We report a case of a 40</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year-old woman, second pregnancy, previous cesarean section due ...We report a case of a 40</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.展开更多
INTRODUCTIONThe incidence of the morbidly adherent placenta has been increasing due to the increased rate of cesarean section. Life-threatening hemorrhage is the major concern for the morbidly adherent placenta, and e...INTRODUCTIONThe incidence of the morbidly adherent placenta has been increasing due to the increased rate of cesarean section. Life-threatening hemorrhage is the major concern for the morbidly adherent placenta, and efficient bleeding control of lower uterine segment is critical to improve outcomes. When traditional conservative methods do not work, further surgical procedures should be attempted. There are several conservative surgical approaches for lower uterine compression, and peripartum hysterectomy is avoided. In the present study, we aimed to report a rather easy suturing method to compress the lower uterine.展开更多
Objective:To evaluate the efficacy and safety of internal iliac artery(IIA)ligation in the management of placenta accreta spectrum(PAS).Methods:PubMed,Embase,Scopus,ScienceDirect,Cochrane Library,and Clinical Trials R...Objective:To evaluate the efficacy and safety of internal iliac artery(IIA)ligation in the management of placenta accreta spectrum(PAS).Methods:PubMed,Embase,Scopus,ScienceDirect,Cochrane Library,and Clinical Trials Registry were searched up to December 2024 for studies on IIA ligation in PAS.This PROSPERO-registered review followed PRISMA guidelines and included randomized controlled trials(RCTs)and non-RCTs comparing IIA ligation with no intervention,IIA balloon,uterine artery ligation,or temporary common iliac artery occlusion.Outcomes included intraoperative blood loss,transfusion needs,procedure duration,complications,intensive care unit admission,and hospital stay,with risk of bias assessed using Cochrane criteria and the Newcastle-Ottawa Scale,and evidence quality rated via GRADE.Effect estimates were reported as mean differences or odds ratios(95% confidence interval(CI))using fixed-or random-effects models based on heterogeneity(I^(2)),withP<0.05 considered significant.Results:A total of 13 studies,including five RCTs and eight non-RCTs,involving 939 participants,met the inclusion criteria and were included in the study.Intraoperative blood loss was evaluated in 10 studies involving 631 participants(299 undergoing IIA ligation and 332 controls).The mean difference was -177.10 mL(95%CI:-701.46-347.27;P=0.51;I^(2)=95%).Postoperative hemoglobin reduction was analyzed in four studies with 233 participants(109 subjected to IIA ligation and 124 controls),yielding a mean difference of -0.17 g/dL(95%CI:-0.47-0.14,P=0.29,I^(2)=1%).Blood transfusion was assessed in five studies enrolling 248 participants(125 in the IIA ligation group and 123 controls).The mean difference was found to be -0.06 units(95%CI:-2.08-1.95,P=0.95,I^(2)=93%).The duration of the procedure was investigated in eight studies comprising 539 participants(271 undergoing IIA ligation and 268 controls).The mean difference was calculated as 12.85 minutes(95%CI:-7.2-32.9,P=0.21,I^(2)=87%).Conclusion:Current evidence suggests that IIA ligation in PAS may not significantly reduce intraoperative blood loss,transfusion requirements,procedure duration,bladder injury,or hospital stay;however,the available studies are heterogeneous and of variable quality,and further high-quality research is needed to confirm these findings.Registration:CRD42024626882,Date 13/12/2024.展开更多
