Placenta Accreta

A new study challenges the prevailing view on the maternal death rate in the United States. The findings show that the rates of maternal death were stable between 1999-2002 and 2018-2021, instead of the dramatic upward trends previously reported. Additionally, the study indicates that direct obstetric causes of death declined over the last 20 years. A new study published in the American Journal of Obstetrics & Gynecology, published by Elsevier, challenges the prevailing view on the maternal death rate in the United States. The findings show that the rates of maternal death were stable between 1999-2002 and 2018-2021, instead of the dramatic upward trends previously reported by the National Vital Statistics System (NVSS), Centers for Disease Control and Prevention (CDC). Additionally, the study indicates that direct obstetric causes of death declined over the last 20 years. To determine whether the reported maternal death rates are accurate, a team of researchers took a deep dive into the underlying data and looked at the factors driving the increase, namely, changes in obstetric factors, maternal chronic conditions, and surveillance issues (i.e., changes in data collection methods). Maternal deaths refer to those occurring during pregnancy, childbirth, or the postpartum period from conditions directly related to pregnancy or those exacerbated by pregnancy and birth (accidental and incidental deaths in pregnancy are not included in the maternal death definition). Lead author K.S. Joseph, MD, PhD, Department of Obstetrics and Gynaecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia; and School of Population and Public Health, University of British Columbia, said "Our study showed that maternal mortality rates were low and stable between 1999-2002 and 2018-2021, which is very different from the high rates and dramatic increases reported by the NVSS in recent years. We found that exclusive reliance on the pregnancy checkbox on death certificates, without corroboration from the cause-of-death information, led to an overestimation of maternal mortality rates by the NVSS in 2018-2021." Researchers examined all deaths in the US between 1999 and 2021 using an approach that enables greater accuracy in how maternal deaths are identified and classified in the mortality database. The study uncovered several indications that the pregnancy checkbox was responsible for misclassifying nonmaternal and incidental deaths in pregnancy as maternal deaths. These included a 46-fold increase in maternal deaths among women with malignant neoplasms (which likely represent incidental deaths in pregnancy and not maternal deaths). Also, a substantially higher proportion of maternal deaths identified by the pregnancy checkbox had a single entry in the cause-of-death section, which requires a listing of all the immediate, intermediate, contributory, and underlying causes of death (thus suggesting a less thorough approach to death certification). Although the pregnancy checkbox was introduced on death certificates in 2003 to improve identification of maternal death, its use between 2003 and 2017 was associated with some substantial errors. A detailed investigation by the National Center for Health Statistics (NCHS), CDC showed that the checkbox was erroneously ticked in many cases, leading to misclassification and overestimation of maternal death. For example, hundreds of decedents, 70 years of age and older (including 147 women aged 85 years and older in 2013), were certified as pregnant at the time of death or in the year prior. The NCHS concluded that the entire increase in maternal mortality in the US between 2003 and 2017 was due to the pregnancy checkbox. In response, NCHS made specific changes regarding pregnancy checkbox use for deaths from 2018 onwards but NVSS reports show that maternal mortality rates have continued to increase (nearly doubling from 2018 to 2021). Roberto Romero, MD, DMedSci, Editor-in-Chief for Obstetrics of the American Journal of Obstetrics & Gynecology (AJOG), and Chief of the Pregnancy Research Branch of NICHD, NIH, stated, "Accurate assessment of the number and causes of maternal death is an important priority for countries and healthcare policymakers. Improving maternal mortality surveillance is key to formulating plans to improve maternal health. Comparisons of the rate of maternal death among countries should be interpreted with great caution because the methods of surveillance and accuracy differ. The article by Dr. Joseph and a distinguished group of epidemiologists and obstetricians published in AJOG calls attention to the need to improve surveillance in the United States and to thoughtful interpretation of reported statistics." Co-author Justin S. Brandt, MD, Director of the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, notes, "By not relying on the pregnancy checkbox, our approach avoided the misclassification that has given the false impression of increasing maternal mortality rates in the US. Identifying maternal deaths by requiring mention of pregnancy among the multiple causes of death shows stable maternal mortality rates and declines in maternal deaths from direct obstetric causes." The research team previously published a study on maternal mortality in the US in 2017, which also showed stable rates of maternal mortality from 1999 to 2014. As mentioned, their results were subsequently validated by a detailed investigation carried out by the NCHS and published in January 2020. Although the study's findings contradict the mainstream narrative of high and rising rates of maternal death in the US, the results are consistent with changes in maternal characteristics and improvements in obstetric practice. For instance, the increase in maternal deaths due to specific placental complications (i.e., placenta accreta spectrum