Neonatal Outcomes in the Surgical Management of Placenta Accreta Spectrum Disorders: A Retrospective Single-Center Observational Study From 468 Vietnamese Pregnancies Beyond 28 Weeks of Gestation

BACKGROUND: Placenta accreta spectrum disorders (PASDs) increase the mortality rate for mothers and newborns over a decade. Thus, the purpose of the study is to evaluate the neonatal outcomes in emergency cesarean section (CS) and planned surgery as well as in Cesarean hysterectomy and the modified one-step conservative uterine surgery (MOSCUS). The secondary aim is to reveal the factors relating to poor neonatal outcomes. METHODS: This was a single-center retrospective study conducted between 2019 and 2020 at Tu Du Hospital, in the southern region of Vietnam. A total of 497 pregnant women involved in PASDs beyond 28 weeks of gestation were enrolled. The clinical outcomes concerning gestational age, birth weight, APGAR score, neonatal intervention, neonatal intensive care unit (NICU) admission, and NICU length of stay (LOS) were compared between emergency and planned surgery, between the Cesarean hysterectomy and the MOSCUS. The univariate and multivariable logistic regression were used to assess the adverse neonatal outcomes. RESULTS: Among 468 intraoperatively diagnosed PASD cases who underwent CS under general anesthesia, neonatal outcomes in the emergency CS (n = 65) were significantly poorer than in planned delivery (n = 403). Emergency CS increased the odds ratio (OR) for earlier gestational age, lower birthweight, lower APGAR score at 5 min, higher rate of neonatal intervention, NICU admission, and longer NICU LOS ≥ 7 days with OR, 95% confidence interval (CI) were 10.743 (5.675-20.338), 3.823 (2.197-6.651), 5.215 (2.277-11.942), 2.256 (1.318-3.861), 2.177 (1.262-3.756), 3.613 (2.052-6.363), and 2.298 (1.140-4.630), respectively, p \u3c 0.05. Conversely, there was no statistically significant difference between the neonatal outcomes in Cesarean hysterectomy (n = 79) and the MOSCUS method (n = 217). Using the multivariable logistic regression, factors independently associated with the 5-min-APGAR score of less than 7 points were time duration from the skin incision to fetal delivery (min) and gestational age (week). One minute-decreased time duration from skin incision to fetal delivery contributed to reduce the risk of adverse neonatal outcome by 2.2% with adjusted OR, 95% CI: 0.978 (0.962-0.993), p = 0.006. Meanwhile, one week-decreased gestational age increased approximately two fold odds of the adverse neonatal outcome with adjusted OR, 95% CI: 1.983 (1.600-2.456), p \u3c 0.0001. CONCLUSIONS: Among pregnancies with PASDs, the neonatal outcomes are worse in the emergency group compared to planned group of cesarean section. Additionally, the neonatal comorbidities in the conservative surgery using the MOSCUS method are similar to Cesarean hysterectomy. Time duration from the skin incision to fetal delivery and gestational age may be considered in PASD surgery. Further data is required to strengthen these findings

Gambaran Luaran Maternal dan Perinatal pada Ibu dengan Kehamilan Plasenta Akreta Berdasarkan Hasil USG di RS M. Djamil Padang

Spektrum Plasenta Akreta (PAS) telah menjadi perhatian khusus saat ini dengan insidensi yang meningkat dari 1,7 per 10.000 kelahiran menjadi 577 per 10.000 kelahiran pada wanita dengan seksio sesarea sebelumnya dan plasenta previa. Salah satu yang paling banyak dikaitkan dengan plasenta akreta adalah tindakan seksio sesarea yang berdampak pada ibu dan juga bayi. Jumlah tindakan seksio sesarea diketahui meningkat dari 1 dalam 2500 kehamilan menjadi 1 dalam 500 kehamilan. Oleh karena itu, plasenta akreta menjadi salah satu keadaan pada ibu hamil yang sangat perlu diperhatikan. Penelitian ini bertujuan untuk mengetahui gambaran luaran maternal dan perinatal pada ibu hamil dengan plasenta akreta yang bersalin di RSUP Dr. M. Djamil Padang pada tahun 2024.Jenis penelitian yang digunakan adalah penelitian deskriptif kuantitatif, menggunakan data sekunder yang berasal dari bagian Rekam Medis RSUP Dr. M. Djamil. Pengambilan sampel menggunakan teknik total sampling dengan jumlah 57 pasien ibu hamil dengan plasenta akreta di RSUP Dr. M. Djamil Padang pada tahun 2024. Data dianalisis secara univariat. Hasil penelitian menunjukkan ibu dengan kehamilan plasenta akreta banyak terjadi pada usia 21 – 35 tahun, multiparitas dan semua ibu memiliki riwayat seksio sesarea pada persalinan sebelumnya Gambaran luaran maternal yang ditemukan terjadi pada ibu dengan kehamilan plasenta akreta adalah rawatan ICU (26,3%) masa rawatan >7 hari (15,8%) dan histerektomi (49,1%). Gambaran luaran perinatal yang ditemukan adalah dilakukan resusitasi (52,6%), rawatan NICU (40,4%), prematur (28,1%), BBLR (28,1%) dan kematian bayi (7%). Berdasarkan hasil penelitian dapat disimpulkan bahwa plasenta akreta memiliki dampak yang signifikan terhadap luaran maternal dan perinatal. Temuan ini menegaskan pentingnya deteksi dini dan penanganan yang tepat pada kasus plasenta akreta untuk mengurangi risiko luaran yang kurang baik bagi ibu dan bay

