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Evaluation of Different Ultrasonographic Modalities in the Diagnosis of Morbidly adherent Placenta: A Cross-Sectional Study

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Open Journal of Obstetrics and Gynecology 2019年第4期9卷 405-416页

作者： Mostafa Hussein Mohammed F. Ramadan Abd Ahmad M. Abu-Elhassan Ahmed M. Abbas Alaa Eldin A. Youssef Department of Obstetrics & Gynecology Faculty of Medicine Assiut University Assiut Egypt

Objective: To compare the accuracy of different ultrasonographic modalities;two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.

关键词： Color Doppler 3D-Power Doppler Placenta Accreta Morbidly adherent Placenta

Maternal Outcome of Cases of Placenta Previa with and without Morbidly adherent Placenta at King Abdul-Aziz University Hospital, Saudi Arabia

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Open Journal of Obstetrics and Gynecology 2018年第13期8卷 1414-1422页

作者： Ashraf Radwan Abdel Magid Abdou Sausan Kafy Mamdouh Sheba Hassan Allam Moaz Bokhari Majed Almutairi Department of Obstetrics and Gynecology King Abdul-Aziz University Rabigh Branch Rabigh KSA Department of Obstetrics and Gynecology King Abdul-Aziz University Hospital Jeddah KSA

Introduction:?Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups;Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum

关键词： Maternal Outcomes Placenta Previa With and without adherent Placenta

Detecting Accuracy of Three Dimensional Power Doppler (3DPD) Vascular Indices for Prenatal Diagnosis of Morbidly adherent Placenta in Patients with Placenta Previa

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Open Journal of Obstetrics and Gynecology 2020年第1期10卷 49-64页

作者： Ahmed Sherif Abdel-Hamid Maged Mahmoud Elshourbagy Mohamed Sayed Aly Shahira Zakaria Mohamed Ali Ghaly Department of Obstetrics and Gynecology Faculty of Medicine Ain-Shams University Cairo Egypt Department of Obstetrics and Gynecology in Shoubra General Hospital Cairo Egypt

Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.

关键词： 3D Color Doppler 2D Ultrasound Placental Vascular Indices Morbidly adherent Placenta Placenta Previa

Morbidly adherent Placenta (MAP): Lessons learnt

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Open Journal of Obstetrics and Gynecology 2013年第1期3卷 217-221页

作者： Leena Wadhwa Sangeeta Gupta Pratibha Gupta Bhawna Satija Rupali Khanna Department of Obstetrics & Gynecology ESI-PGIMSR Basaidarapur Delhi Department of Radiology ESI-PGIMSR Basaidarapur Delhi

Context: Once a rare occurrence, MAP is becoming an increasing threat to maternal lives. Aims: To summarize our experience in the management of patients with morbidly adherent placenta. Introduction: MAP is a potentially life threatening hemorrhagic condition responsible for 7% - 10% maternal mortality. Settings and Design: Tertiary care center. Methods and Material: Retrospective study in which data of twelve patients with clinical diagnosis of morbidly adherent placenta was reviewed from Jan 2009 till Sept 2012. Results: The incidence of placenta accreta was found to be increasing every year. Out of twelve cases with clinical diagnosis of MAP, placenta previa was present in 10/12 patients with MAP. All patients had history of previous section. Two patients with preoperative diagnosis of MAP on USG/MRI were found to be normal intra-operative and in one patient focal accreta was diagnosed intraoperatively. Nine patients of MAP underwent caesarean hysterectomy due to excessive bleeding during placental separation and were confirmed histo-pathologically (3 accreta vera, 3 increta and 3 percreta). Internal iliac artery ligation was done in 2 patients. Two patients with placenta percreta had bladder rupture which was repaired and these two patients subsequently expired. Conclusions: The incidence of placenta accreta is increasing due to higher cesarean section (C/S) rate. Key to successful outcome is awareness, anticipation, preoperative counseling, planning and multidisciplinary approach.

关键词： Placenta Accreta Morbidly adherent Placenta Cesarean Section Hemorrhage Maternal Mortality

Fazari’s Sign in Ultrasound Scan of Morbid adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

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Open Journal of Obstetrics and Gynecology 2020年第4期10卷 599-603页

作者： Atif Bashir Eltayeb Fazari Zeinabsadat Tabatabaei Hakim Latifa Hospital Dubai Health Authority Dubai UAE University of Medical Sciences & Technology Khartoum Sudan

Morbid adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow ... 详细信息

关键词： Morbid adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) Ultrasound Scan Stair Step Sign Fazari’s Triad

Association between etiopathogenesis of morbidly adherent placenta and adenomyosis

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Open Journal of Obstetrics and Gynecology 2012年第3期2卷 321-324页

作者： Christopher A. Enakpene Ozgul Muneyyirci-Delale Department of Obstetrics and Gynecology SUNY Downstate Medical Center New York USA

