Pub Date : 2023-07-01DOI: 10.1097/FM9.0000000000000195
Á. Nieto-Calvache, J. Palacios-Jaraquemada, R. Aryananda, N. Basanta, J. M. Burgos-Luna, F. Rodríguez, Carlos Ordoñez, Daniela Sarria-Ortiz, Laura Muñoz-Córdoba, J. Quintero, Valentina Galindo-Velasco, Adriana Messa-Bryon
Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum:Why Is This Technique Still Performed? Albaro José Nieto-Calvache*, José M. Palacios-Jaraquemada, Rozi Aditya Aryananda, Nicolás Basanta, Juan Manuel Burgos-Luna, Fernando Rodriguez, Carlos Ordoñez, Daniela Sarria-Ortiz, Laura Muñoz-Córdoba, Juan Carlos Quintero, Valentina Galindo-Velasco, Adriana Messa-Bryon
{"title":"Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum: Why Is This Technique Still Performed?","authors":"Á. Nieto-Calvache, J. Palacios-Jaraquemada, R. Aryananda, N. Basanta, J. M. Burgos-Luna, F. Rodríguez, Carlos Ordoñez, Daniela Sarria-Ortiz, Laura Muñoz-Córdoba, J. Quintero, Valentina Galindo-Velasco, Adriana Messa-Bryon","doi":"10.1097/FM9.0000000000000195","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000195","url":null,"abstract":"Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum:Why Is This Technique Still Performed? Albaro José Nieto-Calvache*, José M. Palacios-Jaraquemada, Rozi Aditya Aryananda, Nicolás Basanta, Juan Manuel Burgos-Luna, Fernando Rodriguez, Carlos Ordoñez, Daniela Sarria-Ortiz, Laura Muñoz-Córdoba, Juan Carlos Quintero, Valentina Galindo-Velasco, Adriana Messa-Bryon","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41636925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the relationship between ovarian hyperstimulation syndrome (OHSS) and adverse outcomes using population-based data in the United States. The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders.
Methods: This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota. Data were collected regarding pregnancy history, infertility treatment, and pregnancy outcomes. Using the Rochester Epidemiology Project, study subjects were identified from female patients, aged 18 to 49 years, who were diagnosed with infertility from January 2, 1995 to December 1, 2017, and had a pregnancy greater than 20 weeks' gestation. The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients. Chi-squared test, t test, and multivariate logistic models were used where appropriate.
Results: Patients with OHSS were more likely to deliver preterm (odds ratio, 2.14; 95% confidence interval, 1.26-3.65; P < 0.01), and their neonates were more likely to be small for gestational age (odds ratio, 4.78; 95% confidence interval, 1.61-14.19; P < 0.01). No significant differences between the groups were observed in any other outcome. Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer (odds ratio, 3.03, 95% confidence interval, 1.20-7.66, P = 0.02).
Conclusion: OHSS may lead to preterm birth and small-for-gestational-age neonates, which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.
{"title":"Pregnancy Outcomes Associated with Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study of Infertile Women.","authors":"Ajleeta Sangtani, Maryama Ismail, Amy Weaver, Zaraq Khan","doi":"10.1097/FM9.0000000000000192","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000192","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between ovarian hyperstimulation syndrome (OHSS) and adverse outcomes using population-based data in the United States. The hypothesis is that patients with OHSS were more likely to deliver preterm and more likely to have hypertensive disorders.</p><p><strong>Methods: </strong>This retrospective cohort study identified 94 patients with OHSS and 183 matched referents in eight counties in Minnesota. Data were collected regarding pregnancy history, infertility treatment, and pregnancy outcomes. Using the Rochester Epidemiology Project, study subjects were identified from female patients, aged 18 to 49 years, who were diagnosed with infertility from January 2, 1995 to December 1, 2017, and had a pregnancy greater than 20 weeks' gestation. The primary outcome was preterm delivery or hypertensive disorder of pregnancy incidence in the OHSS group when compared with control patients. Chi-squared test, <i>t</i> test, and multivariate logistic models were used where appropriate.</p><p><strong>Results: </strong>Patients with OHSS were more likely to deliver preterm (odds ratio, 2.14; 95% confidence interval, 1.26-3.65; <i>P</i> < 0.01), and their neonates were more likely to be small for gestational age (odds ratio, 4.78; 95% confidence interval, 1.61-14.19; <i>P</i> < 0.01). No significant differences between the groups were observed in any other outcome. Patients with OHSS are more likely to deliver preterm if they undergo fresh transfer compared with a freeze all and subsequent frozen transfer (odds ratio, 3.03, 95% confidence interval, 1.20-7.66, <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>OHSS may lead to preterm birth and small-for-gestational-age neonates, which changes patient counseling and leads to arranging specialized obstetrical care for these patients with OHSS.</p>","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/5d/mfm-5-144.PMC10399926.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10058272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-28DOI: 10.1097/fm9.0000000000000193
