| Objective:This study retrospectively analyzed the clinical data of patients with placenta previa in the Second Hospital of Jilin University for 10 years,and compared the pregnancy outcomes of different periods or different types of placenta previa.At the same time,the cases of placenta previa combined with placenta accreta were selected for analysis.To explore the diagnostic value of two prenatal ultrasound scores for placenta previa combined with placenta accreta,and to provide reference for future obstetric clinical work.Methods:A total of 1834 patients with placenta previa who were hospitalized and delivered in the obstetrics department of our hospital from January 2012 to December 2021 and met the inclusion and exclusion criteria were included in the study.The diagnostic criteria were based on the guidelines for the Diagnosis and Treatment of Placenta Previa(2020 edition).580 parturients from 2012 to 2016 were included in group A,and 1254 parturients from2017 to 2021 were included in group B.The parturients in group A were divided into groups A1 and A2 according to the type of placenta,and group A1 was the placenta previa group(including previous complete placenta previa and partial placenta previa).Group A2 was low-lying placenta group(including previous marginal placenta previa and low-lying placenta),including 386 patients in group A1 and 194 patients in group A2.Group B was also divided into group B1 and group B2,with 824 patients in group B1 and 430 patients in group B2.The related factors of different periods or different types of placenta previa and the outcomes of maternal and infant were compared.At the same time,the ultrasound data of all patients with placenta previa and placenta accreta in 10 years were collected.The receiver operating characteristic(ROC)curve was used to compare the diagnostic value of two prenatal ultrasound scores for placenta previa complicated with placenta accrete.Results:1.The incidence of placenta previa in our hospital increased from 1.4% in 2012 to 4.0%in 2021,with an average of 3.5%,reaching a peak of 4.2% in 2017.The incidence of placenta previa complicated with placenta accreta in our hospital increased from 2.2‰ in2012 to 5.8‰ in 2021.2.The comparison of the basic situation of pregnant women showed that there were significant differences in the number of pregnancy and delivery between the A1,A2 groups and the B1,B2 groups(P<0.05),and there was a significant difference in the age between the B1 and B2 groups(P<0.05).There was a significant difference in the number of delivery between the A1 and B1 groups and the A2 and B2 groups(P<0.05).3.The comparison of related factors of placenta previa showed that there were significant differences in the way of pregnancy,the number of uterine surgery,the number of cesarean section,the number of abortion and the position of placenta in group A(P<0.05).There were significant differences in smoking,the number of cesarean section,the number of abortion,the number of uterine surgery and uterine dysplasia in group B(P<0.05).There were significant differences in the number of cesarean section and smoking between group A1 and group B1(P<0.05).There were significant differences in the number of uterine surgery,the number of cesarean section,the way of pregnancy and the position of placenta between group A2 and group B2(P<0.05).4.The comparison of intrapartum treatment methods in patients with placenta previa showed that there were statistically significant differences in oxytocin use,hemabate use,blood transfusion rate,uterine massage,suture hemostasis,hand-taken placenta,uterine gauze packing and vascular embolization between group A and group B(P<0.05).There was a statistically significant difference in gauze compression in group A(P<0.05).There were statistically significant differences in the rate of tourniquet ligation of the lower uterine segment,vaginal delivery and hysterectomy in group B(P<0.05).There were significant differences in the use of hemabate,blood transfusion rate,suture hemostasis,tourniquet ligation of the lower uterine segment,gauze compression and vascular embolization between A1 and B1 groups(P<0.05).There were significant differences in suture hemostasis,gauze compression and uterine gauze packing between A2 and B2groups(P<0.05).5.Comparison of maternal outcomes,there were statistically significant differences in the length of operation,gestational age of delivery,prenatal hemorrhage rate,postpartum hemorrhage rate,placental implantation rate,hemorrhagic shock,transfer to obstetric care unit(OICU),transfer to ICU,postpartum hospitalization time and hospitalization cost between group A and group B(P<0.05).There were significant differences in emergency operation rate,postpartum hemorrhage rate,hemorrhagic shock and hospitalization cost between group A1 and group B1(P<0.05).There were significant differences in emergency operation rate,operation time and hospitalization cost between group A2 and group B2(P<0.05).6.Comparison of neonatal outcomes,there were statistically significant differences in the length,weight,1-minute Apgar score,5-minute Apgar score,transfer rate to neonatology and preterm birth rate between group A and group B(P<0.05),and there was a statistically significant difference in gender between group B1 and group B2(P<0.05).There was no significant difference in neonatal outcomes between groups A1,B1 and groups A2,B2(P>0.05).7.The receiver operating characteristic(ROC)curve showed that when placental adhesion and placental accreta were distinguished,the AUC of Chong’s ultrasound score was 0.771(95%CI: 0.704-0.838),the sensitivity was 97.3%,the specificity was 56.8%,and the critical value was 2.5.The AUC of the modified ultrasound score was 0.778(95%CI: 0.713-0.843),the sensitivity was 100.0%,the specificity was 51.9%,and the critical value was 3.5.When distinguishing placenta accreta and penetrating placenta accreta,the AUC of Chong’s ultrasound score was 0.885(95%CI: 0.806-0.963),the sensitivity was 68.6%,the specificity was 87.2%,and the critical value was 4.5.The AUC of the modified ultrasound score was 0.942(95%CI: 0.893-0.991),the sensitivity was91.4%,the specificity was 81.1%,and the critical value was 5.5.Conclusion:1.From 2012 to 2021,the incidence of placenta previa in our hospital showed an overall upward trend,and the incidence of placenta previa combined with placenta accreta also showed an overall upward trend.2.During the same period,the number of pregnancy and delivery in the placenta previa group was higher than that in the low-lying placenta group;in different periods,whether placenta previa or low-lying placenta,the delivery of the latter 5 years group was higher than that of the former 5 years group.3.During the same period,the number of uterine surgery(including the number of cesarean section and the number of abortion)in the placenta previa group was higher than that in the low-lying placenta group.The intrapartum treatment of the placenta previa group was more complicated than that of the low-lying placenta group,which required experienced obstetricians to operate.4.During the same period,the operation time,postpartum hemorrhage rate,placenta implantation rate,ICU transfer rate and hospitalization cost of the placenta previa group were significantly higher than those of the low-lying placenta group,suggesting that the placenta previa group needed more manpower and financial resources.5.During the same period,the rate of transfer to neonatal department and preterm birth rate in the placenta previa group were significantly higher than those in the low-lying placenta group,while the neonatal weight in the low-lying placenta group was significantly higher than that in the placenta previa group.The neonatal outcome of low-lying placenta group was better than that of placenta previa group.There was no significant difference in neonatal outcomes between the former 5 years group and the latter 5 years group in different periods,whether placenta previa or low-lying placenta.6.The two ultrasound scores have certain diagnostic value for placenta previa with placenta accreta.The modified ultrasound score is superior to the Chong’s ultrasound score.It is recommended to use the modified ultrasound score for the diagnosis of placenta previa with placenta accreta. |
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