Journal of Perinatal Medicine最新文献_第10页

Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study 延迟夹断脐带是否会导致初次剖宫产的产妇失血量增加？回顾性比较研究

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-27 DOI: 10.1515/jpm-2023-0450

Fabia L. Urech, Thierry Girard, Maya Brunner, Andreas Schoetzau, Olav Lapaire

{"title":"Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study","authors":"Fabia L. Urech, Thierry Girard, Maya Brunner, Andreas Schoetzau, Olav Lapaire","doi":"10.1515/jpm-2023-0450","DOIUrl":"https://doi.org/10.1515/jpm-2023-0450","url":null,"abstract":"Objectives The University Hospital Basel implemented delayed umbilical cord clamping of 30–60 s in all laboring women on April 1, 2020. This practice has been widely researched showing substantial benefit for the neonate. Few studies focused on maternal blood loss. The objective of our retrospective comparative study was to assess the impact of immediate vs. delayed cord clamping on maternal blood loss in primary scheduled cesarean sections. Methods We analyzed data of 98 women with singleton gestations undergoing primary scheduled cesarean section at term. Data from procedures with early cord clamping (ECC) were compared to those after implementation of delayed cord clamping (DCC). Primary outcomes were perioperative change in maternal hemoglobin levels, estimated and calculated blood loss. Secondary outcomes included duration of cesarean section and neonatal data. Results There was a statistically significant difference in the mean perioperative decline of hemoglobin of 10.4 g/L (SD=7.92) and 18.7 g/L (SD=10.4) between the ECC and DCC group, respectively (p<0.001). The estimated (482 mL in ECC vs. 566 mL in DCC (p=0.011)) and the calculated blood loss (438 mL in ECC vs. 715 mL in DCC (p=0.002)) also differed significantly. Secondary outcomes showed no significant differences. Conclusions In our study DCC resulted in a statistically significant higher maternal blood loss. In our opinion the widely researched neonatal benefit of DCC outweighs the risk of higher maternal blood loss in low-risk patients. However, maternal risks must be minimized, improvements to preoperative blood management and operative techniques are required.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"7 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140812335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care 减少产前基因检测决策中的决策冲突：产前护理开始时进行的父子干预的影响

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-26 DOI: 10.1515/jpm-2023-0442

Christina Collart, Caitlin Craighead, Meng Yao, Susannah Rose, Edward K. Chien, Richard M. Frankel, Marissa Coleridge, Bo Hu, Brownsyne Tucker Edmonds, Angela C. Ranzini, Ruth M. Farrell

{"title":"Reducing decisional conflict in decisions about prenatal genetic testing: the impact of a dyadic intervention at the start of prenatal care","authors":"Christina Collart, Caitlin Craighead, Meng Yao, Susannah Rose, Edward K. Chien, Richard M. Frankel, Marissa Coleridge, Bo Hu, Brownsyne Tucker Edmonds, Angela C. Ranzini, Ruth M. Farrell","doi":"10.1515/jpm-2023-0442","DOIUrl":"https://doi.org/10.1515/jpm-2023-0442","url":null,"abstract":"Objectives Decisional conflict and regret about prenatal genetic screening and diagnostic tests may have important consequences in the current pregnancy and for future reproductive decisions. Identifying mechanisms that reduce conflict associated with the decision to use or decline these options is necessary for optimal patient counseling. Methods We conducted a cluster-randomized controlled trial of a shared decision-making tool (NEST) at the beginning of prenatal care. Enrolled patients completed follow-up surveys at the time of testing (QTT) and in the second–third trimester (QFF), including the Decision Conflict Scale (DCS). Total DCS scores were analyzed using a multivariate linear mixed-effect model. Results Of the total number of participants (n=502) enrolled, 449 completed the QTT and QFF surveys. The mean age of participants was 31.6±3.8, with most parous at the time of study participation (n=321; 71.7 %). Both the NEST (the intervention) and control groups had lower median total DCS scores at QFF (NEST 13.3 [1.7, 25.0] vs. control 16.7 [1.7, 25.0]; p=0.24) compared to QTT (NEST 20.8 [5.0, 25.0] vs. control 18.3 [3.3, 26.7]; p=0.89). Participants exposed to NEST had lower decisional conflict at QFF compared to control (β −3.889; [CI −7.341, −0.437]; p=0.027). Conclusions Using a shared decision-making tool at the start of prenatal care decreased decisional conflict regarding prenatal genetic testing. Such interventions have the potential to provide an important form of decision-making support for patients facing the unique type of complex and preference-based choices about the use of prenatal genetic tests.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"39 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140806757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes 胎膜早破并发妊娠中胎儿超声心动图检查的价值

