Abstract:
OBJECTIVE: Women with placenta accreta spectrum (PAS) having an unplanned delivery may have worse outcome compared with women with a planned delivery. The primary objective of this study was to compare severe maternal morbidity among women with PAS who had a planned scheduled delivery versus an unplanned delivery. Secondary objective was to compare neonatal outcomes. STUDY DESIGN: Retrospective cohort study at two tertiary centers (January 2009 to June 2019) of all women who underwent a hysterectomy with a histologic proven PAS. Primary outcome was severe maternal morbidity which defined as any of the following: transfusion of ≥4 RBC units or ureter/bowel injury. Neonatal outcome was a composite neonatal morbidity defined as any of the following: Apgar score's < 5 at 5 minutes, mechanical ventilation, or respiratory distress syndrome. Maternal demographic, clinical, and sonographic characteristics were compared between the two groups (planned vs. unplanned). Descriptive statistics were used as appropriate, and a statistical significance was established if p-value was < 0.05. RESULTS: Of 109 women who underwent cesarean hysterectomy for PAS, 41 (37.6%) had an unplanned delivery. There was no significant difference in the number of previous cesarean deliveries or ultrasound findings between the two groups. Women with an unplanned delivery were more likely to bleed during pregnancy than those that had a planned delivery (p = 0.04). Women with unplanned delivery had lower gestational age at delivery (30.3 vs. 33.8 weeks, p = 0.001) had a 75% higher rate of the primary outcome (63 vs. 36%, p = 0.007) and had a higher rate of intensive care unit admissions (39 vs. 17.7%, p = 0.01) compared with women with a planned delivery. The neonatal morbidity did not differ between the two groups. CONCLUSION: Since unplanned cesarean hysterectomy among women with PAS occurs in 40% and is associated with significantly higher morbidity, interventions are needed to mitigate the rate of adverse outcomes. KEY POINTS:· Only 60% of women with PAS reached planned delivery at 34 weeks.. · PAS unplanned delivery is associated with high morbidity.. · Some women with PAS may need a scheduled earlier delivery..
journal_name
Am J Perinatoljournal_title
American journal of perinatologyauthors
Fishel Bartal M,Papanna R,Zacharias NM,Soriano-Calderon N,Limas M,Blackwell SC,Chen HY,Chauhan SP,Sibai BMdoi
10.1055/s-0040-1714676subject
Has Abstractpub_date
2020-07-23 00:00:00eissn
0735-1631issn
1098-8785pub_type
杂志文章abstract::The objective of this article is to test whether the concentration of potentially oxidizable lipids (polyunsaturated fatty acids [PUFA], total and free cholesterol) and lipophilic antioxidants (plasmalogens, vitamin E) in the fetal lung correlate with lung maturation (P/S ratio). In amniotic fluid palmitic/stearic aci...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-993952
更新日期:1998-05-01 00:00:00
abstract::The significance and management of prepartum bradycardia is not well established in prepartum fetal assessment. The incidence of prolonged bradycardia was 3.5% (45 per 1284), defined as a decrease of greater than or equal to 40 beats per minute of the fetal heart rate (FHR) below the baseline for at least 2 minutes. T...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999972
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abstract:OBJECTIVE: The study aims to assess the impact on neurodevelopmental outcomes of a prolonged hemodynamically significant patent ductus arteriosus (PDA) after a conservative treatment. STUDY DESIGN: This involves the study of two cohorts of preterm infants 23 to 29 weeks gestation, before (n = 29) and after (n = 54) a ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-1697674
更新日期:2019-10-10 00:00:00
abstract::Intrapartum fetal scalp sampling for platelet counts in maternal autoimmune thrombocytopenia has been advocated for determining route of delivery. We report a case in which two coagulated scalp samples were believed to indicate a normal fetal platelet count. As a result, vaginal delivery of a severely thrombocytopenic...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999401
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:Fetal tachyarrhythmias complicate 0.5% of pregnancies, with high morbidity and mortality. We hypothesized that maternal factors may predispose to fetal supraventricular tachycardia (SVT). STUDY DESIGN:We reviewed medical records of all 124 mothers who presented to the Vanderbilt Fetal Cardiology Clinic from ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0035-1552942
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:We assessed the utility of plasma B-type natriuretic peptide (BNP) in infants with persistent pulmonary hypertension of the newborn (PPHN) in the prediction of inhaled nitric oxide (iNO) requirement. METHODS:This prospective study involved neonates (gestational age ≥ 34 weeks) with PPHN and confirmatory echo...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0035-1548540
更新日期:2015-09-01 00:00:00
abstract::Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infectio...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0040-1709993
更新日期:2020-06-01 00:00:00
abstract::The objective of this study is to review the safety and success of a trial of labor after cesarean in a group of patients managed by a solo practitioner in a rural community. This was a retrospective review of all deliveries performed over an 11-year period by a single practitioner in a rural community. Standard contr...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2003-38317
