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Oxygen-Enhanced Magnetic Resonance Imaging (OE-MRI) of the human placenta is potentially a sensitive marker of in vivo oxygenation. This methodological study shows that full coverage of the placenta is possible using 3D mapping of the change in longitudinal relaxation rate (ΔR1), in a group of healthy pregnant subjects breathing elevated levels of oxygen. Twelve pregnant subjects underwent a comparison of 2D and 3D OE-MRI. ΔR1 was mapped for a single 2D slice (ss-2D), a single matched-slice from the 3D volume (ss-3D) and the full 3D volume (vol-3D). The group-average median ΔR1 values for ss-3D (0.023 s-1) and vol-3D (0.022 s-1) do not differ significantly from ss-2D (0.020 s-1), when compared using a two-tailed paired t-test (ss-3D (p = 0.58) and vol-3D (p = 0.70)). However, median baseline T1 (T1b) for ss-2D was higher (1603 ms) than T1b for ss-3D (1540 ms, p = 0.07) and significantly higher than vol-3D (1515 ms, p = 0.02), when compared using a two-tailed paired t-test. In contrast with previous studies, no correlation of median ΔR1 with gestation age at scan for the normal group (N = 10) was observed for ss-2D, likely due to the smaller gestational range. Full volume OE-MRI maps reveal sensitivity to changes in ΔR1, with some participants showing an enhanced gradient in the intermediate space between the fetal and maternal sides of the placenta in the 3D data. This study shows that it is feasible to acquire whole placental volume OE-MRI data in women with healthy pregnancy. [ABSTRACT FROM AUTHOR]

Placenta Accreta Spectrum (PAS) is a life-threatening condition in which placental trophoblastic cells abnormally invade the uterus, often up to the uterine serosa and, in extreme cases, tissues beyond the uterine wall. Currently, there is no clinical assay for the non-invasive detection of PAS, and only ultrasound and MRI can be used for its diagnosis. Considering the subjectivity of visual assessment, the detection of PAS necessitates a high degree of expertise and, in some instances, can lead to its misdiagnosis. In clinical practice, up to 50% of pregnancies with PAS remain undiagnosed until delivery, and it is associated with increased risk of morbidity/mortality. Although many studies have evaluated the potential of fetal biomarkers circulating in maternal blood, very few studies have evaluated the potential of circulating placental extracellular vesicles (EVs) and their miRNA contents for molecular detection of PAS. Thus, to purify placental EVs from maternal blood, we customized our robust ultra-sensitive immuno-purification assay, termed EV-CATCHER, with a monoclonal antibody targeting the membrane Placental Alkaline Phosphatase (PLAP) protein, which is unique to the placenta and present on the surface of placental EVs. Then, as a pilot evaluation, we compared the miRNA expression profiles of placental EVs purified from the maternal plasma of women diagnosed with placenta previa (controls, n = 16); placenta lying low in uterus but not invasive) to those of placental EVs purified from the plasma of women with placenta percreta (cases, n = 16), PAS with the highest level of invasiveness. Our analyses reveal that miRNA profiling of PLAP+ EVs purified from maternal plasma identified 40 differentially expressed miRNAs when comparing these two placental pathologies. Preliminary miRNA pathway enrichment and gene ontology analysis of the top 14 upregulated and top nine downregulated miRNAs in PLAP+ EVs, purified from the plasma of women diagnosed with placenta percreta versus those diagnosed with placenta previa, suggests a potential role in control of cellular invasion and motility that will require further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum preeclampsia (PPPE) is an under-diagnosed condition, developing within 48 hours to 6 weeks following an uncomplicated pregnancy. The etiology of PPPE is still unknown, leaving patients vulnerable and making the identification and treatment of patients requiring postpartum care an unmet need. We aimed to understand the immune contribution to PPPE at the time of diagnosis, as well as uncover the predictive potential of perinatal biomarkers for the early postnatal identification of high-risk patients. Methods: Placentas were collected at delivery from uncomplicated pregnancies (CTL) and PPPE patients for immunohistochemistry analysis. In this initial study, blood samples in PPPE patients were collected at the time of PPPE diagnosis (48h-25 days postpartum; mean 7.4 days) and compared to CTL blood samples taken 24h after delivery. Single-cell transcriptomics, flow cytometry, intracellular cytokine staining, and the circulating levels of inflammatory mediators were evaluated in the blood. Results: Placental CD163+ cells and 1st trimester blood pressures can be valuable non-invasive and predictive biomarkers of PPPE with strong clinical application prospects. Furthermore, changes in immune cell populations, as well as cytokine production by CD14+, CD4+, and CD8+ cells, suggested a dampened response with an exhausted phenotype including decreased IL1β, IL12, and IFNγ as well as elevated IL10. Discussion: Understandingmaternal immune changes at the time of diagnosis and prenatally within the placenta in our sizable cohort will serve as groundwork for pre-clinical and clinical research, as well as guiding clinical practice for example in the development of immune-targeted therapies, and early postnatal identification of patients who would benefit from more thorough follow-ups and risk education in the weeks following an uncomplicated pregnancy. [ABSTRACT FROM AUTHOR]

This document discusses the use of artificial intelligence (AI) in providing medical information on cerebrovascular diseases. The article highlights the potential benefits of AI in improving the accuracy and efficiency of diagnosis and medical decisions. It specifically focuses on ChatGPT, an AI-powered tool developed by OpenAI that can generate human-like texts for chatbot conversations. The document presents examples of how ChatGPT can provide accurate and comprehensive answers to questions related to pregnancy and the use of warfarin, modifiable risk factors for stroke, the duration of anticoagulant therapy in cerebral sinus vein thrombosis, and the use of combined contact aspiration and stent retriever in the treatment of acute ischemic stroke. While ChatGPT shows promise as a source of medical information, it has limitations and should not replace the expertise of healthcare professionals. It is important to verify the information obtained from ChatGPT with reliable sources. [Extracted from the article]

Objective: The study examines the outcomes of pregnancies conceived at advanced maternal age (AMA) and maternal complications after childbirth among Meitei women of Northeast India. Method: A total of 760 women participants were included in this study and compared among women aged ≥35 years, with a reference group of women aged 20–34 years. Data on obstetric characteristics were collected after obtaining consent. The data were compared using chi‐square analysis, and the results were adjusted using a logistic regression model. Decision trees were developed to predict the potential variables associated with preterm delivery and postpartum complication. Results: In the study, 18.95% of AMA women experienced one or more adverse pregnancy outcomes (APOs). Women with AMA are at significantly increased risk of placenta previa (adjusted odds ratio [AOR] = 4.89, 95% confidence interval [CI]: 2.78–8.57), induction of labor (AOR = 3.69, 95%CI: 2.48–5.50), and caesarean section (AOR = 3.42, 95%CI: 2.28–5.12). Moreover, AMA women have a 1.86–2.76 AOR for developing gestational diabetes, pregnancy‐induced hypertension, urinary tract infections, preterm delivery, and postpartum complications. Decision tree analysis revealed that AMA and urban residence independently predict preterm delivery and postpartum complications. Conclusion: The study's findings confirm the adverse impact of AMA on pregnancy outcomes and postpartum complications. Such issues should be addressed, and counseling on the risk of AMA should be provided, particularly for those in the high‐risk group. Further prospective studies are needed to understand other potential risk factors of APOs and the impact of AMA complications to prevent the associated burden. [ABSTRACT FROM AUTHOR]

Background: The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA). Objective: This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status. Materials and Methods: This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital, Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy. Results: Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p <0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p > 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p >0.05). Conclusion: Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive. [ABSTRACT FROM AUTHOR]

