Egle Savukyne

Placenta accreta spectrum (PAS) has emerged as a pressing global health concern as cesarean delivery rates continue to rise. Once regarded primarily as a placental disorder, PAS is now understood as an abnormal implantation process occurring within uterine scars. Although cesarean hysterectomy remains the predominant management strategy, growing evidence suggests that individualized, uterine-sparing approaches may reduce morbidity and better align with patient preferences. Traditional histopathologic classifications neither correlate with prenatal imaging findings nor reflect surgical complexity, thereby limiting their clinical utility. The PAS topographic classification, developed from intraoperative observations, offers a practical framework for surgical staging and guides patient-specific management strategies. Standardized prenatal ultrasound can anticipate surgical challenges and facilitate preoperative counseling. Despite this, few hospitals currently use this classification. This study qualitatively evaluated the impact of collaborative virtual educational activities designed to disseminate the concepts underlying the topographic classification on the surgical practice of PAS teams. Over a six-month period in 2024, interactive weekly webinars were conducted to discuss the evolving concepts in PAS that justify a shift toward precision medicine. Six months after the webinars concluded, a structured survey documented participants' perceptions of the impact of these sessions on the management of their PAS patients. A total of 112 invitations to participate in the survey were sent, and 91 responses were received (response rate: 81.2%). Among respondents, 97% (n = 88) reported that participation in the virtual academic discussions led to some change in their clinical practice. Thirty-four participants (37.4%) indicated that, following the webinars, they felt more confident proposing modifications to the management of patients at risk for PAS within their institutions. Participants reported that following the virtual academic discussions, they intended to use ultrasonographic evaluation to plan surgery (13 participants, 14.2%), implement individualized management based on topographic classification (18 participants, 19.8%), perform bladder dissection prior to fetal delivery in order to confirm placenta accreta spectrum (PAS) and assess its topography before selecting the appropriate treatment approach (8 participants, 8.8%). Virtual academic meetings designed to disseminate the PAS topographic classification fostered global collaboration, improved clinical practice, and enhanced mutual learning among PAS teams. Beyond technology, respectful, interactive discussions created a psychologically safe learning environment. Teleconferencing proved invaluable for education, research, and quality improvement, with continued support from professional societies essential for sustained progress.

Background and Objectives: To evaluate maternal characteristics associated with placenta previa in comparison with breech cesarean controls, as well as maternal and neonatal outcomes. Materials and Methods: A retrospective case–control study was conducted at the Hospital of Lithuanian University of Health Sciences, Kaunas Clinics (2015–2022). A total of 150 cases of placenta previa were compared with a control group of participants who underwent cesarean delivery due to fetal breech presentation without placenta previa. Results: In multivariable analysis, higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery were independently associated with placenta previa compared with breech cesarean controls. Maternal complications were significantly more frequent in the placenta previa group and included placenta accreta spectrum disorders, second- and third-trimester hemorrhage, postpartum hemorrhage, and increased need for blood transfusion. The most severe outcomes, including cesarean hysterectomy, occurred exclusively in cases complicated by placenta accreta spectrum disorders. Neonatal outcomes in the placenta previa group were characterized by higher rates of preterm birth, low Apgar scores, and birth weight < 2500 g. Adverse neonatal outcomes were partly associated with earlier gestational age at delivery. However, placenta previa remained associated with low Apgar score after adjustment. Conclusions: Compared with breech cesarean controls, placenta previa was associated with multiple maternal characteristics, including higher parity, prior cesarean delivery, in vitro fertilization, prior surgical termination of pregnancy, and prior uterine surgery. The condition is linked to increased maternal hemorrhagic morbidity, particularly in cases complicated by placenta accreta spectrum disorders, as well as adverse neonatal outcomes mainly related to prematurity. These findings highlight the importance of careful antenatal monitoring and delivery planning in specialized centers.