The association between etio-pathogenesis of morbidly adherent placenta (MAP) or placenta cretas and adenomyosis has never been described in medical literature. Contrary to the believe that MAP is due to direct invasion of trophoblastic tissues into the adjacent normal myometrium due to prior uterine surgeries, this article describes how pre-existence of adenomyosis acts as a precursor for the development of placenta cretas. It elucidates how prior uterine traumas such as surgeries, repeated childbirths and endometritis cause endometrial tissues to invade the myometrium as a result of disruption of decidua basalis. The invaded endometrial tissues cause hyper-plasia and hypertrophy of surrounding myometrium to form the clinical entity called adenomyosis. The over-expression of bcl-2 oncogene in the endometrium causes inhibition of apoptosis of endometrial cells removing the barrier of trophoblastic tissues to invade the myometrium to form MAP. This hypothesis is based on the similarity of their clinical perspectives, similar pathological description of the two disease entities and their common molecular components. Both diseases increase with age;more in women older than 35 years and also in those with history of previous endometrial traumas such as surgeries, childbirth and endometritis. Both diseases also share common pathological factors and molecular components due to absence of deciduas basalis and over-expression of bcl-2 oncoprotein gene, inhibition of cell apoptosis and failure to find genetic abnormalities such as mutations of K-ras, P53 or LOH. An ongoing study looking at uterine specimens from cesarean hysterectomies and pelvic MRI evaluation of patients with retained placentas to prove that pre-existing adenomyosis may be a precursor to the development of morbidly adherent placenta is near to conclusion.

关键词： Morbidly adherent Placenta (Placenta Accretes) Adenomyosis Association Epidemiology Etio-Pathogenesis and Clinical Perspective

Escherichia coli in chronic inflammatory bowel diseases: An update on adherent invasive Escherichia coli pathogenicity

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World Journal of Gastrointestinal Pathophysiology 2014年第3期5卷 213-227页

作者： Margarita Martinez-Medina Librado Jesus Garcia-Gil Laboratory of Molecular Microbiology Biology Department University of Girona

Escherichia coli(E. coli), and particularly the adherent invasive E. coli(AIEC) pathotype, has been increasingly implicated in the ethiopathogenesis of Crohn's disease(CD). E. coli strains with similar pathogenic features to AIEC have been associated with other intestinal disorders such as ulcerative colitis, colorectal cancer, and coeliac disease, but AIEC prevalence in these diseases remains largely unexplored. Since AIEC was described one decade ago, substantial progress has been made in deciphering its mechanisms of pathogenicity. However, the molecular bases that characterize the phenotypic properties of this pathotype are still not well resolved. A review of studies focused on E. coli populations in inflammatory bowel disease(IBD) is presented here and we discuss about the putative role of this species on each IBD subtype. Given the relevance of AIEC in CD pathogenesis, we present the latest research findings concerning AIEC host-microbe interactions and pathogenicity. We also review the existing data regarding the prevalence and abundance of AIEC in CD and its association with other intestinal diseases from humans and animals, in order to discuss the AIEC disease- and hostspecificity. Finally, we highlight the fact that dietarycomponents frequently found in industrialized countries may enhance AIEC colonization in the gut, which merits further investigation and the implementation of preventative measures.

关键词： adherent invasive Escherichia coli Inflammatory bowel disease Crohn’s disease Pathogenesis Epidemiology

Peripartum Hysterectomy in Misan Province during 2014-2016

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Open Journal of Obstetrics and Gynecology 2017年第2期7卷 258-268页

作者： Saba J. Al Heshemi Department of Gynecology & Obstetrics in College of Medicine College of Medicine Misan University Misan Iraq

Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.

关键词： Peripartum Hysterectomy Primary Postpartum Hemorrhage Rupture Uterus adherent Placenta

On the orientation of plane tensegrity cytoskeletons under biaxial substrate stretching

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Advances in Bioscience and Biotechnology 2010年第1期1卷 12-25页

作者： Athanassios P. Pirentis Konstantinos A. Lazopoulos 不详

Two different simple cases of plane tensegrity cytoskeleton geometries are presented and investigated in terms of stability. The tensegrity frames are used to model adherent cell cytoskeletal behaviour under the application of plane substrate stretching and describe thoroughly the experimentally observed reorientation phenomenon. Both models comprise two elastic bars (microtubules), four elastic strings (actin filaments) and are attached on an elastic substrate. In the absence of external loading shape stability of the cytoskeleton is dominated by its prestress. Upon application of external loading, the cytoskeleton is reorganized in a new direction such that its total potential energy is rendered a global minimum. Considering linear constitutive relations, yet large deformations, it is revealed that the reorientation phenomenon can be successfully treated as a problem of ma- thematical stability. It is found that apart from the magnitude of contractile prestress and the magnitude of extracellular stretching, the reorientation is strongly shape–dependent as well. Numerical applications not only justify laboratory data reported in literature but such experimental evidence as the concurrent appearance of two distinct and symmetric directions of orientation, indicating the cellular coexistence of phases phenomenon, are clearly detected and incorporated in the proposed mathematical treatment.

关键词： Tensegrity Cytoskeleton adherent Cells Reorientation Stability Coexistence of Phases