Siyun Wang, Ruixi Zhan, L. Yin
{"title":"Application of Laparoscopy in the Diagnosis and Treatment of Pregnancy Complicated with Uterine Myomas","authors":"Siyun Wang, Ruixi Zhan, L. Yin","doi":"10.1097/fm9.0000000000000193","DOIUrl":"https://doi.org/10.1097/fm9.0000000000000193","url":null,"abstract":"","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42406526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-16DOI: 10.1097/FM9.0000000000000194
N. Obore, Wan Jin, H. Qian, Qian Wei, Hu Yan, Yu Hong
;
;
{"title":"Pregnant Women with Severe Factor VII Deficiency Undergoing Cesarean Section Managed with a Short-Term Regimen of Recombinant Factor VIIa","authors":"N. Obore, Wan Jin, H. Qian, Qian Wei, Hu Yan, Yu Hong","doi":"10.1097/FM9.0000000000000194","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000194","url":null,"abstract":";","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41809379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-18DOI: 10.1097/fm9.0000000000000191
Shiping Liu, Wei Bai, Ying Gao, Chunyan Shi, L. Fan, Junya Chen, Jian Shi, Wei-jie Sun, Xinlin Hou, Hui-xia Yang
{"title":"Conservative Treatment of Fetal Goitrous Hypothyroidism Due to Thyroglobulin Mutations: A Case Report and Literature Review","authors":"Shiping Liu, Wei Bai, Ying Gao, Chunyan Shi, L. Fan, Junya Chen, Jian Shi, Wei-jie Sun, Xinlin Hou, Hui-xia Yang","doi":"10.1097/fm9.0000000000000191","DOIUrl":"https://doi.org/10.1097/fm9.0000000000000191","url":null,"abstract":"","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43914481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-04DOI: 10.1097/fm9.0000000000000187
Fangcan Sun, Jiahui Wang, Youguo Chen, Jie Yin, Bing Han
{"title":"Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia","authors":"Fangcan Sun, Jiahui Wang, Youguo Chen, Jie Yin, Bing Han","doi":"10.1097/fm9.0000000000000187","DOIUrl":"https://doi.org/10.1097/fm9.0000000000000187","url":null,"abstract":"","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41852190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.1097/FM9.0000000000000190
L. Du, Yi Liang, Xiaoyi Wang, Lijun Huang, Xingfei Pan, Jingsi Chen, Dunjin Chen
Abstract Objective This study aimed to investigate the immune response of a pregnant woman who recovered from the coronavirus disease 2019 (COVID_RS) by using single-cell transcriptomic profiling of peripheral blood mononuclear cells (PBMCs) and to analyze the properties of different immune cell subsets. Methods PBMCs were collected from the COVID_RS patient at 28 weeks of gestation, before a cesarean section. The PBMCs were then analyzed using single-cell RNA sequencing. The transcriptional profiles of myeloid, T, and natural killer (NK) cell subsets were systematically analyzed and compared with those of healthy pregnant controls from a published single-cell RNA sequencing data set. Results We identified major cell types such as T cells, B cells, NK cells, and myeloid cells in the PBMCs of our COVID_RS patient. The increase of myeloid and B cells and decrease of T cells and NK cells in the PBMCs in this patient were quite distinct compared with that in the control subjects. After reclustering and Augur analysis, we found that CD16 monocytes and mucosal-associated invariant T (MAIT) cells were mostly affected within different myeloid, T, and NK cell subtypes in our COVID_RS patient. The proportion of CD16 monocytes in the total myeloid population was increased, and the frequency of MAIT cells in the total T and NK cells was significantly decreased in the COVID-RS patient. We also observed significant enrichment of gene sets related to antigen processing and presentation, T-cell activation, T-cell differentiation, and tumor necrosis factor superfamily cytokine production in CD16 monocytes, and enrichment of gene sets related to antigen processing and presentation, response to type II interferon, and response to virus in MAIT cells. Conclusion Our study provides a single-cell resolution atlas of the immune gene expression patterns in PBMCs from a COVID_RS patient. Our findings suggest that CD16-positive monocytes and MAIT cells likely play crucial roles in the maternal immune response against severe acute respiratory syndrome coronavirus 2 infection. These results contribute to a better understanding of the maternal immune response to severe acute respiratory syndrome coronavirus 2 infection and may have implications for the development of effective treatments and preventive strategies for the coronavirus disease 2019 in pregnant women.