Background: Since thyroid hormones have an essential role in energy production, early development of the human placenta, embryo development, and implantation, abnormalities in thyroid function can significantly affect pregnancy outcomes. Objective: The present study aimed to investigate the effect of higher thyroid-stimulating hormone (TSH) levels in the normal range in euthyroid women with unexplained infertility. Materials and Methods: In this cross-sectional study, we evaluated the data for 300 euthyroid women aged between 18 and 39 yr with normal TSH levels (≤5 mIU/L) referred to Yazd Reproductive Sciences Institute, Yazd, Iran from December 2018-March 2021 in 2 groups: the case group (with unexplained infertility) and the control group (with male factor infertility). Finally, age, body mass index, and serum levels of TSH were extracted from participants' medical records and compared between groups. Results: The mean age and TSH level of participants were 31.52 ± 3.52 yr and 1.24 ± 2.59 mIU/L, respectively. 142 women (47.3%) had TSH < 2.5, and 158 women (52.7%) had TSH ≥ 2.5 mIU/L. The women with unexplained infertility had significantly higher TSH levels than controls in the same normal range (0.62 vs. 0.64 mIU/L, p <0.001). Although a more significant proportion of women in the case group had TSH levels > 2.5 mIU/L, we did not find a significant association between TSH levels and age or body mass index. Conclusion: Women with unexplained infertility have a higher level of serum TSH in the normal range (≥2.5 mIU/L) than the control group. So, the effect of TSH treatment on these women should be considered. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the outcomes of placenta accreta spectrum (PAS) disorder managed by a multidisciplinary care team (MCT) compared with a conventional care team (CCT) in a PAS referral center in Thailand. Methods: This retrospective single‐center cohort study analyzed PAS management outcomes in the PSU PAS Center between January 2010 and December 2022. The incidence of hemorrhage ≥3500 mL and the composite maternal and neonatal outcomes of PAS were compared before and after the introduction of an MCT in 2016. Results: Of 227 PAS cases, 219 (96.5%) had pathological confirmation. There were 52 (22.9%) cases of placenta accreta, 119 (52.4%) cases of placenta increta, and 56 (24.7%) cases of placenta percreta. The incidence of estimated blood loss (EBL) ≥3500 mL decreased from 61.8% to 34.3% (P < 0.001) after the establishment of the MCT. The median EBL decreased from 4000 (IQR: 2600,7250) mL to 2250 (1300, 4750) mL (P < 0.001). EBL reduction was statistically significant in the accreta and increta groups (P < 0.001). Red blood cell transfusions decreased from five (3, 9) to two (1, 6) units (P < 0.001) per patient. The length of maternal hospital stays and ICU admissions were statistically shorter when PAS was managed by an MCT (P < 0.001). The length of newborn hospital and ICU stays decreased significantly (P < 0.001). Conclusion: The incidence of massive postpartum hemorrhage and a composite of maternal and neonatal morbidities in pregnant women with PAS disorder improved significantly after the establishment of an MCT to manage PAS in a middle‐income country setting. Synopsis: A well‐organized multidisciplinary care‐team model in a setting with limited resources can improve PAS management outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore the change trends in incidence and leading factors to peripartum hysterectomy (PH) at a regional tertiary medical center in northeast China. Methods: This was a retrospective observational study of all PH cases conducted at Shengjing Hospital between January 1, 2012 and December 31, 2021. Information on maternal characteristics of pregnancy and delivery, indications of PH, inventions before hysterectomy, complications, and maternal and neonatal outcomes obtained from the Shengjing Hospital Information System were analyzed. Results: Among a total of 157 553 deliveries, there were 127 cases of PH (overall PH incidence: 0.85/1000 deliveries); 120 patients (94.49%) underwent hysterectomy after cesarean section, and seven (5.51%) underwent vaginal delivery (P < 0.001). Abnormal placentation was the leading indication for PH (101, 79.53%), including placenta previa (PP) with placenta accreta spectrum (PAS) (93, 73.23%), PP alone (5, 3.94%), and PAS alone (3, 2.36%). Among the patients who underwent PH with abnormal placentation, 92.08% had at least one cesarean section (P < 0.001) and 20.19% had bladder injury (P = 0.044). All maternal deaths (n = 2) occurred in referral patients, and the maternal mortality rate was 1.57/100 hysterectomies. Conclusion: Abnormal placentation was the primary indication for PH. For such patients, adequate assessment of their condition and complete communication are strongly recommended. The identification of high‐risk groups for postpartum hemorrhage, timely and effective rescue, and referral are equally important for avoiding PH. Synopsis: Abnormal placentation is the primary indication for peripartum hysterectomy. Prenatal prevention, intrapartum monitoring, and timely control of postpartum hemorrhage are important in peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior–posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Placenta previa, accompanied by placenta percreta, which involves invasion of the bladder, presents a significant risk of excessive bleeding during and after delivery. This case highlights that prophylactic embolization, conservative surgery, and careful monitoring offer an effective approach to avoid hysterectomy in cases of placenta percreta with adjacent organ involvement. Placenta previa complicated by placenta percreta is associated with a high risk of massive intra and post‐partum hemorrhage. We present a case of a 35‐year‐old woman (G2 P1) who was referred to the Akbar‐Abadi hospital at 13 weeks of gestation. Color Doppler ultrasound indicated complete placenta previa‐percreta with bladder invasion. After induction of fetal demise, bilateral uterine and bladder artery endovascular embolization was conducted for the patient. After 48 h, under ultrasound guidance, surgical resection of residual percreta tissue was conducted as much as possible. Eight weeks later, a follow‐up sonography showed the minimum residual placenta tissue and she regained menstrual cycles after 2 months. This case indicated that the combination of prophylactic embolization, conservative surgical management with placenta left in situ, and follow‐up with serial color Doppler monitoring, is an optimum method to avoid hysterectomy in placenta percreta patient with adjacent organ invasion. [ABSTRACT FROM AUTHOR]

Placenta accreta (PA) is a serious obstetric complication associated with maternal morbidity and mortality. While ultrasonography and MRI are effective in the third trimester, early diagnosis in the first two trimesters remains elusive. This study aims to explore the utility of biochemical markers in early PA detection, addressing a critical gap in current diagnostic approaches. A retrospective analysis was conducted on patients diagnosed with placenta previa between October 2021 and December 2022. Cases were divided into PA and non-PA groups based on histopathological examination. Demographic, obstetric characteristics and serum analytes were compared between the groups to identify potential biomarkers for early PA detection. Patients with PA exhibited higher gravida, parity, and abortion numbers. First-trimester free β-hCG levels and second-trimester E3 levels were significantly elevated in the PA group compared to non-accreta cases. No significant differences were observed in PAPP-A, AFP, and second-trimester hCG levels. Additionally, postoperative leukocyte count was lower, and intrapartum bleeding frequency was higher in the PA group. Multiparity and the number of previous cesarean sections emerged as significant risk factors for PA, consistent with previous literature. While previous studies reported associations between biochemical markers and PA, this study uniquely identified significant associations with free β-hCG and E3 levels. Further research is warranted to validate these findings and elucidate their clinical implications [ABSTRACT FROM AUTHOR]

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was conducted to assess maternal and fetal outcome associated with placenta previa Methods: The present prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India between March 2021 to February 2023. Total 240 cases of placenta previa confirmed after 28 weeks POG were included in the study. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: We found that out of total 240 cases, 172 (71.67%) were multigravida, 68 (28.33%) were primigravida, and 118 (49.17%) were >31 years of age. In the present study 52 (21.67%) patients were anaemic, 36 (15%) patients had hypothyroidism. In the present study 44 (18.33%) patients were <34 POG, 68 (28.33%) patients 34-37 POG. In the obstetric morbidity 108 (45%) patients required blood transfusions, 24 (10%) required hysterectomy later and 36 (15%) required ICU admission. In the study 12 (5%) neonates required ARDS, NICU admission, 12 (5%) required Birth asphyxia, NICU admission, 6 (2%) suffered from Congenital anomaly, Early neonatal death was 12 (5%), Good APGAR score was among 96 (40%), Low APGAR score, NICU admission was required to 78 (33%) neonates and still birth was 24 (10%) Conclusion: All cases of placenta previa need to be managed in a higher centre with facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity. [ABSTRACT FROM AUTHOR]

