BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta p...BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.展开更多
Objective:To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.Methods:The clinical data of 623 patients with pernicious...Objective:To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.Methods:The clinical data of 623 patients with pernicious placenta previa combined with placenta accrete,who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed.All patients underwent abdominal aortic balloon occlusion combined with cesarean section,and 78 patients underwent sequential bilateral uterine artery embolization.We analyzed the operation time,intraoperative blood loss,blood transfusion volume,intraoperative and postoperative complications,fetal radiation exposure time and dose,and the Apgar score of the newborns.We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete.Results:Of the 623 patients,545 underwent only abdominal aortic balloon occlusion,and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding.The uterus was successfully preserved in all patients.Except for five cases of right lower extremity arterial thrombosis,the remaining patients did not have postoperative lower extremity arteriovenous thrombosis,renal insufficiency,late postpartum hemorrhage,ectopic embolism,spinal cord or peripheral nerve damage,pelvic infection,or other serious complications.The mean operative time was 65.3(±14.5)min.The mean intraoperative blood loss was620(±570)ml.Ninety-six patients(15.4%,96/623)were treated with blood transfusion,and the average amount of blood transfused was 750(±400)ml.The average number of hospitalization days was 6.8(±3.4)days,the average time of fetal ray exposure was 5.2(±1.6)s,and the average radiation dose was 4.1(±2.7)m Gy.The neonatal Apgar score,was 8.4(±0.6)points at 1 min,and 9.6(±0.4)points at 5 min.In the follow-up to May 31,2019,29 patients were lost to follow-up,96 were lactating,and 498 were menstruating.Except for the cases lost to follow-up,the remaining 596 surviving newborns(including 2 twins)showed no abnormalities at the 42-day postnatal outpatient follow-up examination.Conclusion:Balloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.展开更多
Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’...Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’center assisted obstetrics to complete cesarean section in cases of sinister placenta previa.A total of 130 patients with implanted sinister placenta previa were diagnosed using obstetrical ultrasound and magnetic resonance imaging(MRI).Before cesarean section,the balloon was positioned in the bilateral radial or abdominal aorta.Immediately after delivery of the fetus,the balloon was temporarily filled to transiently seal the target vessel.According to the obstetrician’s assessment of hemostasis,the balloon was withdrawn at the appropriate time.Among the 130 patients,there was one case of abdominal aortic occlusion,with 129 cases blocked by the bilateral common iliac artery.Results:All 130 cases were successfully blocked,with an average blocking time of<15 min,while intraoperative blood loss was 800–1500 ml.Conclusion:Ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa and significantly reduce blood loss with no exposure to X-ray radiation.Thus,the technique merits serious consideration.展开更多
Objective: The incidence of placenta previa (PP) has been increasing due to the rise in cesarean rates. The aim of this study is to determine the success of lower uterine segment compression suture and bakri balloon a...Objective: The incidence of placenta previa (PP) has been increasing due to the rise in cesarean rates. The aim of this study is to determine the success of lower uterine segment compression suture and bakri balloon applications in patients diagnosed with placenta previa. Materials and Methods: 257 patients who underwent cesarean section due to placenta previa totalis (PPT) between the years of 2010-2018 in Ondokuz Mayis University were screened retrospectively. The patients were evaluated in four groups according to their treatment method: medical treatment, bakri balloon application, compression suture and hysterectomy. Results: In the study, between the years 2010-2015, postpartum hysterectomy was performed in the cases of adherent placenta previa, and hysterectomy was performed in 33 patients. Between the years of 2015-2018, first, bakri balloon or compression suture was applied;and if bleeding control was not achieved despite these, then, hysterectomy was performed. Between 2015 and 2018, a total of 27 patients underwent compression suture and 1 patient had a hysterectomy after all. The success rate was 96.3% with compression suture and 91.7% for bakri balloon application. Totally, 24 patients were treated with bakri balloon and yet, two patients underwent hysterectomy. When all the cases were examined, complications caused by urinary bladder and ureteral injury were seen in 5.6% of patients, and all of these complications were also seen in hysterectomy patients. Conclusion: Lower uterine segment transverse suture technique and bakri balloon application should be considered as a good alternative to prevent hysterectomy in patients with placenta previa totalis. In addition, they are effective treatment methods that can be used without increasing maternal morbidity.展开更多
