Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis / Idade materna avançada e sua associação com placenta prévia e descolamento placentário: uma metanálise / Edad materna avanzada y su asociación con placenta previa y desprendimiento de la placenta: un metanálisis

This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.

Este estudo teve como objetivo investigar a existência e magnitude da associação entre idade materna avançada (AMA) e ocorrência de placenta prévia (PP) e descolamento placentário (DP) entre mulheres nulíparas e multíparas, por meio de uma revisão sistemática e meta-análise. Nós pesquisamos artigos publicados entre 1º de janeiro de 2005 e 31 de dezembro de 2015, em qualquer idioma, nos seguintes bancos de dados: PubMed, Scopus, Web of Science e LILACS. As mulheres foram agrupadas em duas categorias de idade: até 34 anos e 35 anos ou mais. A Escala Newcastle-Ottawa foi utilizada para avaliar a qualidade metodológica dos estudos. Uma meta-análise foi realizada para os desfechos PP e DP, usando um modelo de meta-regressão para encontrar possíveis covariáveis associadas à heterogeneidade entre os estudos e o teste de Egger para avaliar o viés de publicação. O protocolo desta revisão sistemática foi registrado no sistema PROSPERO (CRD42016045594). Vinte e três estudos preencheram os critérios e foram incluídos na meta-análise. Para ambos os resultados, um idade mais avançada aumentou a magnitude da associação, e PP (OR = 3,16, IC95%: 2,79-3,57) foi mais fortemente associado com AMA do que DP (OR = 1,44, IC95%: 1,35-1,54). Ao estratificar por paridade, não houve diferença entre nulíparas e multíparas de idade materna avançada para os desfechos de PP e DP. Nossa revisão forneceu evidências de baixa qualidade para ambos os resultados, uma vez que abrange estudos observacionais com alta heterogeneidade estatística, diversidade de populações, sem controle de fatores de confundimento em vários casos e viés de publicação. No entanto, os intervalos de confiança eram pequenos e há um gradiente dose-resposta, bem como uma grande amplitude de efeito para o PP.

Este estudio tuvo como objetivo investigar la existencia y la magnitud de la asociación entre la edad materna avanzada (AMA) y la aparición de placenta previa (PP) y desprendimiento de la placenta (DP) entre mujeres nulíparas y multíparas, mediante una revisión sistemática y un metanálisis. Se realizaron búsquedas en los artículos publicados entre el 1º de enero de 2005 y el 31 de diciembre de 2015, en cualquier idioma, en las siguientes bases de datos: PubMed, Scopus, Web of Science y LILACS. Las mujeres se agruparon en dos categorías de edad: hasta 34 años y 35 años o más. La Escala Newcastle-Ottawa se utilizó para evaluar la calidad metodológica de los estudios. Se realizó un metanálisis para los resultados de PP y DP, utilizando un modelo de metarregresión para encontrar posibles covariables asociadas con la heterogeneidad entre los estudios y la prueba de Egger para evaluar el sesgo de publicación. El protocolo de esta revisión sistemática se registró en el Sistema PROSPERO (CRD42016045594). Veintitrés estudios cumplieron los criterios y se incluyeron en el metanálisis. Para ambos resultados, una edad más avanzada aumentó la magnitud de la fuerza de asociación, y PP (OR = 3,16, IC95%: 2,79-3,57) se asoció más fuertemente con AMA que DP (OR = 1,44, IC95%: 1,35-1,54). Cuando se estratificó por paridad, no hubo diferencia entre las mujeres nulíparas y las multíparas consideradas mayores para los resultados de PP y DP. Nuestra revisión proporcionó pruebas de muy baja calidad para ambos resultados, ya que abarca estudios observacionales con alta heterogeneidad estadística, diversidad de poblaciones, ausencia de control de los factores de confusión en varios casos y sesgo de publicación. Sin embargo, los intervalos de confianza fueron pequeños y existe un gradiente de dosis-respuesta, así como una gran magnitud de efecto para PP.

Frequency, causes and outcome of placenta praevia

The objective of the study was to identify and target preventive interventions among women at increased risk of placenta praevia. This is a Descriptive study. All the case records of women with the diagnosis of pregnancy with placenta praevia were reviewed. The frequency of placenta praevia was 1.45% or 1:69 deliveries complicating a singleton pregnancy. Diagnosis of placenta praevia was confirmed by complete history, examination and finally the ultra sound examination, the course of events during antenatal period, their mode of delivery and fetal outcome of all such patients were assessed. Special attention was paid to the past history of dilatation and curettage, previous LSCS and or other forms of uterine surgical procedures. There were 7082 deliveries during the study period. Out of which 103 patients had placenta praevia. The frequency of placenta praevia was found to be 1.45% or 1:69 deliveries. The maximum No. of patients 38 [36.89%] had placenta praevia type III. Highest percentage of the patients with placenta praevia were between 30-35 years. 40 [38.83%] gave history of one or more Gynecological/Obstetrical procedures before the present pregnancy. Incidence of placenta praevia was significantly higher in patients with previous Caesarean Section i.e 15 [15.15%] had previous one or more LSCS. While 18 [17.4%] had history of previous curettage/induced abortion. The poor socioeconomic status illiteracy early marriages, multiparity, long distances from the referral centers, lack of proper health care facilities at the primary and secondary health care centers predisposed the patients in our area to increased incidence and complications of placenta praevia

Antecedente de cesárea como fator de risco para placenta prévia / Prior history of cesarean delivery as a risk factor for placenta previa

A placenta prévia tem sido reconhecida como importante fator determinante de morbidade materna e resultados perinatais adversos. Alguns estudos têm observado aumento na freqüência de placenta prévia em mulheres com antecedente de operação cesariana, sugerindo associação com procedimentos cirúrgicos que possam prejudicar a cavidade uterina. O dano endometrial e miometrial provocado durante a cesárea podem favorecer a inserção baixa da placenta na cavidade uterina. Entre mulheres com placenta prévia, o risco de placenta acreta aumenta naquelas que apresentam história de duas ou mais cesáreas anteriores. Gestantes que optam pela cesárea (como via de parto) devem ser alertadas quanto ao maior risco para desenvolvimento de placenta prévia em gestação subseqüente.