Objective:To evaluate the diagnostic accuracy of magnetic resonance imaging(MRI)in diagnosing placenta accreta spectrum(PAS).Methods:We conducted a comprehensive literature search from database inception to November 2...Objective:To evaluate the diagnostic accuracy of magnetic resonance imaging(MRI)in diagnosing placenta accreta spectrum(PAS).Methods:We conducted a comprehensive literature search from database inception to November 2023 using terms such as placenta creta,increta,percreta,PAS,MRI,and their respective Medical Subject Headings terms.All prospective and retro-spective cohort,case-control,and cross-sectional studies involving prenatal magnetic resonance imaging diagnosis of PAS with subsequent pathological confirmation were included.Results:A total of 40 studies encompassing 3664 women met the inclusion criteria,with 1894 cases confirmed pathologically as PAS.The overall sensitivity of MRI was 0.867(95%confidence interval(CI):0.807–0.910),and the specificity was 0.860(95%CI:0.799–0.905),with a correlation of 0.693 between sensitivity and specificity.The estimated odds ratio was 28.693(95%CI:14.463–56.924),the negative likelihood ratio was 0.178(95%CI:0.122–0.258),and the positive likelihood ratio was 4.316(95%CI:3.186–5.846).Analysis of individual MRI criteria revealed estimates of sensitivity,specificity,odds ratio,negative likelihood ratio,and positive likelihood ratio for abnormal placental bed vascularization as 0.500,0.740,2.788,0.571,and 1.645 respectively;0.384,0.985,6.270,0.471,and 2.720 for bladder wall interruption;0.766,0.818,13.638,0.262,and 3.375 for the presence of dark intraplacental bands;0.691,0.913,10.828,0.352,and 3.361 for heterogeneous placenta;0.688,0.984,34.886,0.254,and 7.164 for indistinctive myometrium;0.757,0.864,8.496,0.362,and 2.778 for loss of retroplacental dark zone;0.828,0.593,5.829,0.329,and 1.766 for myometrial thinning;and 0.518,0.916,9.473,0.411,and 3.526 for placental bulge,respectively.Conclusion:MRI demonstrates significant utility in diagnosing PAS and its severity.It is recommended for use in all cases with inconclusive ultrasonographic findings.Registration:Registration number CRD42021267501.展开更多
To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean sect...To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean section and scar resection shortly after diagnosis.2 The final decision regarding management depends on the patient's choice,medical advice,the fertility desire,and the social,religious and emotional background that should also be taken into account.展开更多
文摘We report a case of a 40</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">year-old woman, second pregnancy, previous cesarean section due to intrauterine growth restriction and placenta accreta spectrum disorders. She was 25 weeks gestational age, admitted to the hospital 25 weeks gestational age, diagnosed with fetal death. Initial conservative management attempt with uterine preservation progresses to complications requiring total hysterectomy followed by a rare outcome: pelvic thrombi with uterine necrosis, with its associated clinical complications.
文摘INTRODUCTIONThe incidence of the morbidly adherent placenta has been increasing due to the increased rate of cesarean section. Life-threatening hemorrhage is the major concern for the morbidly adherent placenta, and efficient bleeding control of lower uterine segment is critical to improve outcomes. When traditional conservative methods do not work, further surgical procedures should be attempted. There are several conservative surgical approaches for lower uterine compression, and peripartum hysterectomy is avoided. In the present study, we aimed to report a rather easy suturing method to compress the lower uterine.