Introduction: Placenta previa is an obstetric emergency that can be life-threatening for both mother and foetus. Despite the progress made in diagnosis and treatment, it continues to be feared by obstetricians because...Introduction: Placenta previa is an obstetric emergency that can be life-threatening for both mother and foetus. Despite the progress made in diagnosis and treatment, it continues to be feared by obstetricians because of high maternal and perinatal mortality and increased morbidity. This study aims to investigate the diagnostic, therapeutic and prognostic aspects of placenta previa at the Sourô Sanou University Hospital in Bobo-Dioulasso. Method: This was a descriptive cross-sectional study with retrospective data collection from January 1, 2016 to December 31, 2018. Included were 142 pregnant women admitted to the maternity ward of the Sourô Sanou University Hospital (CHUSS) and diagnosed with placenta previa during pregnancy, labor, or in the postpartum period. Result: The frequency of placenta previa was 0.89%;the average age of patients was 28.51 years with extremes of 16 and 44 years. The multigestations represented 28.17% and the pauciparous 31.69%. Patients with a uterine scar represented 15.49%. Ultrasound diagnosis was made in 38 patients (26.76%). Placenta previa was recovered in 56.34% of cases. Patients with severe anaemia were 28.87%, and 57.04% of the anaemic cases received blood transfusion. Caesarean section was performed in 93.66% of patients. Four maternal deaths (2.81%) and 30 stillbirths (27.02%) were reported. Conclusion: Placenta previa remains a fairly frequent pathology with a non-negligible lethality rate and perinatal mortality in the maternity ward of the Sourô Sanou University Hospital.展开更多
This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean se...This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.展开更多
This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Uni...This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision.The two groups were compared in terms of operation time,estimated blood loss,infant expulsion time,exhaust time and postoperative recovery.Meanwhile,comparison was also made in neonatal clinical data between the two groups.Compared with the "J"-shaped incision group,the traditional incision group had a lower Apgar scores(P<0.05).However,there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind(P>0.05).It is concluded that,with caesarean section for placenta previa patients,the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.展开更多
Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous ca...Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.展开更多
Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta ac...Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.展开更多
Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Backgrou...Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.展开更多
Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: ...Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.展开更多
In recent years, the incidence of placenta previa has been increasing. According to the literature, it is mainly related to induced labor, artificial abortion, cesarean section, high aging pregnancy, multipara or smok...In recent years, the incidence of placenta previa has been increasing. According to the literature, it is mainly related to induced labor, artificial abortion, cesarean section, high aging pregnancy, multipara or smoking. The placenta previa is the chief cause of bleeding in late pregnancy and threatens the lives of mother and infant, resulting in a high risk problem in obstetrics. This article studies 322 cases of placenta previa from my hospital and Dalian Obstetrics and Gynecological Hospital from January, 2002 to July, 2009, on the basis of clinicretrospective analysis, in order to deepen our understanding and art of treating placenta previa. The study revealed that: 1. With 322 cases of placenta previa, the incidence was 0.73%. It was higher than the incidence 0.3% reported abroad and lower than the incidence 0.94% reported in our country. The data were from sampling survey and did not prove relations between placenta previa and ages, different from the result obtained abroad in which placenta previa had relation with pregnancy ages. The outcome needs further study. But artificial abortion, induced labor, cesarean section and multipara clearly influence the incidence. The study did not analyze the relation between smoking and placenta previa, but there was external data proving that smoking was related to placenta previa; 2. Ultrasound-B is a better method for examination at present; 3. In cases of vaginal childbirth there was a higher incidence of lateral placenta previa and partial placenta previa. The conservative temporization and timely cesarean section can greatly decrease the mortality of mother and infant.展开更多
Introduction:?Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent place...Introduction:?Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups;Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum展开更多
A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated w...A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.展开更多