disorder) observed in their study is consistent with increases in deliveries to women with a previous cesarean delivery. Similarly, the reduction in maternal deaths due to hypertensive disorders in pregnancy (i.e., preeclampsia/eclampsia), blood clot embolism (i.e., thromboembolism), and infection (i.e., puerperal sepsis) is consistent with advances in the obstetric management of these conditions. The study also showed a reduction in overall maternal mortality, and especially in maternal deaths from direct obstetric causes among non-Hispanic Blacks, which is encouraging. However, the disproportionately high rate of maternal death among Non-Hispanic Blacks in 2018-21 and the persistent racial/ethnic disparities are concerning, as is the small increase in direct obstetric deaths among non-Hispanic Whites. Co-author Cande Ananth, PhD, MPH, MD, Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences; Cardiovascular Institute of New Jersey and Department of Medicine; and Environmental and Occupational Health Sciences Institute, Rutgers, Robert Wood Johnson Medical School; and Department of Biostatistics and Epidemiology, Rutgers School of Public Health, elaborates, "Our analysis suggests that people who are Black remain at much higher risk of dying due to pregnancy complications compared with people who are White. The continuing disparities in maternal mortality rates are concerning and deserve strategic and focused efforts to combat structural racism and designed to address chronic conditions disproportionately represented in this subpopulation." The study provides important insights into cause- and race/ethnicity-specific maternal mortality and provides suggestions for the appropriate use of the pregnancy checkbox on death certificates. The authors hope that these findings will serve as the evidentiary basis for clinical and public health initiatives for reducing maternal mortality.

A new study may change the way clinicians and scientists understand, diagnose and treat placenta accreta spectrum disorder, a serious condition in which the placenta fails to separate from the uterus at birth, jeopardizing the life and health of both mother and baby. A new study led by researchers at UCLA may change the way clinicians and scientists understand, diagnose and treat placenta accreta spectrum disorder, a serious condition in which the placenta fails to separate from the uterus at birth, jeopardizing the life and health of both mother and baby. Researchers previously believed that certain overly invasive placental cells, called trophoblasts, were responsible for keeping the connection intact. But this new research, which identifies genetic and cellular changes within single cells where the placenta and uterus join, shifts the focus to how the structural support of tissues, and the blood vessels of the uterus, can cause a "loss of normal boundary limits" between the placenta and the uterus. "We utilized two new techniques in single-cell analysis to create an atlas of cells involved in placenta accreta to better understand this increasingly prevalent disorder that can have devastating implications for maternal and neonatal health," said Dr. Yalda Afshar, a maternal-fetal medicine specialist and researcher at the David Geffen School of Medicine at UCLA, and the first and corresponding author of an article describing the findings in the American Journal of Obstetrics & Gynecology. "This work revealed a subset of genes differentially expressed in placenta accreta spectrum disorder, which provides the basis for the 'permissive environment' for the placenta to attach to the uterine lining," said Dr. Deborah Krakow, a maternal-fetal medicine specialist and researcher, chair of the Department of Obstetrics and Gynecology at the David Geffen School of Medicine at UCLA, and the paper's senior author. The research showed that the decidua, the layer of the uterine lining that forms during pregnancy, and blood vessels, are sending different signals to the placenta when a pregnant person has placenta accreta. Normally, the placenta -- the temporary organ that provides support for a fetus -- is shed after birth. In placenta accreta, it is stuck on too tight, which becomes the reason for many of the maternal complications of placenta accreta. "Our goal was to characterize the intimate relationship between the maternal and fetal tissue at the site of accreta or malfunction," Afshar said. "The genes and signaling pathways we identified go beyond providing a better understanding of the mechanism of the disease; they may be used as targets to help us refine diagnostic tests, track disease progression over time, and discover new, more effective therapies." The incidence of placenta accreta spectrum (PAS) disorders has increased dramatically in recent decades, the cause of which is not certain, though cesarean deliveries, is one of several risk factors. Today, incidence is estimated at 1 in 272 births in the U.S., up from 1 in about 30,000 pregnancies in the 1960s, researchers say. For this study, the research team performed multiple placental biopsies on 12 placentas -- six with PAS disorder and six controls -- conducting single-cell RNA analysis on 31,406 individual cells. The researchers also applied spatial transcriptomics to 36 regions of interest -- 12 in PAS-adherent, 12 in PAS-nonadherent, and 12 in controls. Spatial transcriptomics allow researchers to precisely measure and map the gene activity within a single tissue sample. "At the end of the day, understanding the biology of pregnancy and pregnancy-related diseases, like accreta, is inspired by only one thing -- finding ways to improve the care we can provide to pregnant people and their families," said Afshar, a physician-scientist who manages the care of many patients with placenta accreta spectrum disorders at UCLA Health.