文摘Objective:To evaluate the efficacy and safety of internal iliac artery(IIA)ligation in the management of placenta accreta spectrum(PAS).Methods:PubMed,Embase,Scopus,ScienceDirect,Cochrane Library,and Clinical Trials Registry were searched up to December 2024 for studies on IIA ligation in PAS.This PROSPERO-registered review followed PRISMA guidelines and included randomized controlled trials(RCTs)and non-RCTs comparing IIA ligation with no intervention,IIA balloon,uterine artery ligation,or temporary common iliac artery occlusion.Outcomes included intraoperative blood loss,transfusion needs,procedure duration,complications,intensive care unit admission,and hospital stay,with risk of bias assessed using Cochrane criteria and the Newcastle-Ottawa Scale,and evidence quality rated via GRADE.Effect estimates were reported as mean differences or odds ratios(95% confidence interval(CI))using fixed-or random-effects models based on heterogeneity(I^(2)),withP<0.05 considered significant.Results:A total of 13 studies,including five RCTs and eight non-RCTs,involving 939 participants,met the inclusion criteria and were included in the study.Intraoperative blood loss was evaluated in 10 studies involving 631 participants(299 undergoing IIA ligation and 332 controls).The mean difference was -177.10 mL(95%CI:-701.46-347.27;P=0.51;I^(2)=95%).Postoperative hemoglobin reduction was analyzed in four studies with 233 participants(109 subjected to IIA ligation and 124 controls),yielding a mean difference of -0.17 g/dL(95%CI:-0.47-0.14,P=0.29,I^(2)=1%).Blood transfusion was assessed in five studies enrolling 248 participants(125 in the IIA ligation group and 123 controls).The mean difference was found to be -0.06 units(95%CI:-2.08-1.95,P=0.95,I^(2)=93%).The duration of the procedure was investigated in eight studies comprising 539 participants(271 undergoing IIA ligation and 268 controls).The mean difference was calculated as 12.85 minutes(95%CI:-7.2-32.9,P=0.21,I^(2)=87%).Conclusion:Current evidence suggests that IIA ligation in PAS may not significantly reduce intraoperative blood loss,transfusion requirements,procedure duration,bladder injury,or hospital stay;however,the available studies are heterogeneous and of variable quality,and further high-quality research is needed to confirm these findings.Registration:CRD42024626882,Date 13/12/2024.
文摘Objective:To evaluate the diagnostic accuracy of magnetic resonance imaging(MRI)in diagnosing placenta accreta spectrum(PAS).Methods:We conducted a comprehensive literature search from database inception to November 2023 using terms such as placenta creta,increta,percreta,PAS,MRI,and their respective Medical Subject Headings terms.All prospective and retro-spective cohort,case-control,and cross-sectional studies involving prenatal magnetic resonance imaging diagnosis of PAS with subsequent pathological confirmation were included.Results:A total of 40 studies encompassing 3664 women met the inclusion criteria,with 1894 cases confirmed pathologically as PAS.The overall sensitivity of MRI was 0.867(95%confidence interval(CI):0.807–0.910),and the specificity was 0.860(95%CI:0.799–0.905),with a correlation of 0.693 between sensitivity and specificity.The estimated odds ratio was 28.693(95%CI:14.463–56.924),the negative likelihood ratio was 0.178(95%CI:0.122–0.258),and the positive likelihood ratio was 4.316(95%CI:3.186–5.846).Analysis of individual MRI criteria revealed estimates of sensitivity,specificity,odds ratio,negative likelihood ratio,and positive likelihood ratio for abnormal placental bed vascularization as 0.500,0.740,2.788,0.571,and 1.645 respectively;0.384,0.985,6.270,0.471,and 2.720 for bladder wall interruption;0.766,0.818,13.638,0.262,and 3.375 for the presence of dark intraplacental bands;0.691,0.913,10.828,0.352,and 3.361 for heterogeneous placenta;0.688,0.984,34.886,0.254,and 7.164 for indistinctive myometrium;0.757,0.864,8.496,0.362,and 2.778 for loss of retroplacental dark zone;0.828,0.593,5.829,0.329,and 1.766 for myometrial thinning;and 0.518,0.916,9.473,0.411,and 3.526 for placental bulge,respectively.Conclusion:MRI demonstrates significant utility in diagnosing PAS and its severity.It is recommended for use in all cases with inconclusive ultrasonographic findings.Registration:Registration number CRD42021267501.
文摘To editor:Cesarean scar pregnancy(CSP)is a rare pathology,with an increasingly clear association with morbidly adherent placenta(MAP).1 Although the most recommended treatment is pregnancy termination by cesarean section and scar resection shortly after diagnosis.2 The final decision regarding management depends on the patient's choice,medical advice,the fertility desire,and the social,religious and emotional background that should also be taken into account.