Objective:To discuss the effect of Hemabate combined with packing therapy on the systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section. Methods:70 patients with postpar...Objective:To discuss the effect of Hemabate combined with packing therapy on the systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section. Methods:70 patients with postpartum hemorrhage after placenta previa cesarean section who were treated in Chengdu Women & Children's Central Hospital between January 2014 and February 2017 were collected and then divided into the control group (n=35) who received uterine packing therapy and the observation group (n=35) who received Hemabate combined with packing therapy according to random number table. Serum levels of oxidative stress indexes and stress hormones immediately after operation and 24 h after operation were compared between two groups of patients.Results: Immediately after operation and 24 h after operation, serum oxidative stress indexes ROS and MDA levels of observation group were significantly lower than those of control group while SOD, GSH-px and CAT levels were significantly higher than those of control group, and serum stress hormones NE, E and Cor levels were significantly lower than those of control group.Conclusion: Hemabate combined with packing therapy can effectively reduce systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section, is a more ideal way of the bleeding.展开更多
Background: Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to ev...Background: Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and subsequent development of placenta previa. Methods & Materials: This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011. This study included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Results: among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 - 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Frequency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight < 2500 g. Conclusion: we concluded that patients with history of one pervious cesarean delivery had more Placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively.展开更多
Objective: To study the effect of gauze combined with water bag packing on the coagulation function, RAS system and stress response of patients with placenta previa complicated with postpartum hemorrhage. Methods: A t...Objective: To study the effect of gauze combined with water bag packing on the coagulation function, RAS system and stress response of patients with placenta previa complicated with postpartum hemorrhage. Methods: A total of 69 patients with placenta previa complicated with postpartum hemorrhage who were treated in the hospital between March 2013 and September 2016 were selected and randomly divided into the research group who accepted gauze combined with water bag packing, the control group A who accepted gauze packing and the control group B who accepted water bag packing. The coagulation function indexes, RAS system indexes and stress response indexes were measured 12 h after delivery. Results:D-D, FDP, REN, AT-II, ALD, NE, E, MDA and ET-1 contents as well as APTT, TT and PT levels of research group 12 hours after delivery were lower than those of control group A and control group B, and D-D, FDP, REN, AT-II, ALD, NE, E, MDA and ET-1 contents as well as APTT, TT and PT levels of control group A were not significantly different from those of control group B. Conclusion: Gauze combined with water bag packing for placenta previa complicated with postpartum hemorrhage can improve the coagulation function and inhibit the excessive activation of RAS system and stress response.展开更多
Objective:To describe and determine the association between Covid-19 vaccination in pregnancy and placental pathology.Methods:Conducted in a tertiary hospital in Medan,Indonesia,from April 30th 2022 to June 30th 2022,...Objective:To describe and determine the association between Covid-19 vaccination in pregnancy and placental pathology.Methods:Conducted in a tertiary hospital in Medan,Indonesia,from April 30th 2022 to June 30th 2022,this single-center cross-sectional study involved Covid-19 vaccinated and unvaccinated women with singleton full-term pregnancies delivering live fetuses via cesarean section.Maternal characteristics,placental pathologies,and the placental index were documented at enrollment.The association between Covid-19 vaccination status and placental pathology was assessed.Results:The study enrolled 200 pregnant women,including 110 vaccinated women and 90 unvaccinated women.No significant differences were observed in birthweight(P=0.48),placental index(P=0.48),and placental pathology findings[intervillous bleeding(P=0.20),increased syncytial knots(P=0.83),chorangiosis(P=0.13),villous stromal edema(P=0.13),vascular dilation and congestion(P=0.13),and vascular wall thrombus(P=0.71)]between the vaccinated and unvaccinated groups.Conclusions:This study revealed no statistically significant association between Covid-19 vaccination and placental pathology.The findings support the safety of Covid-19 vaccination during pregnancy,in regards to changes of the placental pathology.展开更多
Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by...Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.展开更多
基金Curriculum Case Base Construction Project of the First Affiliated Hospital of Xinjiang Shihezi University,No.2021Y-AL15.