Tampa General Hospital is commended for its dedication to world-class maternity care. TAMPA, Fla., June 26, 2023 /PRNewswire/ -- As part of its vision to be the safest and most innovative academic health system in America, Tampa General Hospital (TGH) is pleased to announce its successful redesignation as a Baby-Friendly® Hospital and its inclusion in Newsweek's list of America's Best Maternity Hospitals 2023. This dual recognition showcases the hospital's unwavering steadfastness in providing exceptional care, nurturing environments and comprehensive support to expectant mothers and their newborns. Earning the Baby-Friendly® designation is a prestigious and rigorous achievement and Tampa General remains the only Baby-Friendly® designated birth facility in Hillsborough County. The Baby-Friendly® hospital designation is only given to facilities that have implemented the Ten Steps to Successful Breastfeeding and are compliant with the International Code of Marketing of Breast-milk Substitutes. The U.S. guidelines and evaluation criteria are based on the rigorous global criteria for the WHO/UNICEF Baby-Friendly Hospital Initiative. Tampa General was also recognized on Newsweek's roster of America's Best Maternity Hospitals for 2023, and this marks the hospital's third consecutive appearance on the list. Out of 10,000 maternity hospitals evaluated, Tampa General Hospital stands among a distinguished group of 384 leading institutions, having earned a four-ribbon rating. The hospital's status was determined based on a meticulous analysis of three robust data sources, conducted by Newsweek in partnership with Statista: Nationwide online survey: Health care professionals and hospital managers with knowledge about maternity processes, e.g., neonatal and perinatal doctors, nurses and midwives, were asked to recommend leading maternity hospitals in the U.S. Medical Key Performance Indicators (KPIs) on hospitals with a focus on indicators, relevant to maternity care. Results from patient surveys. "As new research advances our understanding of maternal morbidity, maternal mortality and pregnancy, and women's health, these awards further emphasize our diligence in improving outcomes for both mothers and infants," said Dr. Judette Louis, chief, TGH Women's Institute, James M. Ingram Professor and Chair, Department of Obstetrics and Gynecology, USF Health Morsani College of Medicine. "We are proud of our multidisciplinary team of experts and will continue pushing the boundaries of innovation, research and education to ensure that every mother receives the highest quality medical attention and that every newborn has the best possible start in life. These distinctions reflect our goals to advance the field of obstetrics and gynecology, promote maternal well-being and improve the health of our community." Other acknowledgments presented to Tampa General include: In 2020, Tampa General Hospital became the first in the nation to be named as a Maternal Center of Excellence by the Maternal Safety Foundation for both vaginal birth after cesarean (VBAC) and placenta accreta, a serious complication of pregnancy that occurs when the placenta grows too deeply into the wall of the uterus. A woman's risk for developing this condition increases with the number of previous cesarean births. Tampa General was recognized in 2020 for its achievement in maternal care during a Florida Hospital Association webinar titled "Reducing Unnecessary C-Sections: Successful Florida Strategies." In 2021, the Florida Agency for Health Care Administration and the Florida Department of Health named Tampa General Hospital as one of only 15 delivery hospitals in Florida to promote vaginal deliveries and reduce cesarean section deliveries for first-time mothers with low-risk pregnancies. In 2022, Tampa General Hospital was recognized by the Florida Agency for Health Care Administration and the Florida Department of Health with an award for exceeding national goals for reducing the number of unnecessary cesarean deliveries for first-time mothers with low-risk pregnancies and instead promoting vaginal deliveries. It was one of only 26 delivery hospitals in Florida to achieve the award. "Accolades like these further underscore Tampa General Hospital's determination to deliver extraordinary treatment and support to mothers and their newborns," said Melissa Golombek, vice president, TGH Children's Hospital and Women's Institute. "They reflect our devotion to upholding the utmost standards of maternity services and affirm our position as a leader in providing the safest possible care." The Labor & Delivery Unit and the Jennifer Leigh Muma Neonatal Intensive Care Unit (NICU) at TGH were both designed with mothers and infants in mind, with large operating rooms reserved for cesarean sections, in-vitro procedures, fetal surgery and other gynecological procedures, accommodating mothers delivering twins or other multiples. These environments allow nurses, doctors and other clinicians within these units to provide mothers the information, confidence and skills to initiate and continue breastfeeding, among other important neonatal practices. Furthermore, the NICU at Tampa General is one of just 12 Regional Perinatal Intensive Care Centers designated