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-19 DOI: 10.1515/jpm-2023-0448

Monika Pasieczna, Joanna Kuran-Ohde, Agnieszka Grzyb, Renata Bokiniec, Agata Wójcik-Sęp, Krzysztof Czajkowski, Joanna Szymkiewicz-Dangel

{"title":"Value of fetal echocardiographic examination in pregnancies complicated by preterm premature rupture of membranes","authors":"Monika Pasieczna, Joanna Kuran-Ohde, Agnieszka Grzyb, Renata Bokiniec, Agata Wójcik-Sęp, Krzysztof Czajkowski, Joanna Szymkiewicz-Dangel","doi":"10.1515/jpm-2023-0448","DOIUrl":"https://doi.org/10.1515/jpm-2023-0448","url":null,"abstract":"Objectives Cardiopulmonary and infectious complications are more common in preterm newborns after preterm premature rupture of membranes (pPROM). Fetal echocardiography may be helpful in predicting neonatal condition. Our aim was to assess the cardiovascular changes in fetuses from pregnancies complicated by pPROM and possible utility in predicting the intrauterine or neonatal infection, and neonatal heart failure (HF). Methods It was a prospective study enrolling 46 women with singleton pregnancies complicated by pPROM between 18+0 and 33+6 weeks of gestation and followed until delivery. 46 women with uncomplicated pregnancies served as a control group. Fetal echocardiographic examinations with the assessment of cardiac structure and function (including pulmonary circulation) were performed in all patients. Results Mean gestational age of pPROM patients was 26 weeks. Parameters suggesting impaired cardiac function in fetuses from pPROM were: higher right ventricle Tei index (0.48 vs. 0.42 p<0.001), lower blood flow velocity in Ao z-score (0.14 vs. 0.84 p=0.005), lower cardiovascular profile score (CVPS), higher rate of tricuspid regurgitation (18.2 % vs. 4.4 % p=0.04) and pericardial effusion (32.6 vs. 0 %). Intrauterine infection was diagnosed in 18 patients (39 %). 4 (8.7 %) newborns met the criteria of early onset sepsis (EOS). HF was diagnosed in 9 newborns. In fetal echocardiographic examination HF group had shorter mitral valve inflow time and higher left ventricle Tei index (0.58 vs. 0.49 p=0.007). Conclusions Worse cardiac function was observed in fetuses from pPROM compared to fetuses from uncomplicated pregnancies.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"21 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Understanding current antenatal Hepatitis C testing and care in maternity services in England 了解英格兰产前丙肝检测和产科服务的现状

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-19 DOI: 10.1515/jpm-2023-0508

Amoolya Vusirikala, Georgia Threadgold, Rachel Roche, Matthew Hibbert, Ruth Simmons, Sharon Webb, Mark Gillyon-Powell, Monica Desai, Sema Mandal