文摘BACKGROUND For the past few years,preventive interventional therapy has been widely used domestically and overseas,bringing great benefits to pregnant women at high-risk for complications,such as pernicious placenta previa(PPP)and placenta accreta.Nevertheless,there are still few reports on surgical complications related to interventional therapy,and its safety should be a concern.CASE SUMMARY We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section.However,the balloon shifted during the operation,which damaged the arterial vessels after filling,resulting in severe postpartum haemorrhage in the patient.Fortunately,after emergency interventional stent implantation,the pa-tient was successfully relieved of the massive haemorrhage crisis.CONCLUSION It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases,but surgical complications related to intervention therapy can also cause adverse consequences.It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.
文摘Objective:To evaluate the efficacy and safety of balloon occlusion of the abdominal aorta for the treatment of pernicious placenta previa with placenta accreta.Methods:The clinical data of 623 patients with pernicious placenta previa combined with placenta accrete,who were admitted to our hospital from January 2013 to January 2019 were retrospectively analyzed.All patients underwent abdominal aortic balloon occlusion combined with cesarean section,and 78 patients underwent sequential bilateral uterine artery embolization.We analyzed the operation time,intraoperative blood loss,blood transfusion volume,intraoperative and postoperative complications,fetal radiation exposure time and dose,and the Apgar score of the newborns.We also performed other evaluations to ascertain the efficacy and safety of abdominal aortic balloon occlusion treatment for dangerous placenta previa with placenta accrete.Results:Of the 623 patients,545 underwent only abdominal aortic balloon occlusion,and 78 underwent uterine artery embolization due to intraoperative or postoperative bleeding.The uterus was successfully preserved in all patients.Except for five cases of right lower extremity arterial thrombosis,the remaining patients did not have postoperative lower extremity arteriovenous thrombosis,renal insufficiency,late postpartum hemorrhage,ectopic embolism,spinal cord or peripheral nerve damage,pelvic infection,or other serious complications.The mean operative time was 65.3(±14.5)min.The mean intraoperative blood loss was620(±570)ml.Ninety-six patients(15.4%,96/623)were treated with blood transfusion,and the average amount of blood transfused was 750(±400)ml.The average number of hospitalization days was 6.8(±3.4)days,the average time of fetal ray exposure was 5.2(±1.6)s,and the average radiation dose was 4.1(±2.7)m Gy.The neonatal Apgar score,was 8.4(±0.6)points at 1 min,and 9.6(±0.4)points at 5 min.In the follow-up to May 31,2019,29 patients were lost to follow-up,96 were lactating,and 498 were menstruating.Except for the cases lost to follow-up,the remaining 596 surviving newborns(including 2 twins)showed no abnormalities at the 42-day postnatal outpatient follow-up examination.Conclusion:Balloon occlusion of the abdominal aorta is a safe and effective method for the treatment of pernicious placenta previa with placenta accreta.
文摘Objective:To investigate the clinical utility of ultrasound-guided balloon occlusion in cesarean section in patients with sinister placenta previa.Methods:The Interventional and Ultrasound Departments of the authors’center assisted obstetrics to complete cesarean section in cases of sinister placenta previa.A total of 130 patients with implanted sinister placenta previa were diagnosed using obstetrical ultrasound and magnetic resonance imaging(MRI).Before cesarean section,the balloon was positioned in the bilateral radial or abdominal aorta.Immediately after delivery of the fetus,the balloon was temporarily filled to transiently seal the target vessel.According to the obstetrician’s assessment of hemostasis,the balloon was withdrawn at the appropriate time.Among the 130 patients,there was one case of abdominal aortic occlusion,with 129 cases blocked by the bilateral common iliac artery.Results:All 130 cases were successfully blocked,with an average blocking time of<15 min,while intraoperative blood loss was 800–1500 ml.Conclusion:Ultrasound-guided balloon blocking treatment before cesarean section can mitigate the dangers of placenta previa and significantly reduce blood loss with no exposure to X-ray radiation.Thus,the technique merits serious consideration.