INTROUCTION: Spinal anesthesia (SA) has become a popular technique for LSCS as it is advantageous being a quick, safe and a reliable option that also provides analgesia post-operatively. Hyperbaric drugs which are routinely used can produce very high blocks in pregnant women because of decreased volume and increased pressure of CSF due to engorged epidural veins which is a result of aorto-caval compression and high CSF pressure. Haemodynamic changes1,2,3 like hypotension, Bradycardia were commonly associated complication with spinal-anaesthesia in obstetric parturients. For minimizing spinal-induced haemodynamic changes with anticholinergic drugs may be of interest. Anticholinergics like atropine and Glycopyrrolate are routinely used in anaesthesia for premedication. Atropine easily crosses placental barrier and blood-brain barrier as it has a tertiary amine structure. However, Glycopyrrolate having a structure of quaternary amine, limits its ability to cross these barriers. Hence Glycopyrrolate is the desired option for obstetric parturients AIMS and OBJECTIVES: To study the haemodynamic stability, efficacy and other adverse effects of Glycopyrroate during spinal anaesthesia for caesarean delivery. MATERIAL SOURCE: All the partirients who are undergoing caesarean section divided in to 2 groups of 30 in each group G and Group C. They are included and excluded depending on their physical status and any contra indications to Spinal anaesthesia Results: showed more stable haemodynamics in Group G showing Glycopyrrolate5, 6, 7, 8 is better anticholinergic drug which does not cross placenta barrier. Conclusion: Pre-treatment before administering spinal anaesthesia (SA) in pregnant women who are posted for elective caesarean sections with 0.2 mg of Glycopyrrolate in patients decreases the incidence of hypotension before the extraction of the neonate. Glycopyrrolate also reduces the incidence of Bradycardia. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum is a pathologic condition of placentation in which the villous tissue adheres or invades the uterine wall. Present study was aimed to study cases of abnormal placentation in the form of placenta accreta spectrum and the maternal and perinatal outcomes associated with it in our hospital. Material and Methods: Present study was single-center, prospective, observational study, pregnant female, gestational age>32weeks, with morbidly adherent placenta diagnosed antenatally by USG/DOPPLER/MRI or per operatively (on table). Maternal & Perinatal, outcomes & parameters were studied. Results: Among 58 patients' majority were (43.1%) of the age group of 30 to 34 years, were third gravida (41.4%), 33 (56.9%) delivered before 37 weeks of gestation. 56 (96.6%) patients had at least one LSCS in past pregnancies, 22 (37.9%) had prior curettage, 20 (34.5%) had prior LSCS and curettage, 49 (84.5%) had associated placenta previa. 31 out of 58 patients (53.3%) were diagnosed with morbidly adherent placenta antenatally on ultrasound doppler or MRI and 27 patients (46.6%) were intraoperatively (on table) diagnosed. 33 (56.9%) were diagnosed with placenta percreta, 16 (27.6%) had placenta increta and 9 (15.2%) were diagnosed with placenta accreta. 48 (82.8%) patients had hysterectomy as the first line of treatment. 47 patients (81%) were shifted to ICU, 23 patients (39.7%) had bladder injuries due to placenta percreta invading the bladder, 30 patients (51.7%) had haemorrhagic shock, sepsis was seen in 3 (5.2%) patients, 2 patients (3.4%) landed in DIC and there were 3 (5.2%) mortalities. 33 (56.8%) neonates had APGAR score at 5 mins of < 7, 58.6% were born preterm, 55.1% required NICU admissions, and 13.7% died in neonatal period. Conclusion: Morbidly adherent placenta is one of the most devastating complications in pregnancy, associated with significant and increased maternal and perinatal mortality and morbidity. [ABSTRACT FROM AUTHOR]

• Generally, placenta previa (PP) and specifically major PP is a well-established risk factor during pregnancy, and is associated with the highest maternal and perinatal complication rates. • The presence of PP substantially increases the patient's risk for invasive placentation or placenta accreta spectrum (PAS). When pregnancies are complicated by both types of abnormal placentation (PP with PAS), a much higher risk of worse maternal outcomes is typically expected. • Moreover, evidence suggests that previous CS increases the risks of both PP and PAS, up to more than 67 % by 5th. repeated CS and PP will develop abnormal placentation (PAS). • This study aimed to find out the maternal outcomes of major PP (with or without PAS) among patients with history of "previous CS-one or more". To compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients. This is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children's Hospital over the last ten-years (January 2012–December 2021), Aseer region, Saudi Arabia. Compared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849). (1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes. [ABSTRACT FROM AUTHOR]

[Display omitted] • Missed abortion placenta second trimester. Missed abortion (MA) is a type of miscarriage with multiple etiological factors that refers to fetal death with a failure of the retained intrauterine product of conception to be discharged spontaneously. Currently fetal death in missed abortion is categorized according to three main causes: Fetal, placental, and maternal factors. The aim of the current study was to contribute and increase knowledge in clinical practice of late first and second trimester MA (Gestational age: week 11 + 0 – week 20 + 6). This retrospective case series study includes 794 cases of fetuses and matching placentas sent to the Section of Perinatal Pathology, Department of Pathology, Karolinska Hospital between 2003 and 2019 from five different gynecology departments in the Stockholm region, Sweden. The cases were divided into two groups according to gestational length; gestational week 11 + 0–14 + 6 (group A) and 15 + 0–20 + 6 (group B) respectively, and comparisons were made between groups. Fetal growth restriction and placental pathology were more common in late MA, but number of cases with malformation were higher in early MA. Cord pathology was seen in approximately 40 % of the cases and equally distributed in the gestational weeks included. Fetal growth restriction and placental pathology were more common in late second trimester MA. This might demonstrate an early placental dysfunction affecting fetal growth and may be associated to maternal comorbidity such as autoimmune disease and cardiovascular disease. It is advisable to investigate maternal factors more closely after late second trimester MA before a future pregnancy. The risk for recurrent MA is believed to be low in cases of significant cord pathology. Cord complications were over-represented in missed abortion suggesting a probable etiopathogenetic link to fetal demise in this condition. [ABSTRACT FROM AUTHOR]

• Disorganized smooth muscle, fibrosis and fewer endometrial glands are characteristics of uterine scars. • Glandular structure could be responsible for healing defects after caesarean section. • Uterine scar defects have a fibroblastic highly collagenic stromal reaction. • No correlation was found between biomechanical characteristics and histology. The rate of caesarean section (CS) is increasing worldwide. Defects in uterine healing have a major gynaecological and obstetric impact (uterine rupture, caesarean scar defect, caesarean scar pregnancy, placenta accreta spectrum). The complex process of cellular uterine healing after surgery, and specifically after CS, remains poorly understood in contrast to skin wound healing. This literature review on uterine wound healing was mainly based on histological observations, particularly after CS. The primary objective of the review was to examine the effects of CS on uterine tissue at the cellular level, based on histological observations. The secondary objectives were to describe the biomechanical characteristics and the therapies used to improve scar tissue after CS. This review was performed using PRISMA criteria, and PubMed was the data source. The study included all clinical and animal model studies with CS and histological analysis of the uterine scar area (macroscopic, microscopic, immunohistochemical and biomechanical). Twenty studies were included: 10 human and 10 animal models. In total, 533 female humans and 511 female animals were included. Review articles, meeting abstracts, case series, case reports, and abstracts without access to full-text were excluded. The search was limited to studies published in English. No correlation was found between cutaneous and uterine healing. The histology of uterine scars is characterized by disorganized smooth muscle, fibrosis with collagen fibres and fewer endometrial glands. As for skin healing, the initial inflammation phase and mediation of some growth factors (particularly connective tissue growth factor, vascular endothelial growth factor, platelet-derived growth factor, tumour necrosis factor α and tumour necrosis factor β) seem to be essential. This initial phase has an impact on the subsequent phases of proliferation and maturation. Collagen appears to play a key role in the initial granulation tissue to replace the loss of substance. Subsequent maturation of the scar tissue is essential, with a decrease in collagen and smooth muscle restoration. Unlike skin, the glandular structure of uterine tissue could be responsible for the relatively high incidence of healing defects. Uterine scar defects after CS are characterized by an atrophic disorganized endometrium with atypia and a fibroblastic highly collagenic stromal reaction. Concerning immunohistochemistry, one study found a decrease in tumour necrosis factor β in uterine scar defects. No correlation was found between biomechanical characteristics (particularly uterine strength) and the presence of a collagenous scar after CS. Based on the findings of this review, an illustration of current understanding about uterine healing is provided. There is currently no validated prevention of caesarean scar defects. Various treatments to improve uterine healing after CS have been tested, and appeared to have good efficacy in animal studies: alpha lipoic acid, growth factors, collagen scaffolds and mesenchymal stem cells. Further prospective studies are needed. [ABSTRACT FROM AUTHOR]