{"title":"Cellular and Molecular Atlas of Peripheral Blood Mononuclear Cells from a Pregnant Woman After Recovery from COVID-19","authors":"L. Du, Yi Liang, Xiaoyi Wang, Lijun Huang, Xingfei Pan, Jingsi Chen, Dunjin Chen","doi":"10.1097/FM9.0000000000000190","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000190","url":null,"abstract":"Abstract Objective This study aimed to investigate the immune response of a pregnant woman who recovered from the coronavirus disease 2019 (COVID_RS) by using single-cell transcriptomic profiling of peripheral blood mononuclear cells (PBMCs) and to analyze the properties of different immune cell subsets. Methods PBMCs were collected from the COVID_RS patient at 28 weeks of gestation, before a cesarean section. The PBMCs were then analyzed using single-cell RNA sequencing. The transcriptional profiles of myeloid, T, and natural killer (NK) cell subsets were systematically analyzed and compared with those of healthy pregnant controls from a published single-cell RNA sequencing data set. Results We identified major cell types such as T cells, B cells, NK cells, and myeloid cells in the PBMCs of our COVID_RS patient. The increase of myeloid and B cells and decrease of T cells and NK cells in the PBMCs in this patient were quite distinct compared with that in the control subjects. After reclustering and Augur analysis, we found that CD16 monocytes and mucosal-associated invariant T (MAIT) cells were mostly affected within different myeloid, T, and NK cell subtypes in our COVID_RS patient. The proportion of CD16 monocytes in the total myeloid population was increased, and the frequency of MAIT cells in the total T and NK cells was significantly decreased in the COVID-RS patient. We also observed significant enrichment of gene sets related to antigen processing and presentation, T-cell activation, T-cell differentiation, and tumor necrosis factor superfamily cytokine production in CD16 monocytes, and enrichment of gene sets related to antigen processing and presentation, response to type II interferon, and response to virus in MAIT cells. Conclusion Our study provides a single-cell resolution atlas of the immune gene expression patterns in PBMCs from a COVID_RS patient. Our findings suggest that CD16-positive monocytes and MAIT cells likely play crucial roles in the maternal immune response against severe acute respiratory syndrome coronavirus 2 infection. These results contribute to a better understanding of the maternal immune response to severe acute respiratory syndrome coronavirus 2 infection and may have implications for the development of effective treatments and preventive strategies for the coronavirus disease 2019 in pregnant women.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41435726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-27DOI: 10.1097/FM9.0000000000000189
Q. Feng, Qianwen Cui, Zhan-pei Xiao, Zengyou Liu, S. Fan
Abstract Pregnancy is a physiological state that predisposes women to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a disease that can cause adverse maternal and perinatal outcomes. The severity of coronavirus disease 2019 (COVID-19) disease is known to vary by viral strain; however, evidence for the effects of this virus in pregnant women has yet to be fully elucidated. In this review, we describe maternal and perinatal outcomes, vaccination, and vertical transmission, among pregnant women infected with the different SARS-CoV-2 variants identified to date. We also summarize existing evidence for maternal and perinatal outcomes in pregnant women with specific information relating to SARS-CoV-2 variants. Our analysis showed that Omicron infection was associated with fewer severe maternal and perinatal adverse outcomes while the Delta variant was associated with worse pregnancy outcomes. Maternal deaths arising from COVID-19 were found to be rare (<1.0%), irrespective of whether the virus was a wild-type strain or a variant. Severe maternal morbidity was more frequent for the Delta variant (10.3%), followed by the Alpha (4.7%), wild-type (4.5%), and Omicron (2.9%) variants. The rates of stillbirth were 0.8%, 4.1%, 3.1%, and 2.3%, respectively, in pregnancies infected with the wild-type strain, Alpha, Delta, and Omicron variants, respectively. Preterm birth and admission to neonatal intensive care units were more common for cases with the Delta infection (19.0% and 18.62%, respectively), while risks were similar for those infected with the wild-type (14.7% and 11.2%, respectively), Alpha (14.9% and 13.1%), and Omicron variants (13.2% and 13.8%, respectively). As COVID-19 remains a global pandemic, and new SARS-CoV-2 variants continue to emerge, research relating to the specific impact of new variants on pregnant women needs to be expanded.