Indicaciones de cesáreas en embarazadas asistidas en el Hospital Padre Justo Arias de Rubio: Estado Táchira enero 2004-abril 2005 / Indications of cesarean in pregnant attended in the Hospital Padre Justo Arias of Rubio: State Táchira january 2004-april 2005

El presente es un trabajo retrospectivo donde se analizaron 138 casos de cesáreas en el lapso comprendido enero 2004-abril 2005, en el Hospital Padre Justo Arias de Rubio, con el propósito de identificar las causas de las mismas, siendo la desproporción cefalo-pélvica (DCP), la cesárea anterior, la hipertención inducida por el embarazo, la inducción fallida del trabajo de parto seguida de la presentación viciosa, las mas importantes. Los resultados señalan que la edad predominante fue de 24,5 años, la mayor frecuencia de operación se presentó en primigestas, el 68,8 por ciento de las intervenciones se realizó de forma electiva, encontrándose que todos los casos se realizaron en gestaciones a término. Se concluye que los factores que proporcionan la indicación de cesárea deben ser objeto de revisión, para evitar una próxima interrupción del embarazo por vía alta.

Incidence, causes and outcome of placenta previa

The incidence of Placenta Previa, associated factors, complications, mode of delivery, fetal and maternal outcomes were evaluated in a one year of hospital based study.In a prospective study, 100 cases of pregnancy beyond 28 weeks of gestation, complicated by Placenta Previa were identified. The total number of deliveries were 2828, patients presented with Placenta Previa were 100. Patients with placenta previa were 100 giving and incidence of 3.5%. Of 3.5% major degree of Placenta previa were 2.3% while 1.2% were type I and II. The maximum number of patients were 35 years and above. There were 7 times as many multipara having Placenta previa as nullipara, repeated myometrial/endometrial damage due to repeated pregnancy being the most common cause. About 60% of patients had at least one or more gynaecol / obstet procedures before the present pregnancy. Incidence of Placenta previa was significantly higher in patients with previous C. Section [5.3%] than overall incidence of 3.5%. However, in our study cases were thrice as likely to have had curettage [46%] than previous C. section [15.9%]. Our data suggests that clinical judgment and skills in the performance of C. section, dilatation and curettage, and other forms of uterine invasive technique may help to keep the subsequent incidence of Placenta previa at a reasonably low rate. Routine curettage after all spontaneous abortions may be avoided unless it is needed

Placenta previa casuística en el Hospital Gineco-Obstétrico Isidro Ayora

La etiología de la placenta previa es desconocida, se presume que la vascularización endometrial disminuida a nivel del fondo y cuerpo uterino, constituyen el factor causal. Hemos analizado 149 historias clínicas, concluyendo que en nuestro medio los factores de riesgo son la edad materna entre 23 a 32 años con una media de 30, multiparidad, teniendo mayor riesgo a una edad gestacional de 37 a 40 semanas con un pico a las 38 semanas, el diagnóstico ecográfico es una gran ayuda pero vemos que en nuestro medio la sospecha clínica puede ser el único examen con el que podemos contar preoperatoriamente en no pocas ocasiones; la presencia o ausencia de dolor no es una sintomatología que nos pueda ayudar a precisar el diagnóstico...

Assciation. between previous caesarean section and occurrence of placenta praevia and pathological placental adherence

A 5-year retrospective study was carried out at Sir Ganga Ram Hospital, Lahore, to determine the relationship between previous uterine scars and the incidence of placenta praevia and pathological placental adherence. A total of 21.808 deliveries occurred in the said period and 341 were diagnosed as cases of placenta praevia during Caesarean section, giving an incidence of 1.56%. The incidence of placenta praevia in parturients with unscarred uteri was 1.25% as compared to 5.74% in cases with scarred uteri. The risk of placenta praevia increased in direct proportion to the number of previous uterine incisions. With one previous scar the incidence was 2.60% which went up to 27.27% in cases with 4 or more previous Caesarean sections. The incidences of pathological placental adherence in patients with unscarred uteri and placenta praevia was 3.54% and it escalated to 28.74% in cases with placenta praevia and scarred uterus

Inserçäo baixa da placenta / Low insertion of the placenta

Apresenta causas, diagnóstico e conduta adotada nos casos de placenta prévia, visando a reduçäo da mortalidade materna e do concepto

Localización placentaria en cesareadas anteriores / Placentary localization in previous cesarean

En el presente estudio prospectivo de 150 gestantes en el último trimestre del embarazo, con antecedentes de cesáreas anteriores, no se pudo demostrar que la incidencia de placenta de inserción baja fuera mayor en relación a la población general, comparada con otros hospitales a través de la literatura publicada, sin embargo, se encontró en forma estadísticamente significativa, que un número de cesareas anteriores mayor de 1, aumenta la probabilidad de tener una placenta de inserción baja en embarazos posteriores. Las placentas bajas, en cesáreadas anteriores, muestran tendencia a ser más frecuentes en la cara anterior, hecho importante a tomar en cuenta a la hora de realizar una nueva casárea a estas pacientes