• FET in an HRC has the highest risk for PAS in ART. • A history of ≥2 uterine surgeries are a risk factor for PAS in FET in an HRC. • The transfer of blastocysts is a risk factor for PAS in FET in an HRC. • Thin endometrium before ET is a risk factor for PAS in FET in an HRC. Assisted reproductive technology (ART), especially frozen–thawed embryo transfer (FET) in a hormone replacement cycle (HRC), is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies achieved after FET in an HRC. We performed a case–control study in two tertiary perinatal centres in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centres between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed on the basis of the FIGO classification for the clinical diagnosis of PAS or retained products of conception after delivery at ≥24 weeks of gestation. We excluded women with fresh embryo transfer, FET with a spontaneous ovulatory cycle, a donor oocyte cycle, and missing details of the ART treatment. Finally, among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case–control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of caesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos, and endometrial thickness at the initiation of progestin administration. PAS was associated with ≥2 previous uterine surgeries (adjusted odds ratio, 3.57; 95 % confidence interval, 1.60–7.97) and the stage of embryo transfer (blastocysts: adjusted odds ratio, 2.89; 95 % confidence interval, 1.15–7.26). In patients with <2 previous uterine surgeries, PAS was associated with an endometrial thickness of <7.0 mm (adjusted odds ratio, 5.18; 95 % confidence interval, 1.10–24.44). Multiple uterine surgeries and the transfer of blastocysts are risk factors for PAS in pregnancies conceived after FET in an HRC. In women with <2 previous uterine surgeries, a thin endometrium before FET is also a risk factor for PAS in these pregnancies. [ABSTRACT FROM AUTHOR]

• Increasing mid-trimester previa thickness is associated with previa persistence. • Mid-trimester placenta previa thickness also associated with cesarean delivery. • No association between previa thickness and other adverse outcomes. • May serve as an objective finding to guide care coordination. Increasing placental thickness is associated with adverse outcomes including earlier gestational age at delivery, lower birthweight, and lower umbilical artery pH. We aim to determine whether mid-trimester placenta previa thickness is associated with persistence of previa at time of delivery. Single-center retrospective cohort study of singleton gestations with previa diagnosed at 18–24 weeks delivering between 2015 and 2019. The thickest portion of the placenta was measured in a longitudinal plane on transabdominal imaging to determine placental thickness. We defined three cohorts: 1) thick placenta (>1 standard deviation above the mean), 2) thin placenta (>1 standard deviation below the mean), and 3) average placenta (within 1 standard deviation above or below the mean). Primary outcome was previa persistence at time of delivery. Secondary outcomes included postpartum hemorrhage, cesarean delivery, placenta accreta spectrum, and maternal morbidity composite (use of Bakri balloon, B-lynch, or O'Leary, peripartum hysterectomy, blood transfusion, ICU admission, or death). In all analyses, average thickness was used as the base comparator. Of 239 pregnancies with mid-trimester previa there were 34 thin, 166 average, and 39 thick placentas. Patients with thick placenta were older, more likely to have prior cesarean delivery, fibroid uterus, and delivery at an earlier gestational age. After adjusting for confounders, thick placenta was associated with persistent previa (aOR 6.85 [3.13–15.00]) and cesarean delivery (aOR 2.76 [1.26–6.08]). At diagnosis of mid-trimester previa, thick placenta is associated with persistence at time of delivery and delivery by cesarean section. This suggests placental thickness may assist with risk stratification and coordination of care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies conceived by assisted reproductive technology (ART) and conceived naturally. Methods: We retrospectively analyzed the data on twin pregnancies conceived by ART from January 2015 to January 2022,and compared pregnancy outcomes of MCDA and DCDA twins conceived by ART with those of MCDA and DCDA twins conceived naturally, pregnancy outcomes between MCDA and DCDA twins conceived by ART, and pregnancy outcomes of DCT and TCT pregnancies reduced to DCDA pregnancies with those of DCDA pregnancies conceived naturally. Result: MCDA pregnancies conceived by ART accounted for 4.21% of the total pregnancies conceived by ART and 43.81% of the total MCDA pregnancies. DCDA pregnancies conceived by ART accounted for 95.79% of the total pregnancies conceived by ART and 93.26% of the total DCDA pregnancies. Women with MCDA pregnancies conceived by ART had a higher premature delivery rate, lower neonatal weights, a higher placenta previa rate, and a lower twin survival rate than those with MCDA pregnancies conceived naturally (all p < 0.05). Women with DCDA pregnancies conceived naturally had lower rates of preterm birth, higher neonatal weights, and higher twin survival rates than women with DCDA pregnancies conceived by ART and those with DCT and TCT pregnancies reduced to DCDA pregnancies (all p < 0.05). Conclusion: Our study confirms that the pregnancy outcomes of MCDA pregnancies conceived by ART are worse than those of MCDA pregnancies conceived naturally. Similarly, the pregnancy outcomes of naturally-conceived DCDA pregnancies are better than those of DCDA pregnancies conceived by ART and DCT and TCT pregnancies reduced to DCDA pregnancies. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11–14 weeks. The CS scar niche ("defect") was bordered in the sagittal plane as a notch at the previous CS scar's site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect ("niche") was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas. [ABSTRACT FROM AUTHOR]

Aim: Placenta accreta spectrum disorders (PAS) are a global threat to maternal well-being. The aim of this study was to assess differences in clinical characteristics and maternal outcomes between Turkish natives and Syrian refugees giving birth with a diagnosis of PAS at a tertiary centre, and to experience the management of this condition in the unique context of Türkiye, home to one of the world's largest refugee populations. Material and Method: A retrospective study was conducted using the medical records of 228 singleton pregnancies at high risk of PAS, between January 2019 and October 2022. PAS risk assessment was initially performed by ultrasound at mid-trimester, with diagnosis confirmed histologically or clinically, indicating the presence of placental retention following attempted manual removal. The study population was divided into two groups: native and refugee. We investigated disparities in demographic and medical characteristics and primary maternal and neonatal outcomes. Results: The study found an increased prevalence of previous cesarean delivery (p=0.005), anterior placenta (p<0.000), placenta previa (p=0.047), and deeper placental invasion (increta/percreta) (p<0.000) in the native group (n=161). The native group had a significantly higher rate of estimated blood loss (2093.5±1516.4 mL vs. 714.1±731.6 mL, p<0.000) and peripartum hysterectomy (p=0.005) compared to the refugee group (n=67). The refugee group had a notably higher incidence of delayed diagnosis (p<0.000) and a shorter surgery duration (p=0.027) compared to the native group. Conclusion: The current study highlights significant differences in patient characteristics and outcomes between native and refugee pregnant women with PAS. Despite facing challenges, these women did not encounter adverse perinatal outcomes, indicating the efficacy of healthcare interventions. [ABSTRACT FROM AUTHOR]