{"title":"Understanding current antenatal Hepatitis C testing and care in maternity services in England","authors":"Amoolya Vusirikala, Georgia Threadgold, Rachel Roche, Matthew Hibbert, Ruth Simmons, Sharon Webb, Mark Gillyon-Powell, Monica Desai, Sema Mandal","doi":"10.1515/jpm-2023-0508","DOIUrl":"https://doi.org/10.1515/jpm-2023-0508","url":null,"abstract":"Objectives Universal opt-out antenatal screening for Hepatitis C virus (HCV) is not currently recommened and it is recommended that maternity services offer risk-based testing. We aimed to investigate antenatal HCV testing and adherence to testing guidance. Methods A cross-sectional survey was circulated to maternity service providers between November–December 2020 which included testing policy, training for healthcare staff, and management of women found to be HCV positive. Descriptive data are presented. Results 75 questionnaires were returned, representing 48 % of English maternity service providers. 87 % of providers reported offering antenatal HCV risk-based testing. Risk factors used to identify pregnant women for testing varied. Less than 15 % of respondents considered women that were ever homeless or with history of incarceraton or from higher HCV prevalence areas as high risk. Conclusions Current antenatal HCV testing practices are inadequate and HCV infection likely goes undiagnosed in pregnancy, especially among vulnerable population groups. In the absence of universal antenatal screening, re-framing antenatal HCV risk-based testing and management as a quality improvement initiative and developing HCV specific pathway guidance for maternity units is required.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"123 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bias in the prenatal lung measurements in fetal congenital diaphragmatic hernia with intrauterine growth restriction 胎儿先天性膈疝合并宫内生长受限时产前肺测量的偏差

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-18 DOI: 10.1515/jpm-2023-0425

Emrah Aydın, Narmina Khanmammadova, Patricia Burns, Foong-Yen Lim, Mounira A. Habli, Jose Luis Peiró

{"title":"Bias in the prenatal lung measurements in fetal congenital diaphragmatic hernia with intrauterine growth restriction","authors":"Emrah Aydın, Narmina Khanmammadova, Patricia Burns, Foong-Yen Lim, Mounira A. Habli, Jose Luis Peiró","doi":"10.1515/jpm-2023-0425","DOIUrl":"https://doi.org/10.1515/jpm-2023-0425","url":null,"abstract":"Objectives The failure of a fetus to develop to its full potential due to maternal or placental factors is known as intrauterine growth restriction (IUGR). Fetal head growth is usually preserved in that situation producing a potential discordance between head and body size. Our goal is to discover if IUGR has an impact on the prenatal ultrasound measurements taken to assess pulmonary development in congenital diaphragmatic hernia (CDH). Methods A retrospective chart review (IRB#2017-6361) was performed on all prenatally diagnosed CDH patients from 2007 to 2016. Patient demographics, fetal and neonatal anthropometric measurements, and fetal lung parameters were the main subjects of the data that were gathered. Fetal growth was assessed by the curves based on US data by Olsen et al. and by Peleg et al. Of 147 CDH patients, 19 (12.9 %) patients were diagnosed with IUGR before the 30th gestational week while there were 20 (13.6 %) patients after the 30th gestational week. Results Patients with IUGR and the observed-to-expected lung-to-head ratio (O/E LHR) less than 25 % had better survival rates both to discharge and date compared to non IUGR group (p=0.226, OR 2.25 95 % CI 0.60–1.08 and p=0.175, OR 2.40 95 % CI 0.66–1.17, respectively). Moreover, the ECMO need of the patients who had IUGR and O/E LHR less than 25 % was significantly less than the patients without IUGR (38.5 vs. 80.0 %, p=0.005). Conclusions This study confirms that the intrauterine measurements to predict pulmonary hypoplasia in CDH patients are misleading in the presence of IUGR and cause an overestimation.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"131 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association between aneuploidy screening analytes and adverse outcomes in twin gestations 非整倍体筛查分析物与双胎妊娠不良结局之间的关系

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-18 DOI: 10.1515/jpm-2023-0499