文摘Objective: The incidence of placenta previa (PP) has been increasing due to the rise in cesarean rates. The aim of this study is to determine the success of lower uterine segment compression suture and bakri balloon applications in patients diagnosed with placenta previa. Materials and Methods: 257 patients who underwent cesarean section due to placenta previa totalis (PPT) between the years of 2010-2018 in Ondokuz Mayis University were screened retrospectively. The patients were evaluated in four groups according to their treatment method: medical treatment, bakri balloon application, compression suture and hysterectomy. Results: In the study, between the years 2010-2015, postpartum hysterectomy was performed in the cases of adherent placenta previa, and hysterectomy was performed in 33 patients. Between the years of 2015-2018, first, bakri balloon or compression suture was applied;and if bleeding control was not achieved despite these, then, hysterectomy was performed. Between 2015 and 2018, a total of 27 patients underwent compression suture and 1 patient had a hysterectomy after all. The success rate was 96.3% with compression suture and 91.7% for bakri balloon application. Totally, 24 patients were treated with bakri balloon and yet, two patients underwent hysterectomy. When all the cases were examined, complications caused by urinary bladder and ureteral injury were seen in 5.6% of patients, and all of these complications were also seen in hysterectomy patients. Conclusion: Lower uterine segment transverse suture technique and bakri balloon application should be considered as a good alternative to prevent hysterectomy in patients with placenta previa totalis. In addition, they are effective treatment methods that can be used without increasing maternal morbidity.
文摘Introduction: Placenta previa is an obstetric emergency that can be life-threatening for both mother and foetus. Despite the progress made in diagnosis and treatment, it continues to be feared by obstetricians because of high maternal and perinatal mortality and increased morbidity. This study aims to investigate the diagnostic, therapeutic and prognostic aspects of placenta previa at the Sourô Sanou University Hospital in Bobo-Dioulasso. Method: This was a descriptive cross-sectional study with retrospective data collection from January 1, 2016 to December 31, 2018. Included were 142 pregnant women admitted to the maternity ward of the Sourô Sanou University Hospital (CHUSS) and diagnosed with placenta previa during pregnancy, labor, or in the postpartum period. Result: The frequency of placenta previa was 0.89%;the average age of patients was 28.51 years with extremes of 16 and 44 years. The multigestations represented 28.17% and the pauciparous 31.69%. Patients with a uterine scar represented 15.49%. Ultrasound diagnosis was made in 38 patients (26.76%). Placenta previa was recovered in 56.34% of cases. Patients with severe anaemia were 28.87%, and 57.04% of the anaemic cases received blood transfusion. Caesarean section was performed in 93.66% of patients. Four maternal deaths (2.81%) and 30 stillbirths (27.02%) were reported. Conclusion: Placenta previa remains a fairly frequent pathology with a non-negligible lethality rate and perinatal mortality in the maternity ward of the Sourô Sanou University Hospital.
基金supported by grants from National Natural Science Foundation of China(Nos.30672243 and 81200354)Hubei Provincial Population and Family Planning Commission of China(No.JS-20130017)Huazhong University of Science and Technology(No.2013YGYL016)
文摘This prospective study was conducted to assess the rate of resolution of second trimester placenta previa in women with anterior placenta and posterior placenta, and that in women with and without previous cesarean section. In this study, placenta previa was defined as a placenta lying within 20 mm of the internal cervical os or overlapping it. We recruited 183 women diagnosed with previa between 20+0 weeks and 25+6 weeks. They were grouped according to their placenta location(anterior or posterior) and history of cesarean section. Comparative analysis was performed on demographic data, resolution rate of previa and pregnancy outcomes between anterior group and posterior group, and on those between cesarean section group and non-cesarean section group. Women with an anterior placenta tended to be advanced in parity(P=0.040) and have increased number of dilatation and curettage(P=0.044). The women in cesarean section group were significantly older(P=0.000) and had more parity(P=0.000), gravidity(P=0.000), and dilatation and curettage(P=0.048) than in non-cesarean section group. Resolution of previa at delivery occurred in 87.43% women in this study. Women with a posterior placenta had a higher rate of resolution(P=0.030), while history of cesarean section made no difference. Gestational age at resolution was earlier in posterior group(P=0.002) and non-cesarean section group(P=0.008) than in anterior group and cesarean section group correspondingly. Placenta location and prior cesarean section did not influence obstetric outcomes and neonatal outcomes. This study indicates that it is more likely to have subsequent resolution of the previa when the placenta is posteriorly located for women who are diagnosed with placenta previa in the second trimester.