Background: Pregnancy Associated Malaria (PAM) include malaria in pregnancy (MiP), placental malaria (PM), and congenital malaria (CM). The evidence available in Colombia on PAM focuses on one of the presentations (MiP, PM or CM), and no study longitudinally analyses the infection from the pregnant woman, passing through the placenta, until culminating in the newborn. This study determined the frequency of MiP, PM, and CM caused by Plasmodium vivax, Plasmodium falciparum, or mixed infections, according to Thick Blood Smear (TBS) and quantitative Polymerase Chain Reaction (qPCR). Identifying associated factors of PAM and clinical-epidemiological outcomes in northwestern Colombia. Methods: Prospective study of 431 pregnant women, their placenta, and newborns registered in the data bank of the research Group "Salud y Comunidad César Uribe Piedrahíta" which collected information between 2014 and 2020 in endemic municipalities of the departments of Córdoba and Antioquia. The frequency of infection was determined with 95% confidence intervals. Comparisons were made with the Chi-square test, Student t-test, prevalence ratios, and control for confounding variables by log-binomial regression. Results: The frequency of MiP was 22.3% (4.6% using TBS), PM 24.8% (1.4% using TBS), and CM 11.8% (0% using TBS). Using TBS predominated P. vivax. Using qPCR the proportions of P. vivax and P. falciparum were similar for MiP and PM, but P. falciparum predominated in CM. The frequency was higher in nulliparous, and women with previous malaria. The main clinical effects of PAM were anaemia, low birth weight, and abnormal APGAR score. Conclusions: The magnitude of infections was not detected with TBS because most cases were submicroscopic (TBS-negative, qPCR-positive). This confirmed the importance of improving the molecular detection of cases. PAM continue being underestimated in the country due to that in Colombia the control programme is based on TBS, despite its outcomes on maternal, and congenital health. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum often leads to massive hemorrhage and even maternal shock and death. This study aims to identify whether cervical length and cervical area measured by magnetic resonance imaging correlate with massive hemorrhage in patients with placenta accreta spectrum. Methods: The study was conducted at our hospital, and 158 placenta previa patients with placenta accreta spectrum underwent preoperative magnetic resonance imaging examination were included. The cervical length and cervical area were measured and evaluated their ability to identify massive hemorrhage in patients with placenta accreta spectrum. Results: The cervical length and area in patients with massive hemorrhage were both significantly smaller than those in patients without massive hemorrhage. The results of multivariate analysis show that cervical length and cervical area were significantly associated with massive hemorrhage. In all patients, a negative linear was found between cervical length and amount of blood loss (r =−0.613), and between cervical area and amount of blood loss (r =−0.629). Combined with cervical length and cervical area, the sensitivity, specificity, and the area under the curve for the predictive massive hemorrhage were 88.618%, 90.209%, and 0.890, respectively. Conclusion: The cervical length and area might be used to recognize massive hemorrhage in placenta previa patients with placenta accreta spectrum. [ABSTRACT FROM AUTHOR]

Placenta percreta is a devastating obstetrical condition, considered one of the severe forms of the placenta accreta spectrum (placenta accreta) or “morbidly adherent placenta”. The worldwide incidence of placenta percreta has increased in the last five years, being influenced by several risk factors, such as: uterine scar after previous uterine surgery, history of placenta accreta, abnormal scarring, maternal age over 35 years old, multiparity, previous resectoscopy, human assisted reproductive technologies, and smoking. Optimal diagnosis involves clinical evaluation of the patient, personal medical history, laboratory tests, as well as ultrasound and magnetic resonance imaging in order to assess the degree of placental invasion into adjacent tissues. Surgical treatment involves a major surgery such as caesarean hysterectomy, the most accepted management option, but there are other methods, including interval hysterectomy, caesarean section with placental abandonment in situ, with or without methotrexate administration. This article presents the case of a 33-year-old patient with uterine pregnancy of 31 weeks + 2 days of amenorrhea and uterine scar after caesarean section in 2019. The patient followed in vitro fertilization, presenting laryngotracheitis, essential hypertension, imminence of premature birth, and complete placenta praevia. Ultrasound signs for placenta praevia and placenta percreta, with signs of placental invasion into the muscular and mucosal layers of the urinary bladder. A multidisciplinary medical team took the decision to finish the pregnancy by elective caesarean hysterectomy. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between endometriosis and adverse pregnancy and perinatal outcomes (preeclampsia, placenta previa, and preterm birth). Methods: A population-based retrospective cohort study was conducted among 468,778 eligible women who contributed 912,747 singleton livebirths between 1980 and 2015 in Western Australia (WA). We used probabilistically linked perinatal and hospital separation data from the WA data linkage system's Midwives Notification System and Hospital Morbidity Data Collection databases. We used a doubly robust estimator by combining the inverse probability weighting with the outcome regression model to estimate adjusted risk ratios (RR) and 95% confidence intervals (CIs). Results: There were 19,476 singleton livebirths among 8874 women diagnosed with endometriosis. Using a doubly robust estimator, we found pregnancies in women with endometriosis to be associated with an increased risk of preeclampsia with RR of 1.18, 95% CI 1.11–1.26, placenta previa (RR 1.59, 95% CI 1.42–1.79) and preterm birth (RR 1.45, 95% CI 1.37–1.54). The observed association persisted after stratified by the use of Medically Assisted Reproduction, with a slightly elevated risk among pregnancies conceived spontaneously. Conclusions: In this large population-based cohort, endometriosis is associated with an increased risk of preeclampsia, placenta previa, and preterm birth, independent of the use of Medically Assisted Reproduction. This may help to enhance future obstetric care among this population. [ABSTRACT FROM AUTHOR]

Purpose: To identify and characterise appropriate comparison groups for population studies of health outcomes in ART-conceived births: ovulation induction (OI), subfertile untreated and fertile natural conceptions. Our secondary objective was to examine whether known risks of pregnancy complications and adverse birth outcomes in ART births are elevated in comparison with subfertile (untreated and OI) conception groups. Methods: We linked State and Commonwealth datasets to identify all live and stillbirths (≥ 20 weeks) in Western Australia from 2003 to 2014 by method of conception. Demographic characteristics, maternal pre-existing conditions, adverse obstetric history and pregnancy complications were compared across conception groups. Generalised estimating equations were used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CI) for pregnancy complications and birth outcomes in singletons. Results: We identified 9456 ART, 3870 OI, 11,484 subfertile untreated and 303,921 fertile naturally conceived deliveries. OI and subfertile untreated groups more closely resembled the ART group than the fertile group; however, some differences remained across parity, maternal age, pre-existing conditions and obstetric history. In multivariate analyses, ART singletons had greater risks of placental problems (e.g. placenta praevia aRR 2.42 (95% CI 1.82–3.20)) and adverse birth outcomes (e.g. preterm birth aRR 1.38 (95% CI 1.25–1.52)) than the subfertile untreated group, while OI singletons were more similar to the subfertile group with higher risk of preeclampsia and gestational diabetes. Conclusion: OI and subfertile untreated conception groups offer improved options for interpreting health outcomes in ART births. Pregnancy complications (particularly placental disorders) and adverse outcomes at delivery are more common following ART. [ABSTRACT FROM AUTHOR]