Kelly Yamasato, Aiwa Ono

{"title":"Association between aneuploidy screening analytes and adverse outcomes in twin gestations","authors":"Kelly Yamasato, Aiwa Ono","doi":"10.1515/jpm-2023-0499","DOIUrl":"https://doi.org/10.1515/jpm-2023-0499","url":null,"abstract":"Objectives To evaluate associations between serum analytes used for genetic screening and obstetric complications among twin pregnancies. Methods This cohort included twins delivered at a tertiary care hospital from 2009 to 2017. Abnormal levels of pregnancy associated plasma protein (PAPP-A), first and second trimester human chorionic gonadotropin (hCG), alpha fetoprotein (AFP), estriol, and inhibin, reported as multiples of the median (MoM), were defined as <5 %ile or >95 %ile for our cohort. Associations between abnormal analytes and preterm delivery, small for gestational age, and pregnancy-associated hypertension were calculated using Fisher’s exact test. Results A total of 357 dichorionic/diamniotic and 123 monochorionic/diamniotic twins were included. Among dichorionic/diamniotic twins, elevated AFP (>3.70 MoM) was associated with increased preterm delivery <34 weeks (44.4 vs. 16.5 %, p=0.007), while elevated inhibin (>4.95 MoM) was associated with increased preterm delivery<37 weeks (94.1 vs. 58.8 %, p=0.004). For monochorionic/diamniotic twins, elevated inhibin (>6.34 MoM) was associated increased preterm delivery <34 weeks (66.7 vs. 24.8 %, p=0.04) and hypertension (66.7 vs. 21.4 %, p=0.03). Conclusions Selected abnormal analyte levels were associated with increased rates of adverse outcomes in twin pregnancies, which differed by chorionicity. Our findings assist providers in interpreting abnormal analyte levels in twin pregnancies and may help to identify those at increased risk for adverse outcomes.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"9 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140630661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin? 患有镰状血红蛋白病的牙买加妇女目前的产科结果--阿司匹林的风险平衡？

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-17 DOI: 10.1515/jpm-2023-0378

Shanea M. P. Gibson, Tiffany A. Hunter, Phillip E. Charles, Melonie A. C. Morgan, Shari K. R. Griffith-Anderson, J. Kennedy Cruickshank, Maxine D. Gossell-Williams, Nadine A. Johnson

{"title":"Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy – a balance of risks for aspirin?","authors":"Shanea M. P. Gibson, Tiffany A. Hunter, Phillip E. Charles, Melonie A. C. Morgan, Shari K. R. Griffith-Anderson, J. Kennedy Cruickshank, Maxine D. Gossell-Williams, Nadine A. Johnson","doi":"10.1515/jpm-2023-0378","DOIUrl":"https://doi.org/10.1515/jpm-2023-0378","url":null,"abstract":"Objectives Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. Methods A retrospective comparative analysis of HbSS, HbSC and HbSβThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. Results Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the ‘non-HbSS’ group, i.e. HbSβThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal ‘near-misses’ (OR=10.7, 95 % 3.5–32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4–16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1–8.9; p=0.037) and preterm birth (OR=2.6, 1.2–5.8; p=0.018) compared to HbSC and HbSβThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04–0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03–0.9, p=0.03)). Conclusions HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"2012 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140612956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Chest radiographic thoracic areas and respiratory outcomes in infants with anterior abdominal wall defects 前腹壁缺损婴儿的胸部影像学胸廓面积和呼吸系统预后

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-04-13 DOI: 10.1515/jpm-2024-0102

Allan Jenkinson, Mirna Krishnan, Mark Davenport, Christopher Harris, Theodore Dassios, Anne Greenough

