Midpregnancy Placental Growth Factor Screening and Early Preterm Birth.

Importance: Early preterm birth (ie, at less than 34 weeks' gestation) confers a high risk for adverse health outcomes, yet no universal screening strategy exists, preventing targeted delivery of effective interventions.

Objective: To evaluate the ability of midpregnancy placental growth factor (PlGF) screening to identify pregnancies at highest risk for early preterm birth.

Design, Setting, And Participants: This prospective cohort study was conducted at an urban, tertiary care center from 2020 to 2023.

Improving Early Pregnancy Screening for Placenta Accreta Spectrum: Retrospective Analysis of Early Screening Candidates by Risk Assessment in Canada.

Early screening for placenta accreta spectrum (PAS) is not established in Canada, yet has been demonstrated with a 2-stage strategy in patients classified as at risk at the nuchal translucency examination. We performed a retrospective analysis of women with singleton pregnancies who had first-trimester screening and subsequently had a pathology-confirmed PAS. We sought those who met high-risk clinical criteria for PAS: previous uterine surgeries and an anterior low-lying placenta.

Outcomes in emergency versus electively scheduled cases of placenta accreta spectrum disorder managed by cesarean-hysterectomy within a multidisciplinary care team.

Objective: Compare maternal and perinatal outcomes between emergency and electively scheduled cesarean-hysterectomy for placenta accreta spectrum (PAS) disorders.

Method: Single-center retrospective cohort study including 125 cases of antenatally suspected and pathologically confirmed PAS disorders. Maternal and perinatal outcomes were analyzed.

Identification of Essential Steps in Outlet Forceps-Assisted Vaginal Delivery: A Delphi Study.

Objective: To achieve expert consensus using the Delphi methodology on the sub-steps considered essential in an outlet forceps-assisted vaginal delivery (FAVD). The purpose of this work is to help inform a framework for standardized training and objective assessment in the procedure.

Methods: A Delphi survey was conducted with an international panel of experts in FAVD.

Circulating maternal placental growth factor responses to low-molecular-weight heparin in pregnant patients at risk of placental dysfunction.

Background: Patients at high risk of severe preeclampsia and fetal growth restriction have low circulating levels of placental growth factor and features of maternal vascular malperfusion placental pathology at delivery. Multimodal screening and commencement of aspirin prophylaxis at 11 to 13 weeks' gestation markedly reduces the risk of preterm delivery with preeclampsia. However, the additional role of low-molecular-weight heparin and mechanisms of action remain uncertain.

Stillbirth Following Normal Ultrasound Findings and Maternal Placental Growth Factor Levels.

Background: Attempts to reduce the current rate of antepartum stillbirth in the late third trimester have largely focused on the accurate identification of fetal growth restriction. Universal ultrasound significantly increases detection, especially when combined with maternal angiogenic growth factors, but this screening strategy is not well suited to identify umbilical cord pathology. While this poses unique challenges to pregnancy care, the recurrence risk of cord obstruction is low in comparison with many intrinsic placental diseases.

Safer outcomes for placenta accreta spectrum disorders: A decade of quality improvement.

Objective: To describe the evolution and evaluation of protocol-based multidisciplinary quality improvement (QI) in women undergoing cesarean hysterectomy for radiologically suspected and pathologically confirmed placenta accreta spectrum (PAS) disorders.

Methods: A single-center, retrospective cohort study was conducted of all patients undergoing cesarean hysterectomy for PAS disorders between March 2009 and June 2018. Two distinct periods were defined to compare outcomes: 2009-2011 (initial period) and 2017-2018 (current period).

PlGF (Placental Growth Factor) Testing in Clinical Practice: Evidence From a Canadian Tertiary Maternity Referral Center.

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Minimizing surgical blood loss at cesarean hysterectomy for placenta previa with evidence of placenta increta or placenta percreta: the state of play in 2020.

The evolution of multidisciplinary team-based care for women with placenta accreta spectrum disorder has delivered stepwise improvements in clinical outcomes. Central to this overall goal is the ability to limit blood loss at surgery. Placement of inflatable balloons within the pelvic arteries, most commonly in the anterior divisions of the internal iliac arteries, became popular in many centers, at the expense of prolonging surgical care and with attendant risks of vascular injury.

No. 383-Screening, Diagnosis, and Management of Placenta Accreta Spectrum Disorders.

Background: Placenta accreta spectrum (PAS) disorders are a potentially life-threatening complication of pregnancy that demand coordinated interdisciplinary care to achieve safer outcomes. The rising incidence of this disease is due to a growing number of uterine surgical procedures, including the rising incidence of pregnancy following Caesarean section.

Objective: To provide current evidence-based guidelines on the optimal methods used to effectively screen, diagnose, and manage PAS disorders.

A placenta clinic approach to the diagnosis and management of fetal growth restriction.

Effective detection and management of fetal growth restriction is relevant to all obstetric care providers. Models of best practice to care for these patients and their families continue to evolve. Since much of the disease burden in fetal growth restriction originates in the placenta, the concept of a multidisciplinary placenta clinic program, managed primarily within a maternal-fetal medicine division, has gained popularity.

Conservative Management of Invasive Placenta Using Combined Prophylactic Internal Iliac Artery Balloon Occlusion and Immediate Postoperative Uterine Artery Embolization.

Purpose: The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery.

Methods: Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval.

Two-dimensional sonographic assessment of maximum placental length and thickness in the second trimester: a reproducibility study.

Objectives: To determine the most reproducible method for the sonographic measurement of placental length.

Methods: A prospective study of women with singleton pregnancies who underwent sonographic measurement of placental dimensions during mid-gestation. Two sonographers independently determined placental length using three different approaches (linear, curve-linear and panoramic) and placental thickness.

Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction.

Background: Pregnancy complications such as pre-eclampsia and eclampsia, intrauterine growth restriction and placental abruption are thought to have a common origin related to abnormalities in the development and function of the placenta.

Objectives: To compare, using the best available evidence, the benefits and harms of antenatal antithrombotic therapy to improve maternal or infant health outcomes in women considered at risk of placental dysfunction, when compared with other treatments, placebo or no treatment.

Search Methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 July 2012).

Multidisciplinary management of invasive placenta previa.

Objective: To assess the effectiveness of a multidisciplinary team approach to reduce severe maternal morbidity in women with invasive placenta previa.

Methods: We conducted a prospective study of 33 women with placenta previa and increta-percreta (diagnosed by ultrasound and/or magnetic resonance imaging) delivering at Mount Sinai Hospital, Toronto, following the introduction in January 2008 of a team-based approach to women with this condition. We included women who delivered by June 2012.

Techniques of intrauterine fetal transfusion for women with red-cell isoimmunisation for improving health outcomes.

Background: Red-cell alloimmunisation can occur when there are incompatibilities between a woman's blood type and that of her unborn baby. This can cause the baby to become anaemic (low red blood cell count), which may require treatment during the pregnancy by blood transfusion while the baby remains within the uterus (called an intrauterine blood transfusion).

Objectives: To compare, using the best available evidence, the benefits and harms of different techniques of intrauterine fetal blood transfusion for women with red-cell alloimmunisation.