Analysis On The Timing Of Pregnancy Termination And Maternal And Neonatal Outcomes In Patients With Pernicious Placenta Previa

Objective:Analyzing the maternal and fetal outcomes of patients with dangerous placenta previa（pernicious placenta previa,PPP）in a hospital during the past 8 years,in order to provide a basis for patients with dangerous placenta previa to choose an appropriate time to terminate pregnancy,to improve the clinical adverse pregnancy outcome.Methods:Through the hospital medical record browser,1023 patients with placenta previa were hospitalized in the obstetrical ward of the affiliated Hospital of Yan’an University from January 1,2014 to December 31,2021,including 658cases of placenta previa delivered in hospital,accounting for 64.32%.Among them,89 cases were dangerous placenta previa,accounting for 8.70%.The data of pregnant women with PPP were collected in detail.Strictly following inclusion and exclusion criteria,89 pregnant women were enrolled in the study.According to the presence or absence of placental accreta,41 pregnant women with placenta accreta were divided into group A and 48 pregnant women without placenta accreta were divided into group B.According to the different timing of pregnancy termination,that is,28⁺⁰～33⁺⁶ weeks,34⁺⁰～35⁺⁶ weeks,36⁺⁰～36⁺⁶weeks and 37 weeks and above,the patients in group A and group B were divided into A1 group（n=7）,A2 group（n=11）,A3 group（n=10）,A4 group（n=13）and B1 group（n=6）,B2 group（n=7）,B3 group（n=11）and B4 group（n=24）.According to whether emergency operation was performed to terminate pregnancy,patients in group A and group B were divided into emergency group A（n=23）,elective group A（n=18）,emergency group B（n=20）and elective group B（n=28）.Collecting the general information of pregnant women through the medical records browser（age,number of pregnancies,times of spontaneous delivery,times of miscarriage,regular antenatal examination,vaginal bleeding during pregnancy,number of cesarean sections,time difference from the last cesarean section）,intraoperative and postoperative conditions of pregnant women（intraoperative blood loss,blood transfusion,hemorrhagic shock,postpartum hemorrhage,hysterectomy,admission to ICU,DIC and death）and neonatal outcomes（birth weight,asphyxia,neonatal jaundice,premature delivery,admission to NICU,and death）.SPSS25.0 software was used for statistical analysis,and the maternal and fetal outcomes of pregnancy termination at different times were analyzed.Results:1.In the past 8 years,a total of 1023 inpatients with placenta previa were treated in our hospital,including 64.32%of placenta previa delivered in hospital,of which 89 were dangerous placenta previa,accounting for 8.70%of hospitalized placenta previa and 13.53%of placenta previa delivered in hospital.In the past 8 years,the proportion of patients with dangerous placenta previa delivered in hospital was 8.00%、10.91%、6.17%、15.69%、15.18%、12.90%、19.05%and 23.91%,respectively.2.For PPP complicated with placenta accreta,it was found that the amount of blood loss in group A2 was less than that in group A4,the difference was statistically significant among these groups（P<0.05）.There was no significant difference in the incidence of hysterectomy,hemorrhagic shock,postpartum hemorrhage and admission to ICU,blood transfusion among the four groups（P>0.05）,and no DIC and death were found among the four groups.3.For the PPP patients with placenta accreta,the birth weight of group A1was less than that of group A3 and A4,the difference was statistically significant（P<0.05）.There were statistically significant differences in the rate of neonatal transferred to NICU,asphyxia rate and mortality among the four groups（P<0.05）.Respectively,further pairwise comparison between groups showed that the ratio of newborn transferred to NICU in group A4 was significantly less than that in group A2（P<0.017）,but there was no statistically difference among other groups（P>0.017）.And there was no statistically difference in the rate of neonatal jaundice（P>0.05）.4.For the PPP patients without placenta accreta,there were significant differences in intraoperative blood loss and blood transfusion among the four groups（P<0.05）.Further comparison between the four groups showed that there was no significant difference in intraoperative blood loss and blood transfusion volume（P>0.05）.And there was no significant difference in the incidence of hysterectomy,hemorrhagic shock,postpartum hemorrhage and admission to ICU among the four groups（P>0.05）.None of the pregnant women in the four groups had DIC or death.5.For the PPP patients without placenta accreta,the neonatal weight in group B1 was less than that in group B3 and B4,the difference was statistically significant（P<0.05）.The asphyxia rate and mortality in group B1 were significantly higher than those in group B4（P<0.017）,but difference among other groups was no statistically significant（P>0.017）.There was no statistically discrepancy in the rate of neonatal jaundice and admission to NICU among the four groups（P>0.05）.6.Among the patients with placenta accreta,there was no statistically discrepancy in intraoperative blood loss,blood transfusion,hysterectomy rate,incidence of hemorrhagic shock,postpartum hemorrhage rate and admission rate of ICU between the emergency group and the elective group（P>0.05）.However,it was found that all the indexes of pregnant women in the emergency group were higher than those in the elective group.The neonatal gestational age and birth weight in the emergency group were significantly lower than those in the elective group（P<0.05）.There was no statistically discrepancy in premature delivery,asphyxia,mortality and admission to NICU,but it was found that the incidence in the emergency group was higher than that in the elective group.The results of patients without placenta accreta were basically consistent with those with placenta accreta.Conclusion:1.Patients with dangerous placenta previa with or without placenta accreta terminated pregnancy at different times,their maternal and infant outcomes are different.2.For patients with dangerous placenta previa with placenta accreta,termination of pregnancy at 34⁺⁰～35⁺⁶weeks can better balance the risk between mother and infant,and the mother-infant outcome is the best.3.For dangerous placenta previa patients without placenta accreta,the gestational weeks can be appropriately prolonged and the pregnancy can be terminated between 34⁺⁰～36⁺⁶weeks,which can achieve the best balance between the fetus and the pregnant woman.4.For patients with dangerous placenta previa,the outcome of selective termination of pregnancy is better than that of emergency surgery,whether with or without placenta accreta.However,if massive bleeding occurs in the process of waiting,the pregnancy should be terminated by emergency operation.