Purpose: In this first of two companion papers, we critically review the evidence recently published in the primary literature, which addresses adverse maternal and neonatal pregnancy outcomes associated with programmed embryo transfer cycles. We next consider whether these pathological pregnancy outcomes might be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation. Finally, in the second companion article, we explore potential etiologies and suggest strategies for prevention. Methods: Comprehensive review of primary literature. Results: The preponderance of retrospective and prospective observational studies suggests that increased risk for hypertensive disorders of pregnancy (HDP) and preeclampsia in assisted reproduction involving autologous embryo transfer is associated with programmed cycles. For autologous frozen embryo transfer (FET) and singleton live births, the risk of developing HDP and preeclampsia, respectively, was less for true or modified natural and stimulated cycles relative to programmed cycles: OR 0.63 [95% CI (0.57–0.070)] and 0.44 [95% CI (0.40–0.50)]. Though data are limited, the classification of preeclampsia associated with programmed autologous FET was predominantly late-onset or term disease. Other adverse pregnancy outcomes associated with autologous FET, especially programmed cycles, included increased prevalence of large for gestational age infants and macrosomia, as well as higher birth weights. In one large registry study, FET was associated with fetal overgrowth of a symmetrical nature. Postterm birth and placenta accreta not associated with prior cesarean section, uterine surgery, or concurrent placenta previa were also associated with autologous FET, particularly programmed cycles. The heightened risk of these pathologic pregnancy outcomes in programmed autologous FET does not appear to be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation, although the latter may contribute a modest degree of increased risk for fetal overgrowth and perhaps HDP and preeclampsia in FET irrespective of the endometrial preparation. Conclusions: Programmed autologous FET is associated with an increased risk of several, seemingly diverse, pathologic pregnancy outcomes including HDP, preeclampsia, fetal overgrowth, postterm birth, and placenta accreta. Though the greater risk for preeclampsia specifically associated with programmed autologous FET appears to be well established, further research is needed to substantiate the limited data currently available suggesting that the classification of preeclampsia involved is predominately late-onset or term. If substantiated, then this knowledge could provide insight into placental pathogenesis, which has been proposed to differ between early- and late-onset or term preeclampsia (see companion paper for a discussion of potential mechanisms). If a higher prevalence of preeclampsia with severe features as suggested by some studies is corroborated in future investigations, then the danger to maternal and fetal/neonatal health is considerably greater with severe disease, thus increasing the urgency to find preventative measures. Presupposing significant overlap of these diverse pathologic pregnancy outcomes within subjects who conceive by programmed embryo transfer, there may be common etiologies. [ABSTRACT FROM AUTHOR]

Objective: To estimate short- and long-term maternal complications in relation to planned mode of term breech delivery in first pregnancy. Design: Register-based cohort study Setting: Denmark Population: Nulliparous women with singleton breech delivery at term between 1991 and 2018 (n = 30,778). Methods: We used data from the Danish national health registries to identify nulliparous women with singleton breech presentation at term and their subsequent pregnancies. We performed logistic regression to compare the risks of maternal complications by planned mode of delivery. All data were proceeded and statistical analyses were performed in SAS 9.4 (SAS Institute Inc. Cary, NC, USA). Main outcome measures: Postpartum hemorrhage, operative complications, puerperal infections in first pregnancy and uterine rupture, placenta previa, post-partum hemorrhage, hysterectomy and stillbirth in the subsequent two pregnancies. Results: We identified 19,187 with planned cesarean and 9,681 with planned vaginal breech delivery of which 2,970 (30.7%) delivered vaginally. Planned cesarean significantly reduced the risk of postoperative infections (2.4% vs 3.9% adjusted odds ratio (aOR): 0.54 95% confidence interval (CI) 0.44–0.66) and surgical organ lesions (0.06% vs 0.1%; (aOR): 0.29 95% CI 0.11–0.76) compared to planned vaginal breech delivery. Planned cesarean delivery in the first pregnancy was associated with a significantly higher risk of uterine rupture in the subsequent pregnancies but not with risk of postpartum hemorrhage, placenta previa, hysterectomy, or stillbirth. Conclusion: Compared to planned vaginal breech delivery at term, nulliparous women with planned cesarean breech delivery have a significantly reduced risk of postoperative complications but a higher risk of uterine rupture in their subsequent pregnancies. [ABSTRACT FROM AUTHOR]

Aim: We aim to compare the maternal serum thiol and ischemia‐modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP). Methods: Fifty‐five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated. Results: The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05). Conclusions: Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of low‐molecular‐weight heparin (LMWH) on placenta‐mediated fetal growth restriction (FGR). Methods: A cohort of 570 pregnant women diagnosed with placenta‐mediated FGR were enrolled from January 1, 2015 through to December 31, 2021. A birth database, including demographic data, antenatal complications, and detailed delivery and newborn data, was created to collect variables from the Hospital Information System (HIS) Database. The unique personal registration number, assigned to each patient on first registration with HIS in the West China Second University Hospital, was used to link these patients. LMWH use was defined as at least 1‐week prescription from diagnosis of placenta‐mediated FGR. Pregnant women received LMWH (Enoxaparin 4000 IU/day) by self‐administered subcutaneous injection only when they agreed and signed informed consent. Primary outcome was intrauterine fetal death after 20 weeks of pregnancy. Secondary outcomes included preterm birth (PB), Apgar score less than 7 at 1 min, admission to neonatal intensive care unit (NICU), and birth weight. Logistic regression analysis was conducted to compute adjusted odds ratio (aOR) with 95% confidence intervals (CI) for outcomes. Results: After controlling for confounders, LMWH use was associated with a decreased risk of intrauterine fetal death (aOR 2.49, 95% CI 1.35–4.57, P = 0.003), PB before 37 weeks of pregnancy (aOR 3.35, 95% CI 2.14–5.23, P < 0.001), PB before 34 weeks of pregnancy (aOR 2.25, 95% CI 1.36–3.74, P = 0.002), Apgar score less than 7 at 1 min (aOR 2.25, 95% CI 1.36–3.74, P = 0.002), NICU admission (aOR 2.29, 95% CI 1.48–3.55, P < 0.001). Using LMWH increased the mean birth weight in PB before 32 weeks of pregnancy (mean ± standard deviation [SD] 1126.4 ± 520.0 g, P = 0.020), PB before 37 weeks of pregnancy (mean ± SD 1563.9 ± 502.7 g, P = 0.019), early‐onset FGR (mean ± SD 2125.2 ± 665.7 g, P < 0.001), late‐onset FGR (mean ± SD 2343.4 ± 507.9, P < 0.001), and non‐severe FGR (mean ± SD 2231.1 ± 607.2 g, P < 0.001). Conclusion: Use of LMWH can significantly improve the fetal and neonatal outcomes among pregnant women with placenta‐mediated FGR, particularly reducing the risk of intrauterine fetal death. Synopsis: Low‐molecular‐weight heparin use can significantly improve fetal and neonatal outcomes in pregnant women with placenta‐mediated FGR, particularly reducing the risk of intrauterine fetal death. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy and safety of two uterine sparing techniques in conservative management of placenta accreta spectrum (PAS). Methods: This multicenter randomized controlled study was conducted from January 1, 2017 to December 31, 2020 at two university hospitals. Patients were randomly allocated into two groups; Group 1 was managed by Assar's technique and Group 2 was managed by Shehata's technique. Operative time, blood loss, operative complications (organ or vessel injury), and postoperative complications (early and late) were reported. Success of the technique, units of blood transfusion, and intensive care unit admissions were recorded. Results: Demographic data in both groups were not significantly different. The mean gestational age at the delivery time was 36 weeks in both groups. Operative time was 120 (100–140) minutes and 75 (60–100) minutes in Assar's and Shehata's techniques, respectively (P < 0.001). Blood loss was higher in Shehata's technique than in Assar's (P < 0.001). Intensive care unit admissions were minimal in both groups. Operative complications were comparable in both groups. The success of Assar's and Shehata's techniques in uterine preservation was 85% and 95%, respectively. Conclusion: Both techniques were safe and successful in uterine sparing. Therefore, we recommend these techniques for conservative management of PAS. Clinical trial registration: The trial was registered on UMIN‐CTR and had the unique ID: UMIN000025315 on the following link: https://center6.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000029120. Synopsis: Both uterine sparing techniques were safe and highly successful. Although blood loss was higher in Shehata's technique than in Assar's, it had a shorter operative time. [ABSTRACT FROM AUTHOR]

