ABSTRACT
BACKGROUND: Our objective was to identify the risk factors associated with placenta accreta. METHODS: Cases of peripartum hysterectomy at University Hospital of Bratislava were identified in the period from January 1st 2008 to December 31th 2013. Included were only those cases which had a histological evidence of placenta accreta. RESULTS: Fifty patients, who underwent peripartum hysterectomy were included in the study. Between 2008 and 2013 eight cases of placenta accreta were identified. Five (62.5 %) of these were suspected before delivery. The overall incidence of PA was 0.19 per 1000 deliveries. Median gestational age at delivery was 37 weeks (range 25-41 weeks). Six of eight (75 %) women with placenta accreta had a previous caesarean delivery or curettage. In 5 patients both placenta praevia and prior Caesarean delivery were present. Among the 50 women who underwent peripartum hysterectomy, 8 (16 %) were patients with both prenatally diagnosed placenta praevia and previous caesarean delivery, placenta accreta was suspected in 4 of these (50 %) compared with 10 of 42 (24 %) without this combination of risk factors. CONCLUSIONS: Those in whom placenta accreta was suspected were delivered earlier than 37 weeks of gestation and were less likely to have emergency delivery. Placenta accreta is the second most common indication for an emergency peripartum hysterectomy. There is a high suspicion of placenta accreta in patients with placenta praevia and after previous Caesarean section (Tab. 3, Ref. 17).
Subject(s)
Cesarean Section , Hysterectomy , Placenta Accreta , Adult , Cesarean Section/adverse effects , Cesarean Section/statistics & numerical data , Emergencies , Female , Hospitals, University/statistics & numerical data , Humans , Hysterectomy/methods , Hysterectomy/statistics & numerical data , Incidence , Middle Aged , Outcome Assessment, Health Care , Peripartum Period , Placenta Accreta/pathology , Placenta Accreta/surgery , Placenta Previa/diagnosis , Placenta Previa/surgery , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/prevention & control , Pregnancy , Retrospective Studies , Risk Factors , SlovakiaABSTRACT
OBJECTIVE: Evaluation of puberty onset and menarche in girls in Bratislava region in the years 2006-2007 and 2011-2013. DESIGN: Regional retrospective epidemiological study. SETTING: 1st Department of Gynaecology and Obstetrics, School of Medicine, Comenius University and University Hospital Bratislava, Slovenské republika. METHODS: A study in two periods was performed. The first was in the years 2006-2007 and the second in 2011-2013. Together 217 girls aged 7-16 were enrolled. Secondary sexual characteristics according to Tanner were evaluated. Ultrasound examination of the uterus and ovaries was performed. The results were statistically evaluated by software Statistical Package for Social Sciences (SPSS) by age, and compared to results of Slovak study held in the years 1976-1980. RESULTS: The mean age of menarche onset of girls in the group was 12.37. Pubarche and adrenarche onset were at 10.7 and 11.7 year respectively. Thelarche onset was at 10.9 year. Development of secondary sexual characteristics significantly correlated with ultrasound parameters of internal genitalia and with age of menarche. Average ultrasound parameters increases with age to 15 years. Significant changes were for average anteroposterior uterine size in 11 and 13 years old girls, for proportion corpus/cervix of the uterus in 9 and 11 years old girls and for average ovarian volume in 9, 11, 14 and 15 years old girls. CONCLUSION: The results from our study comparing to those from study held in 1976-1980 shows continuous secular trend in Bratislava region. KEYWORDS: age of menarche, secular trend, puberty, secondary sexual characteristics.
