Maternal serum markers, characteristics and morbidly adherent placenta in women with previa

Lyell, DJ; Faucett, Allison; Baer, Rebecca J.; Blumenfeld, Yair J.; Druzin, Maurice L.; El‐Sayed, Yasser Y.; Shaw, Gary M.; Currier, Robert; Jelliffe‐Pawlowski, Laura L.

doi:10.1038/jp.2015.40

Cited by 47 publications

(42 citation statements)

References 36 publications

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“…Our results are consistent with the previous studies indicating that elevated second trimester MS‐AFP levels are associated with MAP among women with placenta previa [7–9,12]. However, they particularly evaluated the association of significantly elevated MS‐AFP levels (> 2.5 MoM, higher than the cut‐off value for the upper limit of normal in second trimester screening) and suggested that this value can be used to predict the occurrence of placenta accreta [8–10].…”

Section: Discussionsupporting

confidence: 92%

“…According to the results of the previous reports, elevated maternal serum alphafetoprotein (MS‐AFP) and human chorionic gonadotropin (hCG) have a relation with the increased risk of placenta accreta [7–10]. Besides, two recent retrospective studies revealed increased levels of pregnancy‐associated plasma protein‐A (PAPP‐A) among women with placenta accreta [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Öztaş

Özler

Çağlar

et al. 2016

The Kaohsiung J of Med Scie

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Morbidly adherent placenta (MAP) is a growing concern currently and is still a diagnostic challenge for obstetricians. As emergency hysterectomy due to unscheduled delivery in MAP carries significant risks, we aimed to evaluate whether first and second trimester serum analytes may be used in the prediction of MAP requiring hysterectomy. A retrospective chart review of all identified cases of placenta previa totalis with and without MAP was performed. A total of 316 pregnant women diagnosed as placenta previa totalis were identified and included in the analysis. Cases were examined in three groups (Group 1: 204 nonadherent placenta previa patients; Group 2: 61 MAP patients managed with endouterine hemostatic square sutures and/or Bakri balloon tamponade; and Group 3: 51 patients with MAP requiring hysterectomy). Among all first and second trimester screening analytes only maternal serum alphafetoprotein (MS-AFP) levels were significantly higher in patients with MAP requiring hysterectomy (p < 0.001). According to the Receiver Operating Characteristic (ROC) analysis performed for the predictive value of MS-AFP levels, the area under the curve (AUC) was 0.742 [95% confidence interval (CI): 0.505-0.979]. The best MS-AFP cut-off value was 1.25 multiple of the median (MoM) with 85.94% sensitivity and 71.43% specificity (p = 0.036). The best predictors which affect the increased risk of hysterectomy, was further evaluated by multivariate logistic regression analyses. Only elevated maternal serum alphafetoprotein (MS-AFP) was found to be an independent predictor of MAP requiring hysterectomy [odds ratio (OR) = 25.329, 95% confidence interval (CI):1.487-43.143, p = 0.025]. In conclusion, increased second trimester MS-AFP levels independently predict morbidly adherent placenta requiring hysterectomy among women with placenta previa totalis.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Öztaş

Özler

Çağlar

et al. 2016

The Kaohsiung J of Med Scie

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“…This comes in agreement with the opinion of some other authors [23][24][25].The elevated levels of MSAFP in cases of pathologically adherent placenta could be explained by a disruption of the maternal-fetal-placental barrier, placental vascular damage, feto-maternal bleeding or relative placental ischemia [23,24]. Despite many authors studied and proved elevated level of MSAFP and its association with morbid placental adherence among women with placenta previa [6,9,25] and some used it as a predictor for pregnancy outcome, but they used it earlier in the second trimester. Our results come consistent to this finding but we investigated our patients in the third trimester owing to authorize admission of participants and avoiding dropping ones during the research time.…”

Section: Discussionsupporting

confidence: 88%

“…Studies have proven that important risk factors included prior cesarean deliveries, placenta previa, prior uterine surgery or curettage, advanced maternal age, and multiparity [4,5]. On the other hand, entities examined for predicting abnormal invasion of placenta were the maternal serum biological markers in first and second trimesters namely, elevated maternal serum alpha-fetoprotein (MSAFP), human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein-A (PAPP-A) [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Value of measurement of maternal serum alpha fetoprotien in diagnosis of pathologically adherent placenta in cases of placenta pravia

Fyala

2018

The Egypt. J. of Fert.y of Steri.

