Low lying placenta: natural course, clinical data, complications and a new model for early prediction of persistency.

Autor:	Farladansky-Gershnabel S; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Gluska H; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Sharon-Weiner M; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Shechter-Maor G; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Schreiber H; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Weitzner O; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Biron-Shental T; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Markovitch O; Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jazyk:	angličtina
Zdroj:	The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians [J Matern Fetal Neonatal Med] 2023 Dec; Vol. 36 (1), pp. 2204998.
DOI:	10.1080/14767058.2023.2204998
Abstrakt:	Objective: To define the natural course and complications, and develop a model for predicting persistency when low-lying placenta (LLP) is detected early in pregnancy. Methods: This retrospective cohort study included women with LLP detected during an early anatomic scan performed at 13-16 weeks gestation. Additional transvaginal ultrasound exams were assessed for resolution at 22-24 weeks and 36-39 weeks. Patients were categorized as: Group 1-LLP resolved by the second-trimester scan, Group 2-LLP resolved by the third trimester, or Group 3-LLP persisted to delivery. Clinical and laboratory parameters, as well as maternal and neonatal complications, were compared. A linear support vector machine classification was used to define a prediction model for persistent LLP. Results: Among 236 pregnancies with LLP, 189 (80%) resolved by 22-24 weeks, 25 (10.5%) resolved by 36-39 weeks and 22 (9.5%) persisted until delivery. Second trimester hCG levels were higher the longer the LLP persisted (0.8 ± 0.7MoM vs. 1.13 + 0.4 MoM vs. 1.7 ± 1.5 MoM, adjusted p  = .03, respectively) and cervical length (mm) was shorter (first trimester: 4.3 ± 0.7 vs. 4.1 ± 0.5 vs. 3.6 ± 1; adjusted p  = .008; Second trimester: 4.4 ± 0.1 vs. 4.1 ± 1.2 vs. 3.8 ± 0.8; adjusted p  = .02). The predictive accuracy of the linear support vector machine classification model, calculated based on these parameters, was 90.3%. Conclusions: Persistent LLP has unique clinical characteristics and more complications compared to cases that resolved. Persistency can be predicted with 90.3% accuracy, as early as the beginning of the second trimester by using a linear support vector machine classification model.
Databáze:	MEDLINE
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