{"title":"Maternal and Perinatal Outcomes of SARS-CoV-2 and Variants in Pregnancy","authors":"Q. Feng, Qianwen Cui, Zhan-pei Xiao, Zengyou Liu, S. Fan","doi":"10.1097/FM9.0000000000000189","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000189","url":null,"abstract":"Abstract Pregnancy is a physiological state that predisposes women to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a disease that can cause adverse maternal and perinatal outcomes. The severity of coronavirus disease 2019 (COVID-19) disease is known to vary by viral strain; however, evidence for the effects of this virus in pregnant women has yet to be fully elucidated. In this review, we describe maternal and perinatal outcomes, vaccination, and vertical transmission, among pregnant women infected with the different SARS-CoV-2 variants identified to date. We also summarize existing evidence for maternal and perinatal outcomes in pregnant women with specific information relating to SARS-CoV-2 variants. Our analysis showed that Omicron infection was associated with fewer severe maternal and perinatal adverse outcomes while the Delta variant was associated with worse pregnancy outcomes. Maternal deaths arising from COVID-19 were found to be rare (<1.0%), irrespective of whether the virus was a wild-type strain or a variant. Severe maternal morbidity was more frequent for the Delta variant (10.3%), followed by the Alpha (4.7%), wild-type (4.5%), and Omicron (2.9%) variants. The rates of stillbirth were 0.8%, 4.1%, 3.1%, and 2.3%, respectively, in pregnancies infected with the wild-type strain, Alpha, Delta, and Omicron variants, respectively. Preterm birth and admission to neonatal intensive care units were more common for cases with the Delta infection (19.0% and 18.62%, respectively), while risks were similar for those infected with the wild-type (14.7% and 11.2%, respectively), Alpha (14.9% and 13.1%), and Omicron variants (13.2% and 13.8%, respectively). As COVID-19 remains a global pandemic, and new SARS-CoV-2 variants continue to emerge, research relating to the specific impact of new variants on pregnant women needs to be expanded.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48976964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-24DOI: 10.1097/fm9.0000000000000188
Kuanhui Xiang, Yihua Zhou
{"title":"Breastmilk—Old but Not Obsolete: from the Safety of Breastfeeding During the Coronavirus Disease 2019 Pandemic to Broad Antiviral Drug Development","authors":"Kuanhui Xiang, Yihua Zhou","doi":"10.1097/fm9.0000000000000188","DOIUrl":"https://doi.org/10.1097/fm9.0000000000000188","url":null,"abstract":"","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43733690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-03DOI: 10.1097/FM9.0000000000000183
Xinrui Yang, Weiran Zheng, Jie Yan, Hui-lin Yang
Abstract Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications. Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1, 2018, and December 31, 2018; 45 patients without a history of pregnancy were selected. The collected data mainly included demographic characteristics (including age, operative history, and ultrasound findings) and maternal-fetal outcomes (including any history of intraoperative bleeding, blood transfusion details, maternal-fetal complications, and fetal Apgar scores). SPSS 24.0 was used for statistical analyses. The Mann-Whitney U test and logistic regression were performed; a two-tailed P < 0.050 was considered statistically significant. Results Ultrasound-based detection of placenta previa (χ2 = 9.911, P = 0.003) showed a strong association with placenta accreta spectrum types. The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa (χ2 = 11.626, P = 0.009) and being diagnosed by ultrasound (χ2 = 5.449, P = 0.047). Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis (χ2 = 8.785, P = 0.004). On univariate analysis, older age led to more complications (U = 82.000, P = 0.011), and in vitro fertilization-embryo transfer caused more intraoperative bleeding (U = 91.500, P = 0.007). Although the 1- and 5-minute Apgar scores were statistically significant, the rates of neonatal asphyxia did not differ (P > 0.050). Endometrial damage led to lower Apgar scores on both univariate (1 minute: U = 29.500, P = 0.027; and 5 minutes: U = 33.500, P = 0.031) and multivariate (1 minute: β = −1.510, 95% confidence interval, −2.639 to 0.381, P = 0.010; and 5 minutes: β = −0.968, 95% confidence interval, −1.779 to 0.157, P = 0.021) analyses. Conclusion In patients who had no history of pregnancy, placenta previa was a strong risk factor for severe placenta accreta spectrum disorders. Endometrial damage led to lower Apgar scores; this warrants greater consideration in the clinic.
