An Analysis Of Obstetric Risk Factors And Perinatal Outcomes Of Pregnancies With Pernicious Placenta Previa

Objective : Pregnant women diagnosed as pernicious placenta previa(PPP)were retrospectively analyzed and followed up during the last three years in ourhospital. To discuss the the related factors, clinical characteristics and perinataloutcomes of PPP.Methods:There were 143 pregnant women(research group) diagnosed as PPPin Jiangxi maternal and Child Health Hospital from January 2012 to December2014.At the same period in our hospital, 321 pregnant women of cesarean sectionhistory without placenta previa were selected randomly as control group 1,295 casesof placenta previa without cesarean were selected randomly as control group 2. Toanalyze its related factors of the disease and perinatal outcomes, the clinical data ofthe three groups were retrospectively analyzed and followed up.Results:1.General situation:There were 43740 deliveries at our hospital in recentthree years, and among them, 4792 patients(10.95%) had previouscesarean section, 1303 patients(2.98%) had placenta previa.Amongpregnancies complicated with placenta previa,155 patients(12.0%) had PPP,theincidence of it was 3.54‰.Among patients with PPP, 75 patients(48.4%) hadplacenta accreta.Among the 155 patients, 9 cases whoes information wereincomplete, 3 cases were twin pregnancy, they all except.Finally 143 cases of thepregnant women with PPP were included in this study.2.Related factors analysis: 1) Single factor analysis showed that maternal age,gravidity,parity, history of abortion,place of residence, prior cesarean deliverytimes, a prior cesarean section performed in a tertiary hospital, a primary cesareansection with labor were influencing factors of PPP, statistically significant(P <0.05).2) Multiple factors analysis results show that: ①the PPP and the control group 1:age(≥35 years, OR 2.152, 95% CI 1.028-4.505), history of abortion(2 times or more,OR 3.076, 95% CI 1.717-5.511), parity(2 times, OR1.734, 95% CI1.014 2.967; ≥3times, OR 4.833, 95% CI1.587-14.718), prior cesarean delivery times(≥2 times,OR2.641, 95% CI 1.452-4.806) for the risk factors of PPP.At the same time, we foundthat the residence of the city(OR0.379, 95%CI 0.237-0.604), a prior cesarean sectionperformed in a tertiary hospital(OR 0.184, 95% CI0.108-0.184),a primary cesareansection with labor( OR0.461, 95%CI 0.226- 0.940), are less likely, to developPPP.②the PPP and the control group 2:multiple gravidity,parity were risk factors forPPP.3.Pregnancy outcome and complications of delivery: compared with the normalplacenta previa group,PPP are more likely to occur implantation(52.5% vs 16.9%),postpartum hemorrhage(38.5% vs 9.5%), thus increasing the blood transfusion(43.4% vs 43.4%), hysterectomy(7.0% vs 0.7%), so as to extend the length ofhospital stay after childbirth.4.Types and prognosis of placenta previa:Among 143 pregnancies complicatedwith PPP,88 patients(61.5%) had central placenta previa,15 patients(10.5%) hadpartial placenta previa,40 patients(28.0%) had marginal placenta previa.Pregnanciescomplicated with PPP had a higher incidence of central placenta previa than thenormal placenta previa group,statistically significant(P < 0.05).In different types ofPPP, central placenta previa proportion(61.5%) is highest. Complicated withmarginal placenta previa,central placenta previa were more likely to occurpostpartum hemorrhage(52.3% vs 12.5%), placenta implantation(69.3% vs 20.0%),uterus resection(11.4% vs 0.0%), there are statistical differences(P < 0.05).5.Perinatal outcomes : birth weight of newborns(2.61±0.65Kg)and gestationalage( 35.36±2.62w)from mothers with PPP were significantly lower than controlgroup1,2.Newborns from mothers with PPP had a higher rate of preterm birth(59.4%), neonatal asphyxia rate(11.9%), turn the NICU treatment ratio(6.3%), whichwere increased the risk of death(0.7%).Conclusions : Previous cesarean section, previous abortion, gravidity, parity,advanced maternal age are independently risk factors associated with PPP.Theresidence of the city,prior cesarean section performed in a tertiary hospital,primarycesarean section with labor are less likely to develop PPP.PPP is likely to causepostpartum hemorrhage, hysterectomy, has a higher incidence of placentaimplantation.In different types of PPP, central placenta previa has a higher proportionof and a worse pregnant prognosis.PPP prone to premature birth, neonatal asphyxia,NICU and neonatal death risk.Maternal and perinatal prognosis is worse.