Introduction: Being associated with a systemic infection, SARS-CoV-2 affects multiple organs, including the placenta. SARS-CoV-2 placentitis is a new condition that shows the destructive effects of fibrin deposition in the perivillous area, chronic histiocytic intervillositis and trophoblast necrosis after the placenta is infected with SARS-CoV-2. Until now, there have been no published reports regarding the ultrasound signs of massive perivillous fibrin deposition and the recommended monitoring for these cases. Aim: Our aim was to analyze the sonographic appearance of the placenta in a series of SARS-CoV-2 infected pregnant women during their third trimester. Material and method: In all cases included in the present study, we performed serial obstetrical ultrasounds every seven days until delivery, followed by histopathological examination of the placenta postpartum. Results: In women with intrauterine growth restriction (IUGR), sonographic images of the placentas revealed that they matured faster within three weeks of receiving a COVID-19 diagnosis and reached a more rapid senescence. In all cases, there was a gradual increase in placental calcification from week to week, but only in pregnant women with a grade 3 placenta at the moment of inclusion in the study the deterioration was severe, leading to placental insufficiency and subsequently to IUGR. Conclusion: The cases who had an increased placental degree at the time of infection were associated with abnormally rapid placental aging. These aspects can be evaluated sonographically. [ABSTRACT FROM AUTHOR]

Background: The most common causes of morbid adherent placenta (MAP) include hysterectomies, excessive blood loss, and bladder injuries. Placental trophoblasts that penetrate the endometrium past the Nitabuch layer of decidua basalis cause placenta accreta, while placental trophoblasts that penetrate the myometrium cause placenta increta. Objectives: To evaluate the role of the multislice 3D color flow Doppler in the diagnosis of MAP in relation to intrapartum findings and the mean value of placental volume vascularization index (VI) and flow index (FI) and vascularization flow index (VFI). Patients and Methods: This was a prospective study that included 41 pregnant women at Department of Obstetrics and Gynecology in Menoufia University Hospital, from December 2021 till March 2023. Results: Cutoff point of placental (VI) as a marker in prediction of placental invasion among cases was 23.760, with sensitivity of 94.1%, specificity of 95.8% at AUC of 0.771. Cutoff point of placenta (FI) as a marker in prediction of placental invasion among cases was 32.405, with sensitivity of 88.2%, specificity of 83.3% at AUC of 0.513. Cutoff point of placental (VFI) as a marker in prediction of placental invasion among cases was 9.305, with sensitivity of 94.1%, specificity of 95.8% at AUC of 0.749. Conclusion: among the 3D color flow Doppler indices, VI had the best index in prediction of placental invasion, followed by VFI while FI had the lowest. Additionally, loss of sonolucency was the most 3D multislice color flow Doppler in the diagnosis of MAP with accuracy 92.3%, followed by placental lacunae with accuracy 84.5%, then abnormal uterine serosa bladder line by 80.55% of accuracy. [ABSTRACT FROM AUTHOR]

• High cumulative oxytocin dose in labour increases adverse postpartum outcomes. • High cumulative oxytocin dose almost tripled cases of severe bleedings postpartum. • Overdistended bladders were twice as common after high cumulative oxytocin doses. • More women had a negative birth experience after high cumulative oxytocin doses. This study aimed to determine the association between the total cumulative oxytocin dose during labour and adverse postpartum outcomes, childbirth experience and breastfeeding in term primiparous women with spontaneous onset of labour. A prospective observational multicentre study, including 1395 women with spontaneous labour, in seven hospitals in Southeast Sweden. Multivariable logistic regression (Crude Odds Ratios (OR) and adjusted OR (aOR) for relevant confounders) was used to analyze the association between oxytocin dose and postpartum outcomes. The exposure was the cumulative oxytocin dose during labour, classified in percentiles (<25th, 25-75th, >75th). The outcomes were occurrence of obstetric anal sphincter injury, postpartum haemorrhage (blood loss > 1000 ml), Apgar score < 7 at five minutes, umbilical cord arterial pH, postpartum bladder overdistension, exclusive breastfeeding at one week and three months, and the woman's perceived birth experience. Women receiving high amounts (>75th percentile, >4370 mU) of oxytocin infusion during labour had an increased risk of postpartum haemorrhage (OR 2.73 (1.78–4.19)), an overdistended bladder (OR 2.19 (1.11–4.31)), an infant with an Apgar score < 7 at five minutes (OR 2.89 (1.27–6.57)), a negative birth experience (OR 1.83 (1.25–2.69)), and a decreased chance of exclusive breastfeeding at one week (OR 0.63 (0.41–0.96)). After adjusting for confounders, all outcomes remained statistically significant except risk of low Apgar score and chance of exclusive breastfeeding. In women with high cumulative oxytocin dose during labour prompt, and prophylactic administration of uterotonics after delivery of the placenta should be considered to reduce the risk of postpartum haemorrhage. The risk for bladder overdistension can be reduced by implementing routines for observation for signs of bladder filling in the early postpartum period, as well as routine use of bladder scans post micturition to assess for successful bladder emptying. As women's birth experience have a major impact on their future mental health, should be routinely assessed postpartum, and support should be offered to women with negative experiences. [ABSTRACT FROM AUTHOR]

O -GlcNAcylation is a dynamic modulator of signaling pathways, equal in magnitude to the widely studied phosphorylation. With the rapid development of tools for its detection at the single protein level, the O -GlcNAc modification rapidly emerged as a novel diagnostic and therapeutic target in human diseases. Yet, mapping the human O -GlcNAcome in various tissues is essential for generating relevant biomarkers. In this study, we used human banked tissue as a sample source to identify O -GlcNAcylated protein targets relevant to human diseases. Using human term placentas, we propose (1) a method to clean frozen banked tissue of blood proteins; (2) an optimized protocol for the enrichment of O -GlcNAcylated proteins using immunoaffinity purification; and (3) a bioinformatic workflow to identify the most promising O -GlcNAc targets. As a proof-of-concept, we used 45 mg of banked placental samples from two pregnancies to generate intracellular protein extracts depleted of blood protein. Then, antibody-based O -GlcNAc enrichment on denatured samples yielded over 2000 unique HexNAc PSMs and 900 unique sites using 300 μg of protein lysate. Due to efficient sample cleanup, we also captured 82 HexNAc proteins with high placental expression. Finally, we provide a bioinformatic tool (CytOVS) to sort the HexNAc proteins based on their cellular localization and extract the most promising O -GlcNAc targets to explore further. To conclude, we provide a simple 3-step workflow to generate a manageable list of O -GlcNAc proteins from human tissue and improve our understanding of O-GlcNAcylation's role in health and diseases. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Placenta accreta syndrome (PAS) may led to heavy blood loss and maternal death. Here we analyzed the main risk factors of PAS+ pregnancies and its complications in a referral hospital in the north of Iran. Methods: In a case control study, all pregnant women with PAS referred to our department during 2016 till 2021 were enrolled and divided in two groups case (PAS+) and control (PAS−) based on preoperative imaging, intraoperative findings, and pathological reports. The sociodemographic features and neonatal‐maternal outcomes also were recorded. Results: The most frequent reason for cesarean (C/S) was repeated C/S (62.9%, 56/89). A significant difference showed up in the time lag between previous C/S and the present delivery (p < 0.001) which shows that when the time distance is longer, the risk of PAS rises (OR: 1.01 [95% CI: 1.003−1.017]). Also, a positive history of prior abortion and elective type of previous C/S were related to PAS+ pregnancies. Our other finding showed that PAS+ pregnancies will end in lower gestational age and have a longer duration of operation and hospitalization, heavy blood transfusion, and hysterectomy. Also, PAS+ pregnancies were not related to poor neonatal outcomes. Conclusions: It seems that, in addition to repeated C/S as a strong risk factor, previous abortion is a forgotten key which leads to incomplete evacuation or damage the endometrial‐myometrial layers. [ABSTRACT FROM AUTHOR]