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Objective: to investigate the significance of elevated MSAFP in diagnosing pathologically adherent placenta among women with placenta previa and its predictive value for pregnancy outcome.Study Design: A retrospective study involved eighty women with placenta praevia divided into 4 equal groups according the degree of invasion as suspected by TAS, Doppler and MRI studies and confirmed postoperatively by histo-pathological examination. G1; included those with placenta pravia alone G2; those with placenta accreta, G3; those with increta degree while G4 contained those with placenta percreta. MSAFP level were evaluated for all patients between 34-36 weeks gestational age.Results: Baseline characteristics of the study group showed no significant difference among groups 1, 2, 3 as regard maternal age, gravidity, parity, fetal gestational age and body mass index (p>0.05) but when compared separately with group 4, there was significant increased mean (+SD) (P <0.05) but not in the body mass index. Maternal risk factors of placenta praevia and abnormal placental adherence proved more previous uterine scars in groups 3 and 4, (P < 0.002). MSAFP levels represented a remarkable increase in groups 2 and 3 and shooting up in group 4 (mean+SD, 91.3+19.1, 153.2+38.1, 178.3+25.2, 263.3+36.1 respectively, P value 0.001). Fetal and maternal outcomes as well as intraoperative findings showed some statistical significant differences between the studied groups as maternal intraoperative blood loss was found more evident in G4 (mean + SD 931± 312) compared to G1, 2 and 3 (640 ± 191, 767 ± 331, 834± 284; respectively, P value 0.02) with more liability for postpartum hemorrhage, 7 cases (35%) versus 0, 2 and 3 cases in G1, 2, 3. respectively (P 0.003).IIAL was resorted to in 7 cases in G4 compared to nothing in G1 and G2 while in 2 cases only in G3. Bladder injuries were reported in 5 cases in G4 and 1 case in G3 but not in G1 and 2 (P 0.002). The mean operative time in minutes (SD) was found relatively shorter in G1 but longer in G2 and 3 but longest in G4 (34 ± 9.1, 44 ± 5.1, 49 ± 9.2, 55 ± 8.1, respectively, P value 0.01). There were more need for intra and postoperative blood transfusion in cases of G4, 7 cases versus 2 cases only in G2 and 3. Again, there was more requested emergent caesarean hysterectomy in G4 (4 cases versus one case in G3, P 0.01). The postoperative data confirmed that there was evident longer duration of hospital stay in G4 (5 + 2.3) compared to other groups 1, 2 and 3 (3.2 + 1.1, 3+ 1.2, 3.5+1.3, P value 0.01). Admission to intensive care unit was recorded higher in G4, 5 cases compared to 1 case only in G3 (P 0.002). No maternal mortality recorded as well as neonatal intensive care unit admission.ROC analyses finds elevated MSAFP stated the maximum sum of sensitivity and specificity for the significant test and showed the AUC was 0.752 (95% CI: 0.505-0.979)with 83.54% sensitivity and 71.53% specificity (p = 0.042). Conclusion:Increased third trimester MSAFP levels can predict morbidly adherent placenta in pla...

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“…But when placental necrosis happens, the separation of placenta and uterus leads to barrier leak, which will increase the amount of AFP delivered from the fetus to the mother. Studies have demonstrated that maternal serum AFP is clinically elevated in cases of a morbidly adherent placenta, and it is a secondary indicator of placenta previa[ 6 - 8 ]. However, until now there have been no reports emphasizing its relationship with the degree of placental damage (such as hematoma necrosis).…”

Section: Discussionmentioning

confidence: 99%

Possible connection between elevated serum α-fetoprotein and placental necrosis during pregnancy: A case report and review of literature

Zhang

et al. 2018

WJCC

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Placenta previa is the main cause of bleeding throughout pregnancy, and it is associated with serious complications, such as infection, that lead to a poor prognosis. Gynecological sonography is recommended as the first-line examination technique for the surveillance and determination of vaginal bleeding and for early intervention. We report the case of a patient with gradually expanded hypoechoic lesion and extremely high serum α-fetoprotein level during her third trimester, and discuss their potential relationship in evaluating the progression of placental necrosis.

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Maternal serum markers, characteristics and morbidly adherent placenta in women with previa

Abstract: Elevated PAPP-A, elevated MS-AFP and prior CDs are associated with MAP among women with previa.

Cited by 47 publications

References 36 publications

Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy

Value of measurement of maternal serum alpha fetoprotien in diagnosis of pathologically adherent placenta in cases of placenta pravia

Possible connection between elevated serum α-fetoprotein and placental necrosis during pregnancy: A case report and review of literature

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