing proportion of deliveries by caesarean. 60,61 This finding is of particular concern in the context of increasing rates of caesarean delivery and older maternal age at childbirth.…”

Section: Placenta Accreta/increta/percretamentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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BackgroundStudies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.ObjectivesTo (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.MethodsMixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.SettingMaternity units in all four countries of the UK.ParticipantsWomen with near-miss maternal morbidities, their partners and comparison women without severe morbidity.Main outcome measuresThe incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.ResultsWomen and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.LimitationsThis programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.ConclusionsImplementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Placenta Accreta/increta/percretamentioning

confidence: 99%

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight

Acosta

Brocklehurst

et al. 2016

Programme Grants Appl Res

101

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“…Another feature of PA is larger radial and arcuate arteries showing pregnancy-induced changes (a loss of muscular and elastic tissue from their walls), which are morphological changes usually confined to the smaller spiral arteries. 12,13 The early prenatal diagnosis of PA is based on the presence of characteristic findings on targeted ultrasound examination, whenever PA is suspected or in the presence of risk factors. 14 Magnetic resonance imaging (MRI) is also effective in prenatal diagnosis, and is useful in the case of inconclusive findings.…”

Section: Introductionmentioning

confidence: 99%

Placenta accreta is associated with IVF pregnancies: a retrospective chart review

Esh-Broder¹,

Ariel

Abas-Bashir³

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

168

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deliveries occurred in our hospital, including 752 (3%) deliveries of IVF pregnancies.Methods Placenta accreta was only diagnosed when there were histological findings from the placenta associated with the suitable clinical course. Demographic, obstetrical and fertility characteristics of these patients were retrieved from hospital files.Main outcome measure Rates of PA in pregnancies achieved with IVF versus rates of PA in spontaneous pregnancies.Results The rate of PA in the IVF group was 12/752 (16/1000) pregnancies, compared with 30/24 441 (1.2/1000) among spontaneous pregnancies (P < 0.0001; OR 13.2; 95% CI 6.7-25.8). Among the variables examined, parity, rate of caesarean delivery in the index pregnancy, and birthweight differed significantly between IVF and spontaneous pregnancies.Conclusions The odds of developing PA are significantly higher in IVF pregnancies than in spontaneous pregnancies. These differences may stem from differences in the endometrial environment, or from changes to the endometrium wrought by IVF treatment protocols.

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“…Approximately one in three pregnancies is delivered by caesarean, accounting for over one million surgeries each year "as solved by ) [5]" . In the USA, it increased from 21.2 to 32.8% from 1990 to 2011 "as solved by (Van der Voet et al, 2014) [6]" .Caesarean delivery rates in industrialized countries continue to rise "as solved by (SCOTT), and (Khong, 2008). [7], [8]".…”

Section: Introductionmentioning

confidence: 99%

“…In the USA, it increased from 21.2 to 32.8% from 1990 to 2011 "as solved by (Van der Voet et al, 2014) [6]" .Caesarean delivery rates in industrialized countries continue to rise "as solved by (SCOTT), and (Khong, 2008). [7], [8]". Furthermore, rate of caesarean delivery has been increasing in low-resource countries "as solved by (Stanton et al) [9]", In Nepal, caesarean rates among tertiary hospitals ranged from 12% to 25% in 2012 "as solved by (Karkee et al 2014) [10]" At Ain Shams University Hospital Hospital, incidence of C.S increased from 20% in 1993 to 44% in 2013 and expected to be more (Ain Shams Maternity Hospital Statistics).…”

Section: Introductionmentioning

confidence: 99%

Histological and histopathological study of the lower uterine segment after previous caesarean section and placenta accreta

Abdulsalam

Azzam²,

Helaly³

et al. 2017

IJBAS

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The pathology of placenta accreta, a worldwide epidemic

Cited by 186 publications

References 45 publications

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Placenta accreta is associated with IVF pregnancies: a retrospective chart review

Histological and histopathological study of the lower uterine segment after previous caesarean section and placenta accreta

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