Placenta Accreta Spectrum in delivered women is associated with history of curettage: A case-control study at Dr. Moewardi General Hospital, Surakarta, Indonesia

HIGHLIGHTS • Placenta Accreta Spectrum cases rise in proportion to the high frequency of uterine wall damage. • A significant association was found between curettage history and Placenta Accreta Spectrum.   ABSTRACT Objective: Placenta Accreta Spectrum (PAS) is a condition in which the placental villi directly adhere to the myometrium, a leading cause of serious obstetric bleeding. The situation has increased morbidity and mortality in pregnant women due to 3.000 – 5.000 mL blood loss. The incidence of PAS has risen globally from 0.12% to 0.31%, linked to frequent uterine damage from procedures like cesarean sections or curettage. This study aims to determine the association between history of curettage and PAS. Materials and Methods: The type of research used is analytic observational with a case-control approach. The sampling technique used in this study is purposive sampling, and 134 samples match the inclusion criteria. The samples used are delivered women referred to Dr. Moewardi General Hospital, Surakarta, Indonesia, from May 2022 until May 2024. Data analysis utilizing IBM SPSS 25. Chi-square test determines the association between two variables at a significance level of p < 0.05, while logistic regression is used to determine the most influential variables. Results: The sample consisted of 67 patients with PAS and 67 without PAS. There was a significant association between the history of curettage and PAS, as determined by a Chi-square test, with a p-value of 0.000. Further analysis using logistic regression on the history of curettage obtained a value of p = 0.001 and OR = 5.769 (CI95% 2.090 – 15.928). Conclusion: The history of curettage is significantly associated with PAS. Patients who have had curettage in the past are 5.769 times more likely to experience PAS than patients without a history of curettage

DETERMINANT FACTORS AFFECTING THE INCIDENCE OF PLACENTA ACCRETA

Background: Placenta accreta is a rare condition during pregnancy characterized by abnormal placentation that can increase maternal morbidity and mortality. The increase in the incidence of placenta accreta is directly related to the increase in section caesarean rates. The maternal mortality rate in NTB in 2021 was 15% due to hemorrhage, in 2022 there was an increase in the incidence of placenta accreta at the NTB Provincial Hospital. The aim of the research is  to identify the determinant factors affecting the incidence of placenta accreta at the NTB Provincial Hospital in 2022. Methods: This was a descriptive observational study. The population in this study were all mothers who delivered at the NTB Provincial Hospital from January to December 2022. The sample number was 50 patients diagnosed with placenta accreta. The sampling technique used was total sampling with the research variable of maternal characteristics. Data were collected from the medical records of mothers with placenta accreta from January to December 2022, and the results were analyzed using descriptive analysis. Results: Placenta accreta patients were more common in mothers with age ≤ 35 years with a median of 34.34 ± 4.28, multiparous parity (76%), overweight BMI (54%), 3-9 years labour spacing (82%), history of SC ˂ 2 times (52%) and ≥ 2 times (48%), and with a history of uterine surgery 24%. Conclusion: Determinant factors that affect the incidence of placenta accreta in NTB Provincial Hospital in 2022 are mothers with age < 35 years, multigravida, overweight body mass index, mostly with a parity of 3-9 years, without degenerative diseases, all have a history of cesarean section and almost a quarter have a history of other operations on the uterus

Non-tubal Ectopic Pregnancy

"Non-Tubal Ectopic Pregnancy" is a comprehensive book, written in an organized and concise format. The book offers an immersion into non-tubal ectopic pregnancy and the reader is invited, chapter after chapter, to visit the most important aspects of non-tubal ectopic pregnancies. The book covers all aspects of non-tubal ectopic pregnancies including epidemiology, diagnosis, and management. Experts from all over the world have contributed to it, bringing the best from their research.The book presents the reader with the latest advances on non-tubal ectopic pregnancies