【摘要】目的探讨无妊娠史患者发生胎盘增生谱系障碍的相关因素，并评价其预后意义。方法回顾性队列研究纳入2018年1月1日至2018年12月31日在中国10家三级医院根据标准化诊断标准诊断为胎盘增生谱系障碍的1009例患者;选择无妊娠史的患者45例。收集的资料主要包括人口统计学特征(包括年龄、手术史和超声检查结果)和母胎结局(包括术中出血史、输血细节、母胎并发症和胎儿Apgar评分)。采用SPSS 24.0进行统计分析。采用Mann-Whitney U检验和logistic回归;双尾P < 0.050认为有统计学意义。结果超声检测前置胎盘(χ2 = 9.911, P = 0.003)与胎盘增生谱类型有较强相关性。胎盘增生谱的严重程度与合并完全性前置胎盘的可能性(χ2 = 11.626, P = 0.009)和超声诊断的可能性(χ2 = 5.449, P = 0.047)成正比。输血对胎盘增生谱类型的影响也与产妇预后有关(χ2 = 8.785, P = 0.004)。单因素分析中，年龄越大并发症越多(U = 82.000, P = 0.011)，体外受精-胚胎移植术中出血越多(U = 91.500, P = 0.007)。虽然1分钟和5分钟Apgar评分有统计学意义，但新生儿窒息率没有差异(P < 0.05)。子宫内膜损伤导致Apgar评分较低(1分钟:U = 29.500, P = 0.027;和5分钟:U = 33.500, P = 0.031)和多变量(1分钟:β =−1.510,95%可信区间，−2.639 ~ 0.381,P = 0.010;和5分钟:β =−0.968,95%可信区间，−1.779至0.157,P = 0.021)分析。结论在无妊娠史的患者中，前置胎盘是发生重度胎盘增生谱系障碍的重要危险因素。子宫内膜损伤导致Apgar评分降低;这在临床上值得更多的考虑。
{"title":"High Risk Factors for Placenta Accreta Other than Pregnancy and Their Impact on Patient Prognosis","authors":"Xinrui Yang, Weiran Zheng, Jie Yan, Hui-lin Yang","doi":"10.1097/FM9.0000000000000183","DOIUrl":"https://doi.org/10.1097/FM9.0000000000000183","url":null,"abstract":"Abstract Objective This study aimed to determine the most pertinent factors responsible for placenta accreta spectrum disorders in patients without any history of pregnancy and evaluate their prognostic implications. Methods This retrospective cohort study included 1009 patients diagnosed with placenta accreta spectrum disorders based on standardized diagnostic criteria across 10 tertiary hospitals in China between January 1, 2018, and December 31, 2018; 45 patients without a history of pregnancy were selected. The collected data mainly included demographic characteristics (including age, operative history, and ultrasound findings) and maternal-fetal outcomes (including any history of intraoperative bleeding, blood transfusion details, maternal-fetal complications, and fetal Apgar scores). SPSS 24.0 was used for statistical analyses. The Mann-Whitney U test and logistic regression were performed; a two-tailed P < 0.050 was considered statistically significant. Results Ultrasound-based detection of placenta previa (χ2 = 9.911, P = 0.003) showed a strong association with placenta accreta spectrum types. The severity of placenta accreta spectrum was directly proportional to the likelihood of having coexistent complete placenta previa (χ2 = 11.626, P = 0.009) and being diagnosed by ultrasound (χ2 = 5.449, P = 0.047). Blood transfusion also impacted placenta accreta spectrum types in relation to maternal prognosis (χ2 = 8.785, P = 0.004). On univariate analysis, older age led to more complications (U = 82.000, P = 0.011), and in vitro fertilization-embryo transfer caused more intraoperative bleeding (U = 91.500, P = 0.007). Although the 1- and 5-minute Apgar scores were statistically significant, the rates of neonatal asphyxia did not differ (P > 0.050). Endometrial damage led to lower Apgar scores on both univariate (1 minute: U = 29.500, P = 0.027; and 5 minutes: U = 33.500, P = 0.031) and multivariate (1 minute: β = −1.510, 95% confidence interval, −2.639 to 0.381, P = 0.010; and 5 minutes: β = −0.968, 95% confidence interval, −1.779 to 0.157, P = 0.021) analyses. Conclusion In patients who had no history of pregnancy, placenta previa was a strong risk factor for severe placenta accreta spectrum disorders. Endometrial damage led to lower Apgar scores; this warrants greater consideration in the clinic.","PeriodicalId":74121,"journal":{"name":"Maternal-fetal medicine (Wolters Kluwer Health, Inc.)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46145640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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