{"title":"Chest radiographic thoracic areas and respiratory outcomes in infants with anterior abdominal wall defects","authors":"Allan Jenkinson, Mirna Krishnan, Mark Davenport, Christopher Harris, Theodore Dassios, Anne Greenough","doi":"10.1515/jpm-2024-0102","DOIUrl":"https://doi.org/10.1515/jpm-2024-0102","url":null,"abstract":"Objectives Infants with anterior abdominal wall defects (AWD) can suffer from pulmonary complications. Our aims were to determine if the chest radiographic thoracic areas (CRTAs) on day one differed between infants with exomphalos or gastroschisis, whether this related to differing severity of outcomes and if they were lower than those of controls indicating abnormal antenatal lung growth. Methods A review of infants with exomphalos or gastroschisis born between January 2004 and January 2023 was conducted. The control group was term, newborn infants ventilated for poor respiratory drive at birth. Chest radiographs on day one were analysed and the highest CRTA in the first 24 h after birth for each infant included in the analysis. Results The 127 infants with gastroschisis had a lower gestational age and birthweight than the 62 exomphalos infants and 130 controls (all p<0.001) The CRTAs of the controls were greater than the CRTAs of the exomphalos and the gastroschisis infants (p = 0.001). The median CRTA corrected for birthweight was lower in the exomphalos infants [688, IQR 568-875 mm2/kg] than the gastroschisis infants [813, IQE 695-915 mm2/kg] No gastroschisis infant developed bronchopulmonary dysplasia (BPD). A CRTA of 1759 mm2 had a sensitivity of 81 % and specificity of 71 % in predicting BPD in infants with exomphalos. Conclusions Infants with gastroschisis or exomphalos had lower CRTAs than controls suggesting both groups had abnormal antenatal lung development. The CRTA was lower in the exomphalos infants who also had worse respiratory outcomes, hence CRTA assessment may a useful prognostic aid.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"48 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimal closure of the uterus during cesarean section: beyond the two layers. 剖宫产术中子宫的最佳闭合：超越两层。

IF 1.7 4区医学

Journal of Perinatal Medicine Pub Date : 2024-01-25 Print Date: 2024-05-27 DOI: 10.1515/jpm-2024-0003

Caroline Gagnon, Catherine Bergeron, Sarah Maheux-Lacroix, Emmanuel Bujold

引用次数: 0

Sensitivity of antenatal ultrasound in diagnosing posterior placenta accreta spectrum disorders 产前超声诊断后置胎盘频谱紊乱的敏感性

IF 2.4 4区医学

Journal of Perinatal Medicine Pub Date : 2024-01-19 DOI: 10.1515/jpm-2023-0491

Gabriela Dellapiana, Thalia Mok, Lawrence D. Platt, Neil S. Silverman, Christina S. Han, Tania F. Esakoff

{"title":"Sensitivity of antenatal ultrasound in diagnosing posterior placenta accreta spectrum disorders","authors":"Gabriela Dellapiana, Thalia Mok, Lawrence D. Platt, Neil S. Silverman, Christina S. Han, Tania F. Esakoff","doi":"10.1515/jpm-2023-0491","DOIUrl":"https://doi.org/10.1515/jpm-2023-0491","url":null,"abstract":"Objectives Optimal management of placenta accreta spectrum (PAS) requires antenatal diagnosis. We sought to evaluate the sensitivity of ultrasound findings suggestive of PAS in detecting posterior PAS. Methods Cohort study of patients with posterior placentation and pathology-confirmed PAS from 2011 to 2020 at a tertiary center. Patients were excluded if ultrasound images were unavailable. Ultrasounds were reviewed for presence of lacunae, hypervascularity, myometrial thinning, loss of the hypoechoic zone, bridging vessels, abnormal uterine serosa–bladder interface, placental bulge, placental extension into/beyond the myometrium, and an exophytic mass. Risk factors, postpartum outcomes, and ultrasound findings were compared by antepartum suspicion for PAS. Sensitivity was calculated for each ultrasound finding. Results Thirty-three patients were included. PAS was not suspected antenatally in 70 % (23/33). Patients with unsuspected PAS were more likely to be non-Hispanic, have in vitro fertilization, no prior Cesarean deliveries, no placenta previa, and delivered later in gestation. Depth of invasion and estimated blood loss were less for unsuspected PAS, but there was no difference in hysterectomy between groups. Ultrasound findings were less frequently seen in those who were not suspected antenatally: lacunae 17.4 vs. 100 % (p<0.001), hypervascularity 8.7 vs. 80 % (p<0.001), myometrial thinning 4.4 vs. 70 % (p<0.001), and placental bridging vessels 0 vs. 60 % (p<0.001). There was poor sensitivity (0–42.4 %) for all findings. Conclusions Posterior PAS is less likely to be detected antenatally due to a lower sensitivity of typical ultrasound findings in the setting of a posterior placenta. Further studies are needed to better identify reliable markers of posterior PAS.","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":"11 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139510257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0