National Survey and Review of Maternal Near Miss in Oman

Background: Review of the care provided to women who nearly died but survived complications occurring during pregnancy, childbirth, or the postnatal period, known as maternal near miss (MNM). It is one of the recommended approaches to improve the quality of care (QoC) especially in settings with few maternal deaths. Oman has a well-established maternal deaths surveillance system, but there has not been a significant decline in the maternal mortality ratio, and the majority of maternal deaths are considered preventable. In addition, the burden of severe maternal morbidity is unknown. This study explores the potential of MNM review to improve quality of care in Oman. The objectives are to determine the incidence, underlying causes of, and factors associated with MNM in Oman, to assess QoC and make recommendations for its improvement. Method: Existing WHO guidelines and criteria were reviewed, and a systematic review of the literature was conducted to establish criteria for the identification of MNM in Oman. A national survey with in-depth review of MNM cases was implemented. MNM cases were identified from 23 hospitals across all 11 governorates, capturing more than 90% of total deliveries in the country. Between October 2016 and September 2017 all cases fulfilling the MNM criteria were reviewed at the hospital and regional levels by trained reviewers. 50% of cases were reviewed additionally by the National Maternal Mortality Review Committee and a panel of international experts. The level of agreement between various levels of reviewers was determined using Cohen’s kappa coefficient. Results: During the one-year period of data collection a total of 25 maternal deaths and 312 MNM cases were reported, given an MNM incidence of 4.0 per 1000 women giving birth (deliveries), and a ratio of MNM: maternal mortality of 10.3:1. Hypertensive disorders (44%), obstetric haemorrhage (23%), and non-obstetric complications (18%) were the most common underlying causes of MNM. Previous caesarean sections (20.0%), medical disorders (20.0%), and grand-multiparity (20.0%) were the main contributory conditions to MNM. Overall there was good care given (43.6%). In up to 36.5% of cases improved care could have made a difference to the outcome. The most commonly identified associated factors were related to the healthcare team providing care (50.0%), in particular inappropriate management (28.2%) and failure to initially recognise the seriousness of the condition (25.6%). Factors related to the women themselves included non-adherence to prescribed treatment, delay in seeking care was associated with around one third of MNM events. Factors related to organisation of care were recorded in about a quarter of all MNM events with non-availability or outdated policy and guidelines identified as the most common identified factors. Conclusion: The study used a participatory process to develop criteria for identify MNM and a system for reviewing these. It demonstrated it is feasible to complement maternal deaths review with MNM review. The most common causes of MNM are preventable, and the majority of factors associated with MNM are within the scope of health system resources. Using participatory approach that involved international experts, Omanese health workers and managers, an action plan for improvement of QoC in Oman was developed

Female Biology

Over twenty years ago I developed a course for the upper- level biology major at the University of San Francisco called Female Biology. This was from what I perceived as a gap in the undergraduate biology curriculum- students were not learning about the evolutionary aspects of being female and studying the specific health-related issues unique to women. The information in the most widely used general biology textbooks written from a male perspective, focuses on research gained from male models by work conducted in male-led laboratories. There still exists a problem with a lack of adequate representation of women in biomedical research. The focus of the course is the unique biological aspects of the female sex. There is also an emphasis on the inequities experienced by female scientists. Topics covered include evolution and genetics of sex, gender identity, sexuality, reproduction, anatomy, and physiology. Additionally, an effort is made in this course to recognize disparities in healthcare across marginalized female and transgender populations. Female Biology Copyright © 2023 by Jennifer A. Dever is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives CC BY-NC-ND 4.0 International License, except where otherwise noted

Policy Implementation Analysis of District Health System to Improve Health Services: Study in North Central Timor Regency, East Nusa Tenggara Timur Province, Indonesis

Context: Improving degree of public health in a region requires quality health services. For this reason, district health system has been formed which can be implemented comprehensively to the target community. A study is needed to find out the factors that influence policy implementation so that quality of health services can be improved. This study used quantitative method with structural equation models to find patterns of the relationship between the district health system and health services. The results showed that there are 7 indicators that are part of the district health system factors, 2 indicators that are part of the resposivensss factor, 8 indicators that are part of the policy implementation factor, and 3 indicators that are part of the health service factor. These indicators have loading factor ≥ 0.5. The district health system consisting of 7 subsystems if properly implemented will have a positive impact on health services by 1.98. Contribution of policy implementation in improving health services will be great if the district health system is implemented together with responsiveness, so that the total effect becomes 2.20

Female Biology

Over twenty years ago I developed a course for the upper- level biology major at the University of San Francisco called Female Biology. This was from what I perceived as a gap in the undergraduate biology curriculum- students were not learning about the evolutionary aspects of being female and studying the specific health-related issues unique to women. The information in the most widely used general biology textbooks written from a male perspective, focuses on research gained from male models by work conducted in male-led laboratories. There still exists a problem with a lack of adequate representation of women in biomedical research. The focus of the course is the unique biological aspects of the female sex. There is also an emphasis on the inequities experienced by female scientists. Topics covered include evolution and genetics of sex, gender identity, sexuality, reproduction, anatomy, and physiology. Additionally, an effort is made in this course to recognize disparities in healthcare across marginalized female and transgender populations. Book available for free download in PDF and epub format - compatible with most eReaders. Female Biology Copyright © 2023 by Jennifer A. Dever is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives CC BY-NC-ND 4.0 International License, except where otherwise noted.https://repository.usfca.edu/faculty_books_all/1102/thumbnail.jp

A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women

Abstract Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS