This study aimed to evaluate our center's experience in diagnosing and managing placenta accreta spectrum (PAS) in a high-risk population, focusing on prenatal ultrasound features associated with PAS severity and maternal outcomes. We conducted a retrospective analysis of 102 high-risk patients with confirmed placenta previa who delivered at our center between 2018 and 2023. Patients underwent transabdominal and transvaginal ultrasound scans, assessing typical sonographic features. Binary and multivariate logistic regression analyses were performed to identify sonographic markers predictive of PAS and relative complications. Key ultrasound features-retroplacental myometrial thinning (<1 mm), vascular lacunae, and retroplacental vascularization-were significantly associated with PAS and a higher risk of surgical complications. An exceedingly rare sign, the "riddled cervix" sign, was observed in only three patients with extensive cervical or parametrial involvement. Those patients had the worst surgical outcomes. This study highlights the utility of specific ultrasound features in stratifying PAS risk and guiding clinical and surgical management in high-risk pregnancies. The findings support integrating these markers into prenatal diagnostic protocols to improve patient outcomes and inform surgical planning.
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http://dx.doi.org/10.3390/jimaging10120315 | DOI Listing |
Cureus
December 2024
Department of Obstetrics and Gynecology Faculty of Medicine, Fukuoka University, Fukuoka, JPN.
An adherent placenta is a life-threatening condition that impairs the mother's life owing to hemorrhagic shock and disseminated intravascular coagulation. Profound hemorrhage resulting from placental abruption is often managed using hysterectomy to preserve the mother's life, although the consequent loss of fertility can be devastating, particularly in younger women. Thus, strategies that facilitate fertility preservation while effectively controlling hemorrhage should be considered viable alternatives.
View Article and Find Full Text PDFCureus
December 2024
Radiology Department, Hospital Regional Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Monterrey, Universidad de Monterrey, Monterrey, MEX.
Placenta percreta is a rare form of disorder found in the spectrum of placenta accreta and represents a considerable cause of maternal complications with an increase in mortality. The radiologist's role is essential due to the support of images acquired by magnetic resonance imaging, given their high sensitivity and specificity to predict the degree of placental invasion in substitution or accompaniment of the ultrasound study between 28 and 32 weeks of gestation. We present the case of a 29-year-old patient who was in her third pregnancy with a history of two cesarean sections at the ISSSTE Regional Hospital in Monterrey, Nuevo León.
View Article and Find Full Text PDFInt J Gynaecol Obstet
January 2025
Department of Obstetrics and Gynecology, The First Affiliate Hospital of Jinan University, Jinan University, Guangzhou, China.
Objectives: To develop and validate a nomogram to predict severe postpartum hemorrhage following cesarean delivery.
Methods: This is a two-center retrospective cohort study. Cesarean delivery patients from the First Affiliate Hospital of Jinan University were divided into a development cohort (n = 11 137) and an internal validation cohort (n = 4739).
AJOG Glob Rep
February 2025
Urology (Mavuduru), Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background: Cesarean hysterectomy for placenta accreta spectrum disorder may be associated with severe hemorrhage because of placental invasion of the myometrium and the uterovesical space or parametrium. It leads to serious complications, such as massive hemorrhage requiring massive transfusion, coagulopathy, bladder and ureteric injuries, need for intensive care unit admission and prolonged hospital stay. To reduce the complications of cesarean hysterectomy for placenta accreta spectrum disorder, ongoing efforts are being made to develop different surgical approaches.
View Article and Find Full Text PDFAm J Obstet Gynecol
January 2025
Department of Obstetrics and Gynecology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
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