by the state of Florida and allows Tampa General and USF Health providers to partner to deliver specialized medical care 24 hours a day to premature and sick infants and to women with high-risk pregnancies. Due to these state-of-the-art facilities and a strong clinical team, the academic health system delivered more than 7,000 babies – the most in its history – during the 2022 fiscal year (October 2021 through September 2022) and completed the most high-risk deliveries in the region. "We are so proud that more and more families are choosing to deliver their babies at Tampa General," said Nikki Hurley, MSN, RN, NE-BC, senior director, TGH Children's Hospital. "We believe it is a testament to the successful collaboration between our physicians and team members and ultimately results in a better outcome for moms and their babies." Tampa General Hospital's Women's Institute provides a full range of women's health services, from routine obstetrics and gynecology to more complex maternal-fetal medicine and neonatal care. As an academic health system and nationally recognized leader in high-risk obstetrics, Tampa General offers access to the highest level of women's and infant care in virtually every medical subspecialty, as well as psychology, genetic counseling, pediatrics and more. Tampa General Hospital is ranked in the top 50 hospitals in the nation and is the highest-ranked hospital in Florida for Obstetrics & Gynecology by U.S. News & World Report for 2022-23, and has achieved every Maternity Care standard set by the Leapfrog Group in 2022. To learn more about the Obstetrics Center at Tampa General Hospital, please visit . Tampa General Hospital, a 1,040-bed, not-for-profit, academic health system,, is one of the largest hospitals in America and delivers world-class care as the region's only center for Level l trauma and comprehensive burn care. Tampa General Hospital is the highest-ranked hospital in the market in U.S. News & World Report's 2022-23 Best Hospitals, and is tied as the third highest-ranked hospital in Florida, with seven specialties ranking among the best programs in the United States. Tampa General Hospital has been designated as a model of excellence by the 2022 Fortune/Merative 100 Top Hospitals list. The academic health system's commitment to growing and developing its team members is recognized by two prestigious Forbes magazine rankings – first nationally in the 2022 America's Best Employers for Women and sixth out of 100 Florida companies in the 2022 America's Best Employers by State. Tampa General is the safety net hospital for the region, caring for everyone regardless of their ability to pay, and in fiscal year 2021, provided a net community benefit worth more than $224.5 million in the form of health care for underinsured patients, community education, and financial support to community health organizations in Tampa Bay. It is one of the nation's busiest adult solid organ transplant centers and is the primary teaching hospital for the USF Health Morsani College of Medicine. With six medical helicopters, Tampa General Hospital transports critically injured or ill patients from 23 surrounding counties to receive the advanced care they need. Tampa General houses a nationally accredited comprehensive stroke center, and its 32-bed Neuroscience, Intensive Care Unit is the largest on the West Coast of Florida . It also is home to the Jennifer Leigh Muma 82-bed neonatal intensive care unit, and a nationally accredited rehabilitation center. Tampa General Hospital's footprint includes 17 Tampa General Medical Group Primary Care offices, TGH Family Care Center Kennedy, TGH Brandon Healthplex, TGH Virtual Health, and 21 TGH Imaging powered by Tower outpatient radiology centers throughout Hillsborough, Pasco, Pinellas and Palm Beach counties. Tampa Bay area residents also receive world-class care from the TGH Urgent Care powered by Fast Track network of clinics. To see a medical care professional live anytime, anywhere on a smartphone, tablet or computer, visit Virtual Health | Tampa General Hospital (tgh.org). As one of the largest hospitals in the country, Tampa General Hospital is the first in Florida to partner with GE Healthcare and open a clinical command center that provides real-time situational awareness to improve and better coordinate patient care at a lower cost. For more information, go to . ABOUT USF HEALTH USF Health's mission is to envision and implement the future of health. It is the partnership of the USF Health Morsani College of Medicine, the College of Nursing, the College of Public Health, the Taneja College of Pharmacy, the School of Physical Therapy and Rehabilitation Sciences, the Biomedical Sciences Graduate and Postdoctoral Programs, and USF Health's multispecialty physicians' group. The University of South Florida is a high-impact global research university dedicated to student success. Over the past 10 years, no other public university in the country has risen faster in U.S. News & World Report's national university rankings than USF. For more information, visit health.usf.edu. Media Contact: Beth Hardy, APR Senior Communications Specialist (813) 844-7322 (direct) (813) 510-6363 (cell) [email protected] SOURCE Tampa General Hospital