Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum

Background: To standardize research terminology and reduce unanticipated placenta accreta spectrum (PAS), the European Working Group for Abnormally Invasive Placenta (EW-AIP) developed a consensus checklist for reporting PAS suspected on antenatal ultrasound. The diagnostic accuracy of the EW-AIP checklist has not been assessed. Objective: To test the performance of the EW-AIP sonographic checklist in predicting histologic PAS. Study Design: This is a multi-site, blinded, retrospective review of transabdominal ultrasound studies performed between 26-32 weeks gestation for subjects with histologic PAS between 2016-2020. We matched a 1:1 control cohort of subjects without histologic PAS. To reduce reader bias, we matched the control cohort for known risk factors including previa, number of prior cesarean deliveries, prior dilation and curettage (D&C), in vitro fertilization (IVF), and clinical factors affecting image quality including multiple gestation, body mass index (BMI) and gestational age at the ultrasound. Nine sonologists from 5 referral centers, blinded to the histologic outcomes, interpreted the randomized ultrasound studies using the EW-AIP checklist. The primary outcome was the sensitivity and specificity of the checklist to predict PAS. Two separate sensitivity analyses were performed: 1) we excluded subjects with mild disease (i.e. only assessed subjects with histologic increta and percreta); 2) we excluded interpretations from the 2 most junior sonologists. Results: 78 subjects were included (39 PAS, 39 matched control). Clinical risk factors and image quality markers were statistically similar between cohorts. The checklist sensitivity (95% Confidence Interval, CI) was 76.6% (63.4%-90.6%) and specificity (95% CI) was 92.0% (63.4%-99.9%), with a positive and negative likelihood ratio of 9.6 and 0.3, respectively. When we excluded subjects with mild PAS disease, the sensitivity (95% CI) increased to 84.7% (73.6%-96.4%) and specificity was unchanged at 92.0% (83.2%-99.9%). Sensitivity and specificity were unchanged when the interpretations from the 2 most junior sonologists were excluded. Conclusion: The 2016 EW-AIP checklist for interpreting PAS has a reasonable performance in detecting and excluding histologic placenta accreta spectrum

Wnt2 coordinates the commitment of mesoderm to hematopoietic, endothelial, and cardiac lineages in embryoid bodies

Our recent gene expression profiling analyses demonstrated that Wnt2 is highly expressed in Flk1(+) cells, which serve as common progenitors of endothelial cells, blood cells, and mural cells. In this report, we characterize the role of Wnt2 in mesoderm development during embryonic stem (ES) cell differentiation by creating ES cell lines in which Wnt2 was deleted. Wnt2(-/-) embryoid bodies (EBs) generated increased numbers of Flk1(+) cells and blast colony-forming cells compared with wild-type EBs, and had higher Flk1 expression at comparable stages of differentiation. Although Flk1(+) cells were increased, we found that endothelial cell and terminal cardiomyocyte differentiation was impaired, but hematopoietic cell differentiation was enhanced and smooth muscle cell differentiation was unchanged in Wnt2(-/-) Ells. Later stage Wnt2(-/-) EBs had either lower or undetectable expression of endothelial and cardiac genes compared with wild-type EBs. Consistently, vascular plexi were poorly formed and neither beating cardiomyocytes nor alpha-actinin-staining cells were detectable in later stage Wnt2(-/-) EBs. In contrast, hematopoietic cell gene expression was upregulated, and the number of hematopoietic progenitor colonies was significantly enhanced in Wnt2(-/-) EBs. Our data indicate that Wnt2 functions at multiple stages of development during ES cell differentiation and during the commitment and diversification of mesoderm: as a negative regulator for hemangioblast differentiation and hematopoiesis but alternatively as a positive regulator for endothelial and terminal cardiomyocyte differentiation

Chagas Disease Screening in Maternal Donors of Publicly Banked Umbilical Cord Blood, United States

To assess patterns of Chagas disease, we reviewed results of screening umbilical cord blood from a US public cord blood bank during 2007–2014. Nineteen maternal donors tested positive for Trypanosoma cruzi parasites (0.04%). Because perinatal transmission of Chagas disease is associated with substantial illness, targeted prenatal programs should screen for this disease

Delivery outcomes in the subsequent pregnancy following the conservative management of placenta accreta spectrum disorder: A systematic review and meta-analysis

Objective:Cesarean hysterectomy is generally presumed to decrease maternal morbidity and mortality secondary to placenta accreta spectrum disorder (PAS). Recently, uterine-sparing techniques have been introduced in conservative management of PAS to preserve fertility and potentially reduce surgical complications. However, despite often expressing the intention for future conception, few data are available regarding the subsequent pregnancy outcome after conservative management of PAS. Thus, we aimed to perform a systematic review and meta-analysis to assess the subsequent pregnancy outcomes following conservative management of PAS. Data sources:PubMed, Scopus, and Web of Science databases were searched from inception to September 2022. Study eligibility criteria:We included all studies, with the exception of case studies, that reported the first subsequent pregnancy outcomes in individuals with a previous history of PAS who underwent any type of conservative management. Study appraisal and synthesis method:The R programming language with the meta package was used. The random effects model and inverse variance method were used to pool the proportion of pregnancy outcomes. Results:We identified five studies involving 1,458 subjects that were eligible for quantitative synthesis. The type of conservative management included placenta left in situ (n=1), resection surgery (n=1), and not reported in three studies. The PAS recurrence rate in the subsequent pregnancy was 11.8% (95% CI: 1.1-60.3, I2 = 86.4%), and 1.9% (95% CI: 0.0-34.1, I2 = 82.4%) underwent Cesarean hysterectomy. Postpartum hemorrhage occurred in 10.3% (95% CI: 0.3-81.4, I2 = 96.7%). A composite adverse maternal outcome was reported in 22.7% of subjects (95% CI: 0.0-99.4, I2 = 56.3%). Conclusion:Favorable pregnancy outcome is possible following successful conservation of the uterus in a PAS pregnancy. Approximately one out of four subsequent pregnancies following conservative management of PAS experienced significant adverse maternal outcomes. Given such high incidence of adverse outcomes and morbidity, patient and provider preparation is vital when managing this population