Placenta accreta spectrum (PAS) is a severe obstetric disorder that requires extensive resources and multidisciplinary expertise. In many European centers,

Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with increasing cesarean delivery rates worldwide. Existing classifica

Background and Objectives: To assess pregnancy and delivery complications in obese women with gestational diabetes mellitus (GDM) and neonatal weight and condition after birth. Materials and Methods: A retrospective tertiary referral centre study included all cases of GDM in the Department of Obstetrics and Gynaecology of the Lithuanian University of Health Sciences (LUHS) Birth Registry from 1 January 2019 to 31 December 2019. We included 583 women with GDM and singleton pregnancies. Women were divided into two groups according to their pre-pregnancy weight: 202 were obese (BMI ≥ 30 kg/m²), and 381 were weight (BMI 18.5–24.9 kg/m²). Survey data were analysed using IBM SPSS Statistics 26.0 and MS Excel 2016 software. A value of p < 0.05 was considered significant. Results: Fasting glycaemia was significantly higher in obese women with GDM than in normal-weight women with GDM (p < 0.001). In addition, fasting glycaemia was higher in obese women with GDM requiring insulin correction than in normal-weight women (p = 0.006). OGTT 0-min glycaemia was higher in obese than in non-obese women with gestational diabetes (p < 0.001). Women with pre-pregnancy obesity had a higher incidence of primary hypertension (p < 0.001), hypertensive disorders in pregnancy (p < 0.001), gestational cholestasis (p = 0.002), polyhydramnios (p < 0.001), induced labour (p < 0.001), and caesarean section (p = 0.015), with emergency caesarean sections being more frequent than planned caesarean sections (p = 0.011) compared to normal-weight women with GDM. Labour dystocia (p = 0.003) and foetal distress (p = 0,019) were more common during labour in obese women. Neonates of these women more often had macrosomia (p < 0.001) and lower Apgar scores at 1 min (p = 0.024) and at 5 min (p = 0.024) compared to neonates of normal-weight women. Conclusions: Obese women with GDM experience more pregnancy complications than normal-weight women with GDM.

Introduction: The main goal of placenta accreta spectrum (PAS) screening is to enable delivery in an expert center in the presence of an experienced team at an appropriate time. Our study aimed to identify independent risk factors for emergency deliveries within the IS‐PAS 2.0 database cohort and establish a multivariate predictive model.Material and Methods: A retrospective analysis of prospectively collected PAS cases from the IS‐PAS database between January 2020 and June 2022 by 23 international expert centers was performed. All PAS cases (singleton and multiple pregnancies) managed according to local protocols were included. Individuals with emergent delivery were identified and compared to those with scheduled delivery. A multivariate analysis was conducted to identify the possible risk factors for emergency delivery and was used to establish a predictive model. Maternal outcomes were compared.Results: Overall, 315 women were included in the study. Of these, 182 participants (89 with emergent and 93 with scheduled delivery) were included in the final analysis after exclusion of those with unsuspected PAS antenatally or who lacked information about the urgency of delivery. Gestational age at delivery was higher in the scheduled group (34.7 vs. 32.9, p < 0.001). Antenatal bleeding (OR 2.9, p = 0.02) and a placenta located over a uterine scar (OR 0.38, p = 0.001) were the independent predictive factors for emergent delivery (AUC 0.68). Ultrasound (US) markers: loss of clear zone (p = 0.001), placental lacunae (p = 0.01), placental bulge (p = 0.02), and presence of bridging vessels (p = 0.02) were more frequently documented in the scheduled group. None of these markers improved the predictive values of the model. Higher PAS grades were identified in the scheduled group (p = 0.01). There were no significant differences in maternal outcomes.Conclusions: Antenatal bleeding and the placental location away from the uterine scar remained the most significant predictors for emergent delivery among patients with PAS, even when combining more predictive risk factors, including US markers. Based on these results, patients who bleed antenatally may benefit from transfer to an expert center, as we found no differences in maternal outcomes between groups delivered in expert centers. Earlier‐scheduled delivery is not supported due to the low predictive value of our model.

Introduction: This study aimed to validate the Sargent risk stratification algorithm for the prediction of placenta accreta spectrum (PAS) severity using data collected from multiple centers and using the multicenter data to improve the model.Material and Methods: We conducted a multicenter analysis using data collected for the IS‐PAS database. The Sargent model's effectiveness in distinguishing between abnormally adherent placenta (FIGO grade 1) and abnormally invasive placenta (FIGO grades 2 and 3) was evaluated. A new model was developed using multicenter data from the IS‐PAS database.Results: The database included 315 cases of suspected PAS, of which 226 had fully documented standardized ultrasound signs. The final diagnosis was normal placentation in 5, abnormally adherent placenta/FIGO grade 1 in 43, and abnormally invasive placenta/FIGO grades 2 and 3 in 178. The external validation of the Sargent model revealed moderate predictive accuracy in a multicenter setting (C‐index 0.68), compared to its higher accuracy in a single‐center context (C‐index 0.90). The newly developed model achieved a C‐index of 0.74.Conclusions: The study underscores the difficulty in developing universally applicable PAS prediction models. While models like that of Sargent et al. show promise, their reproducibility varies across settings, likely due to the interpretation of the ultrasound signs. The findings support the need for updating the current ultrasound descriptors and for the development of any new predictive models to use data collected by different operators in multiple clinical settings.

Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11–14 weeks. The CS scar niche (“defect”) was bordered in the sagittal plane as a notch at the previous CS scar’s site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect (“niche”) was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas.

Aim. To compare the impact of the time and method of diagnosis on gestational diabetes mellitus (GDM) in women who gave birth at the Hospital of the Lithuanian University of Health Sciences (LUHS) Kauno klinikos. Methods. A retrospective study was performed using data from the Department of Obstetrics and Gynecology of the LUHS Birth Registry to analyze the data of women who gave birth and had GDM in 2020–2021. The subjects were divided based on the type of diagnosis: GDM was diagnosed either at the first antenatal visit when fasting plasma glycemia (FPG) was ≥5.1 mmol/L (early diagnosis group) or after OGTT at 24 + 0 − 28 + 6 weeks of gestation when at least one pathological glycemic index was observed: fasting glycemia 5.1–6.9 mmol/L or 1-h glycemia ≥10.0 mmol/L or 2 h glycemia 8.5–11.0 mmol/L (late diagnosis group). The results were processed using IBM SPSS. Results. The early diagnosis group had 1254 (65.7%) women, the late diagnosis group had 654 (34.3%). More primigravida women were in the late diagnosis group (p = 0.017) while more multigravida were in the early diagnosis group (p = 0.033). The early diagnosis group had more obese women (p = 0.001), including those with a BMI > 40 (p = 0.001). In the early diagnosis group, GDM was more frequently diagnosed in women who gained 16 kg (p = 0.001). FPG was higher in the early diagnosis group (p = 0.001). Glycemia was more commonly corrected with lifestyle changes in the late diagnosis group (p = 0.001), and with additional insulin therapy in the early diagnosis group (p = 0.001). Polyhydramnios and preeclampsia were more common in the late diagnosis group (p = 0.027 and p = 0.009). There were more large-for-gestational-age neonates in the late diagnosis group (p = 0.005). Macrosomia was more common in the late diagnosis group (p = 0.008). Conclusions. GDM is more commonly diagnosed with OGTT in primigravida women. Higher pregestational weight and BMI has an impact on the early diagnosis of GDM and need for insulin therapy with lifestyle changes. Late diagnosis of GDM is connected with obstetric complications.

Objectives: The congenital embryonic tumor known as sacrococcygeal teratoma (SCT) affects 1 in 35.000–40.000 newborns and is more prevalent in female fetuses and neonates. A total of 25–50% of SCTs are diagnosed by an ultrasound (US) examination during the second trimester of pregnancy. Planning the manner of delivery, determining the risk of negative outcomes, and choosing treatment options depend on the results of antenatal differential diagnosis. Case presentation: This is a unique case of a 29-year-old second gravida, suspected of having a fetal sacrococcygeal dysplasia differentiable between Type 2 SCT and terminal myelocystocele. An MRI revealed no typical SCT changes, as a matter of course, the diagnosis of myelocystocele could not have been excluded. The results of the genetic examination allowed to exclude the chromosomal pathology. Punctuation of the external component of the formation and a cytological examination were suggested. Nevertheless, the patient and her partner refused further studies and insisted on the termination of pregnancy. Medical abortion was induced and histological findings confirmed fetal morphology to be mature SCT. Conclusions: Cystic sacrococcygeal teratoma is an unusual malformation of fetal development. In the antenatal period SCT is diagnosed based upon an ultrasound evaluation, an MRI, and a multidisciplinary assessment of clinical experts. Differential diagnosis based upon clinical imaging during the gestational period is elaborate. The final medical diagnosis needs to be verified by a histological evaluation of pathological tissue. An antenatal medical diagnosis of fetal dysplasia is considerable for the further prognosis of fetal and newborn development.