更新日期:2003-02-01 00:00:00
abstract::Liposomal amphotericin B L-Amp B, a novel formulation of Amp B, is effective for the treatment of invasive fungal infections in children and adults and is associated with less toxicity than the conventional preparation. Data on the use of L-Amp B in neonates is scarce. We describe the clinical course of two premature ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994337
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To determine if patients with a history of low pregnancy-associated plasma protein A (PAPP-A) in an initial pregnancy are at higher risk for adverse obstetric outcomes in a subsequent pregnancy. STUDY DESIGN:This was a retrospective cohort study in patients who underwent first trimester screening for PAPP-A ...
journal_title:American journal of perinatology
pub_type: 杂志文章
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更新日期:2019-05-01 00:00:00
abstract::Type 1 cystic sacrococcygeal teratomas, usually associated with good outcome following neonatal resection, must be differentiated at the time of prenatal diagnosis from sonographically similar meningomyeloceles, which carry a grave prognosis. We present an unusual case in which color Doppler imaging assisted correct m...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994089
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE:This study aimed to assess the applicability of the insertion of small diameter catheters through the femoral vein in extremely low-birth-weight (ELBW) infants. STUDY DESIGN:All femoral small diameter catheters (Silastic or femoral arterial catheter [FAC]) inserted in ELBW infants in a tertiary level neonata...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-1693718
更新日期:2020-12-01 00:00:00
abstract::Objective To determine if mandatory online training in electronic fetal monitoring (EFM) improved agreement in documentation between obstetric care providers and nurses on labor and delivery. Methods Health care professionals working in obstetrics at our institution were required to complete a course on EFM interpreta...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0036-1572540
更新日期:2016-07-01 00:00:00
abstract::The incidence of triplet pregnancies has increased several times due to the widespread use of ovulation induction agents. Premature delivery is the main complication of triplet gestations. In twin conceptions it was shown definitely that elective cervical suture does not prolong these pregnancies. However, in higher o...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994691
更新日期:1993-01-01 00:00:00
abstract::Tuberous sclerosis complex (TSC) is an autosomal-dominant phakomatosis that can result in cardiac and central nervous system lesions and may adversely impact fetal and maternal health. We report a case of a 19-year-old primagravida with TSC whose pregnancy was complicated by preeclampsia, preterm labor, and fetal demi...
journal_title:American journal of perinatology
pub_type: 杂志文章,评审
doi:10.1055/s-2005-861572
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:Our aim was to estimate the incidence of unintentional hysterotomy extension at the time of cesarean delivery and to identify associated risk factors and maternal morbidity. STUDY DESIGN:We conducted a secondary analysis of a randomized controlled trial evaluating chlorhexidine-alcohol versus iodine-alcohol ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1676112
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the interobserver reliability of fetal heart rate (FHR) pattern definition and interpretation assessed by physicians at various levels of training using standard Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) definitions and standard principles of interpret...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0032-1326991
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:Prediction of gestational latency after placement of physical exam indicated cerclage (PEIC) is limited. Uterocervical angle (UCA) has been associated with spontaneous preterm delivery in the general population. Our objective was to examine whether UCA is associated with gestational latency in women with PEIC...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0037-1621734
更新日期:2018-07-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to investigate whether maternal bronchial asthma increases the risk for long-term respiratory morbidity of the offspring. STUDY DESIGN:A population-based cohort study compared the incidence of long-term pediatric hospitalizations due to respiratory disease of the offspring of ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1639507
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVE: The aim of this study was to estimate if preterm premature rupture of membranes in women with cerclage is due to the cerclage itself or rather the underlying risk factors for preterm birth in this population. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies who underwent Shirodka...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0040-1710009
更新日期:2020-05-23 00:00:00
abstract::We present an unusual case of a primigravida with a viable cervical pregnancy diagnosed by transvaginal ultrasound and magnetic resonance imaging. Staggered conservative therapeutic measures included systemic high-dose Methotrexate with Folinic acid rescue followed by bilateral embolization of the uterine arteries in ...