The article discusses the definition and diagnosis of vasa previa, a condition where fetal blood vessels are exposed and unprotected over the cervix. The author argues against the commonly used definition of vasa previa as vessels within 2 cm of the internal os, stating that this definition is not supported by data and can be dangerous. They propose that any unprotected fetal vessels within a radius of 5 cm of the internal os should be defined as vasa previa. The author emphasizes the importance of providing accurate information and involving patients in the decision-making process to ensure their autonomy and informed consent. [Extracted from the article]

Objectives: Placental damağe miğht be the primary underlyinğ cause of the hiğh rates of fetal adverse outcomes in cases with ğestational diabetes mellitus (GDM). Histopatholoğical chanğes were considered to be associated with GDM in the literature. However, there are also studies showinğ no chanğes in the placenta in some ğestational diabetic women. The pathophysioloğy of these placental alterations remains elusive. Therefore, this study aimed to examine the histopatholoğical chanğes in the placentas of patients with GDM and compare them with the placentas of the healthy control ğroup. Material and methods: This experimental non-randomized case-control study was conducted with 40 GDM patients and 40 healthy preğnant women at Dicle University Faculty of Medicine between March 2023 and December 2023. Placental tissues obtained followinğ cesarean delivery were subjected to routine tissue processinğ. Placental samples were stained with hematoxylin-eosin and examined histopatholoğically usinğ a liğht microscope. Results: When histopatholoğical findinğs were compared between the GDM and control ğroups, villous değeneration, conğestion in blood vessels, fibrinoid accumulation, inflammation and intervillous hemorrhağe were hiğher in the GDM ğroup than in the control ğroup (p<0.001). Conclusion: The intricate relationship between GDM and placental patholoğy underscores the profound impact of metabolic chanğes on placental structure and function throuğhout preğnancy. Understandinğ these patholoğical chanğes is crucial for elucidatinğ the proğression of GDM and its implications for maternal and fetal health, hiğhliğhtinğ the importance of comprehensive placental analysis in manağinğ preğnancies complicated by GDM. [ABSTRACT FROM AUTHOR]

The article discusses the feasibility of a project called FairEmbo, which aims to reduce maternal mortality caused by postpartum hemorrhage (PPH) in low-income countries. The project proposes using absorbable surgical sutures as a cost-effective alternative to expensive embolic agents for the treatment of PPH. The article presents the successful treatment of three patients with PPH using embolization of the uterine arteries with surgical sutures. The procedure was effective in achieving complete obstruction of the targeted vessels, and the patients experienced rapid recovery with no major complications. The article concludes that embolization with absorbable suture fragments is a feasible and effective treatment for PPH. [Extracted from the article]

Background: this study aimed to determine the expression of RNA-binding oncofetal proteins IMP3 and LIN28A in extravillous (EVT) and villous trophoblast (VT) cells of placentas from pre-eclamptic (PE) pregnancies to better understand the pathogenesis of PE. Methods: placental tissue of 10 patients with PE with severe features, 10 patients with PE without severe features and 20 age-matched healthy pregnancy controls were analyzed by immunohistochemistry, double immunofluorescence and qPCR. Results: We found a decreased percentage of IMP3-positive EVT cells in PE with and without severe features compared to that of the healthy control (p < 0.001). IMP3 expression was significantly low in VT of PE placentas compared to that of the healthy control (p = 0.002). There was no significant difference in LIN28A expression between groups of PE and the control group. Additionally, we noticed the trend toward downregulation of IMP3 mRNA and LIN28A mRNA in severe PE compared to that of healthy controls. Conclusions: We demonstrated that IMP3 expression is decreased in EVT and VT cells of placentas from pregnancies complicated with both PE with and without severe features. However, additional functional investigations are needed to clarify the role of IMP3 as a potential therapeutic target in the management of PE. [ABSTRACT FROM AUTHOR]

This article discusses the clinical application of intraoperative ultrasound for the management of placenta accreta spectrum (PAS) disorders. The study aimed to determine if intraoperative ultrasound, combined with preoperative and surgical findings, could provide evidence for conservative management with safe placental removal in suspected PAS cases. The researchers conducted a prospective study and evaluated nine suspected cases at three stages: preoperative, intraoperative, and postoperative. Intraoperative ultrasound images were found to be clearer than preoperative images, and the identification of a retroplacental myometrial layer was associated with complete placental separation. The authors conclude that intraoperative ultrasound can provide additional information for surgical staging and safe placental removal, but further studies are needed. [Extracted from the article]

A 35-year-old woman at 36 weeks and 4 days gestation with known complete anterior placenta previa and no other medical history presented for routine obstetric follow-up. She reported increasing fatigue in the prior week but otherwise endorsed no new concerns. She denied recent vaginal bleeding or discharge, abdominal pain, contractions, or extremity swelling. On evaluation, her BP was 126/74 mm Hg with a heart rate of 72 beats per min. The results from the physical examination were normal. There was a category II fetal heart rate tracing and a 6/10 biophysical profile (ie, no fetal breathing movements, nonreactive nonstress test), which prompted referral to the hospital. On admission, sonogram confirmed cephalic presentation and redemonstrated complete anterior placenta previa with no evidence of hemorrhage. She received antenatal steroids and was scheduled for a cesarean section delivery. She received bupivacaine spinal anesthesia for the procedure. The surgical procedure progressed with a low transverse uterine incision and subsequent delivery of the baby with no complications noted. Immediately after delivery of the baby and during gentle traction of the placenta, the patient experienced rapid cardiovascular collapse in the form of hypotension and bradycardia. [ABSTRACT FROM AUTHOR]

A study published in the journal Paediatric & Perinatal Epidemiology examined the accuracy of ICD-10 codes for placenta accreta spectrum (PAS) in a single referral center from 2015 to 2020. Out of 22,345 deliveries, only 51 cases had a histopathologic diagnosis of PAS, indicating a high rate of false positive cases. Inaccurate data on PAS incidence can make it difficult to understand the true scope of the problem and identify risk factors. False positive results can lead to suboptimal screening and treatment, while misclassification can dilute the magnitude of risk factors and lead to unnecessary referrals and increased costs. The study suggests the need for a standardized and objective definition of PAS and efforts to improve the accuracy of ICD-10 coding. [Extracted from the article]

Background: The greatest risk for the occurrence of the placenta accreta spectrum (PAS) is represented by uterine scars, which most frequently result after cesarean sections. Uterine rupture is a rare condition and appears mainly in the third trimester of pregnancy. The association between these two conditions is extremely rare in the first trimester of pregnancy. Methods: We performed a systematic review of abnormal placental adhesions and spontaneous uterine ruptures in the first trimester of pregnancy. We also reported a case of spontaneous uterine rupture in a 12-week pregnancy that presented with massive hemoperitoneum and hemorrhagic shock. Results: A 33-year-old patient with two previous cesarean sections, at the twelfth week of pregnancy at the time to this visit to the emergency room, presented with syncope and intense pelvic–abdominal pain. A clinical examination and ultrasound scan established the diagnosis of hemoperitoneum and hemorrhagic shock. Surgical exploration was performed, uterine rupture was identified, and hemostasis hysterectomy was necessary. The histopathological results showed placenta percreta. There have been eight reported cases of spontaneous uterine rupture in the first trimester of pregnancy associated with PAS. In these cases, it was found that 62.5% of the patients had undergone at least one cesarean section in the past; in 75% of the cases, hysterectomy was performed; and, in 87.5% of the cases, the presence of placenta percreta was confirmed. Conclusions: A high rate of cesarean sections determines the increase in the incidence of placenta accreta spectrum disorders. The possible life-threatening complications caused by this pathology can be observed in early pregnancies. [ABSTRACT FROM AUTHOR]