Clinical Analysis Of Placental Location And Adverse Pregnancy Outcomes

Objective:Through retrospective analysis,to study the effect of placental location(except placenta previa)on adverse pregnancy outcomes,and to explore the feasibility of using placental location as an auxiliary screening index for high-risk pregnancy,so as to provide reference basis for early prevention,early detection and early intervention of high-risk pregnancy.Methods:A retrospective cohort study was conducted on singleton pregnant women who were delivered in the Obstetrics Center of Qingdao Women’s and Children’s Hospital from September 2019 to January 2020.A total of 2756 pregnant women were enrolled in the retrospective cohort study.According to the placental location before delivery,they were divided into two groups: typical group(including anterior and posterior wall placenta,n=2381)and atypical group(including lateral wall and fundus placenta,n=375).The typical group was further divided into two subgroups: anterior wall group(n=1155)and posterior wall group(n=1226).Atypical group was also divided into two subgroups:lateral wall group(n=313)and fundus group(n=62).The general information of pregnant women,newborn birth information and adverse pregnancy outcomes,including abnormal fetal position,preterm birth,preeclampsia(PE),fetal growth restriction(FGR),macrosomia and so on,were obtained by in-hospital electronic medical record system.The adverse pregnancy outcomes of different study groups were compared and analyzed by SPSS26.0 statistical software.Results:1.Different placental locations and adverse pregnancy outcomes of pregnant women:The incidence of PE and breech presentation in the atypical group was significantly higher than that in the typical group(7.73% vs 2.18%;13.07% vs 5.08%;P<0.05).Further subgroup comparison: the incidences of PE and breech presentation in the lateral wall group were 7.35% and 11.82% respectively,while those in the fundus group were9.68% and 19.35% respectively,which were significantly higher than those in the anterior and posterior wall groups(P<0.0083).The incidences of PE and breech presentation in the anterior wall group were 1.90% and 4.76% respectively,while those in the posterior wall group were 2.45% and 5.38%,respectively.There was no significant difference between the two groups(P>0.0083).There was no significant difference in the incidence of premature rupture of membranes,oligohydramnios and gestational diabetes mellitus between the typical group and the atypical group(P>0.05).Multivariate logistic regression analysis showed that compared with the anterior wall group,the posterior wall group did not increase the risk of PE and breech presentation(P>0.05),while the lateral wall group and fundus group increased the risk of PE(OR=3.72,95%CI:2.03-6.81,P<0.001;OR=6.19,95%CI:2.37-16.16,P<0.001)and breech presentation(OR=2.46,95% CI:1.57-3.83,P < 0.001;OR=4.24,95%CI:2.12-8.51,P<0.001).2.Different placental locations and adverse neonatal outcomes:The birth weight and gestational age of newborns in the atypical group were significantly lower than those in the typical group(3256.13±432.97 g vs 3392.92±465.64g;38.42±1.33 w vs 38.95±1.04w;P<0.05).Further subgroup comparison: the birth weight and gestational age of newborns in the lateral wall group were 3264.38±426.26 g and38.44±1.35 weeks respectively,while those in the fundus group were 3214.52±466.83 g and 38.33±1.22 weeks respectively,which were significantly lower than those in the anterior and posterior wall groups(P<0.05).The birth weight and gestational age of newborns in the anterior wall group were 3390.70±460.40 g and 38.94±1.06 weeks respectively,while those in the posterior wall group were 3395.01±470.71 g and 38.96±1.01 weeks respectively.There was no significant difference between the two groups(P>0.05).The incidence of FGR and preterm birth in the atypical group was significantly higher than that in the typical group(2.93% vs 0.38%;11.20% vs3.99%;P<0.05).Further subgroup comparison: the incidences of FGR and preterm birth in the lateral wall group were 2.56% and 10.86% respectively,while those in the fundus group were 4.84% and 12.90%,respectively,which were higher than those in the anterior wall group and the posterior wall group(P<0.0083).The incidence of FGR and preterm birth in the anterior wall group was 0.43% and 3.90% respectively,while the incidence of FGR and preterm birth in the posterior wall group was 0.33% and 4.08%,respectively.There was no statistical difference between the two groups(P>0.0083).There was no significant difference in the incidence of fetal distress,macrosomia,neonatal asphyxia and umbilical cord entanglement between the typical group and the atypical group(P>0.05).Multivariate logistic regression analysis showed that compared with the anterior wall group,the posterior wall group did not increase the risk of preterm birth and FGR,while the lateral wall group and fundus group increased the risk of preterm birth(OR=2.56,95%CI:1.57-4.18,P<0.001;OR=2.41,95%CI:1.02-5.72,P=0.045)and FGR(OR=4.21,95%CI:1.27-13.95,P = 0.019;OR=6.24,95%CI:1.21-32.15;P=0.029).Conclusions:1.Placental location(except placenta previa)is related to a variety of adverse pregnancy outcomes.Pregnant women with lateral wall or fundus placenta have an increased risk of developing PE,breech presentation,preterm birth and FGR.2.Placental location can be used as an auxiliary screening index for high-risk pregnancy.For pregnant women with lateral wall or fundus placenta,we can focus on standardized pregnancy management,improve the awareness of supervision and evaluation,and achieve early prevention,early detection and early intervention to reduce the occurrence of adverse pregnancy outcomes.