journal_title:American journal of perinatology
pub_type: 杂志文章,评审
doi:10.1055/s-2003-42341
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:Bacillus Calmette-Guerin (BCG) scar formation is considered a visual marker of vaccination and cell-mediated immune response. This study characterized the association between pregnancy and birth characteristics with BCG scar formation. STUDY DESIGN:Pregnant women were enrolled prospectively. Infants were fo...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1676614
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE: It is well established that women with a previous vaginal delivery have higher success rates in relation to vaginal birth after cesarean than those without. The aim of this study was to examine the effect of past mode of delivery on contractile parameters of human myometrium in vitro. STUDY DESIGN: Myometri...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-1694980
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:This study was aimed to evaluate the prevalence of sonographic markers for placenta accreta spectrum (PAS) in pregnancies at low-risk for PAS. STUDY DESIGN:Pregnant women at low-risk for PAS presenting for routine second trimester ultrasound who enrolled in the study were evaluated prospectively for sonograp...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0038-1676488
更新日期:2019-07-01 00:00:00
abstract::Background Late-onset sepsis (LOS) in very low-birth-weight (VLBW) infants is associated with significant morbidity and mortality. Objectives To determine the incidence of LOS workup, association, and predictive value of clinical indicators leading to culture-positive versus culture-negative sepsis workup. Methods All...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0036-1579648
更新日期:2016-07-01 00:00:00
abstract:OBJECTIVE:To develop a model to predict cesarean-associated red blood cell transfusion. STUDY DESIGN:Secondary analysis of all cesarean deliveries in the Maternal-Fetal Medicine Units Network Cesarean Registry. Using a split-sample technique, the derivation group was used to identify associated factors and build predi...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-0039-1678604
更新日期:2019-07-01 00:00:00
abstract::Discordancy in twins is generally described as a weight difference between the fetuses of 15 to 25% and its prevalence in normal twin gestations is estimated at 15 to 29%. The present study was performed in order to determine the frequency of discordant newborns in uncomplicated triplet gestations. One hundred and fou...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-994724
更新日期:1993-05-01 00:00:00
abstract::The occurrence of preterm labor is not uncommon in the pregnant quadriplegic. Early diagnosis is hampered by the inability of most quadriplegics to sense uterine contractions in the usual way. A patient we recently treated for preterm labor learned to recognize contractions by the associated symptoms of autonomic hype...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2007-999845
更新日期:1986-04-01 00:00:00
abstract::The objective of this paper is to determine if phenobarbital exposure during pregnancy affects developmental outcome at age 2 years. Between 1991 and 1994, 401 pregnant patients at risk for delivery prior to 34 weeks' gestation were invited to participate; 48 mothers declined entry. Before delivery, pharmacy randomize...
journal_title:American journal of perinatology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1055/s-2007-993836
更新日期:1999-01-01 00:00:00
abstract::To study a possible relation between the use of postnatal glucocorticoids and the incidence and severity of retinopathy of prematurity (ROP), we conducted a retrospective study over a 4-year period that compared data of 161 preterm infants treated with hydrocortisone for bronchopulmonary dysplasia (BPD) with the data ...
journal_title:American journal of perinatology
pub_type: 杂志文章
doi:10.1055/s-2000-13437
更新日期:2000-01-01 00:00:00