| Background:Pernicious placenta previa (PPP) is defined as placenta previa occurs after cesarean section, which is always accompanied by placenta accrete. In recent years, the number of caesarean section has gone up dramatically. Sequelae of caesarean section appear gradually after the implementation of national Two-Child Policy. Women in second birth after caesarean section is increasing, making PPP is common and become a challenge for obstetricians.PPP can have serious adverse consequences for both mother and baby, including unpredictable hemorrhage, and mother may require a blood transfusion or even a hysterectomy. Studies have shown the risk factors for PPP are numerous, but the pathogenesis is unclear. Due to the limitation of screening methods and evaluating system,the diagnosis and treatment of PPP need to be standardized. Therefore, this study analysis the risk factors for PPP and explore the maternal and neonatal outcomes, which can not only respond to the family planning, but also protect the pregnant women and improve the technology of obstetricians to deal with PPP.Methods:Clinical datas of pregnant women delivered in Women’s Hospital School of Medicine Zhejiang University from August2012to August2014were collected, take the location of placenta over or proximal to the uterine cervix as the diagnostic criteria of placenta previa. Women with gestational age less than28weeks, multiple pregnancies and complications which influence the coagulation were excluded. All the470cases of pregnant women with placenta previa were divided into pernicious group(n=101) and no-pernicious group(n=369) according to the history of cesarean section.The inclusion criteria of pernicious group:(1)pregnant women with history of cesarean section surgery;(2)placenta previa was diagnosed by color Doppler ultrasound,magnetic resonance imaging(MRI) or cesarean section. The inclusion criteria of no-pernicious group:(1)pregnant women without history of cesarean section surgery;(2)placenta previa was diagnosed by color Doppler ultrasound,MRI or cesarean section.Then compared the general profile, maternal and neonatal outcomes of two groups. According to different the location of the main part of the placenta, pernicious group were divided into anterior group(n=64)and posterior group(n=37), then compared the bleeding amount, the rate of placental accrete and hysterectomy of two groups.Results:1Comparison of general information between two groups:The age, gestational age, gravidity and number of uterine cavity surgery of pernicious group and no-pernicious group were (32.5±4.1vs30.7±4.5)y,(35.6±2.7vs36.7±2.7) w,(3.4±1.2vs2.1±1.4) and (1.0±1.05vs0.6±0.98),There were significant differences between two groups (P<0.05). Rate of elder gravid, recurrent cavity surgery(≥2)and preterm delivery of pernicious group were higher than no-pernicious group, were31.7%vs17.3%,54.5%vs36.9%, respectively(P<0.05)2Comparison of the situation and prognosis of the surgery between two groups: The postpartum hemorrhage,rate of postpartum hemorrhage (≥1000ml),amount of blood transfusion,rate of transfusion,rate of placental implantation, hysterectomy, days of hospitalization and neonatal birth weight in pernicious group and no-pernicious were (1053.1±1292.4vs456.2±432.9)ml,(29.7%vs8.1%),(1130.9±1451.9vs106.5±375.9)ml,(35.7%vs10.8%),(27.7%vs5.7%),(11.9%vs0.8%,)(6.1±2.6vs5.2±1.2) d and (2782.67±719.95vs2979.58±664.08) g,There were significant differences between two groups(P<0.05). 3Risk factors of postpartum massive hemorrhage in PPP group:Multiple regression ananlysis showed that placenta accrete was significantly associated with postpartum massive hemorrhage in pernicious group (P<0.01). OR ratio is15.59.4Preoperative diagnosis of PPP:There were75cases of PPP diagnosed before caesarean section. The accuracy of the ultrasound was74.3%. Among them,37cases attached to the anterior and38cases attached to the posterior were diagnosed by ultrasound, the crude agreement of them were98.4%and94.6%.5Maternal outcomes of placental position in PPP group:There had no significant differences of postpartum hemorrhage, rate of placenta accrete and rate of hysterectomy between anterior group and posterior group(P>0.05),]the results were (1132.8±1345.0vs987.5±1258.8)ml,(29.8%vs24.3%) and (14.1%vs8.1%).6Neonatal outcome between two groups:There were significant differences in the gestational age, rate of preterm delivery and neonatal birth weight between pernicious group and no-pernicious group (P<0.05),the results were (35.6±2.7vs36.7±2.7) w,(54.5%vs36.9%) and (2782.67±719.95vs2979.58±664.08) g. However, the difference of Apgar score at lmin and5min is not significant (P>0.05).Conclusion:Advanced maternal age, multiple pregnancy, uterine cavity surgeries were risk factors for PPP which resulting in the increasing of the incidence of preterm and low birth weight. PPP with placenta accrete increased the risk of postpartum massive hemorrhage, but the placental position have no influence on the rate of placenta accrete. The sensitivity of ultrasound diagnosis of PPP were high. Full recognition and valuation the danger of pregnant women with PPP before operation and pay more attention to antenatal care were key messures to decrease the adverse maternal outcomes. |
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