基金supported by a grant from the National Natural Sciences Foundation of China (No. 30872776)
文摘This study evaluated the efficacy and safety of "J"-shaped uterine incision for caesarean section for patients diagnosed with placenta previa.A total of 55 consecutive cases of placenta previa treated in Union Hospital were retrospectively analyzed over a period of two years and 10 months.The subjects were divided into two groups with respect to the uterine incision.Twenty-four pregnant women with placenta previa who were indicated for caesarean section underwent the procedure using a new "J"-shaped uterine incision and 31 pregnant women with placenta previa received caesarean section that used the traditional transverse incision.The two groups were compared in terms of operation time,estimated blood loss,infant expulsion time,exhaust time and postoperative recovery.Meanwhile,comparison was also made in neonatal clinical data between the two groups.Compared with the "J"-shaped incision group,the traditional incision group had a lower Apgar scores(P<0.05).However,there existed no statistically significant differences in the overall time of operation and postoperative period of breaking wind(P>0.05).It is concluded that,with caesarean section for placenta previa patients,the "J"-shaped uterine incision significantly decreases intraoperative blood loss and facilitates the fetal delivery.
基金Supported by Beijing Clinical Study(Z111107058811025)Beijing Government Excellent Person Sponsor Program
文摘Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.
基金This project was supported by grants from National Natural Science Foundation of China （Nos. 81701476 and 81200354）, Hubei Provincial Population and Family Planning Commission of China （No. JS-20130017）, and Applied Basic Research Plan of Wuhan （No. 2015060101010037）.
文摘Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.
文摘Objective:?The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background:?Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design:?A prospective cohort study?is?designed for women with gestational age between 28 and?32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions.?3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta;data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion:?In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.
文摘Objective: To evaluate the effectiveness of conservative compression surgical suture techniques used for the management of pernicious placenta previa to conserve fertility in the subsequent pregnancies. Study Design: This was a non-comparative retrospective study of 188 patients diagnosed with pernicious placenta previa who underwent cesarean section in The First Hospital of Jilin University, China, from 1 January 2013 to 1 January 2018. Successful group was defined as those in which the intraoperative bleeding was managed by either modified CHO or by B-lynch suture technique and those who had further intervention including hysterectomy were designated as failure group. Results: Out of 217 patients, 188 met inclusion criteria and 29 patients were excluded. In 188 cases, 183 (97.34%) cases successes and 5 (2.65%) cases had hysterectomy. Among included group, 118 patients (62.76%) had undergone emergency cesarean section and 70 patients (37.23%) underwent elective cesarean section. The emergency group had significantly lesser gestation period of gestation at the time of cesarean section (P = 0.021) and lower neonatal weight (P = 0.001) than that of elective group. The estimated blood loss during surgery was 500 - 3200 ml (mean: 925 ml). Additionally, the amount of bleeding was found to be significantly more in patient with intraoperative complication (P = 0.007) and in patient with implanted placenta (P 0.001). Conclusion: The conservative compression suture technique including modified CHO and B-lynch suture technique during the cesarean delivery is a feasible, safe and effective alternative conservative surgical technique for the management of bleeding in case of pernicious placenta previa. Besides good surgical outcome and proper neonatal result this technique also reduces the rate of hysterectomy, thus conserving the fertility.
文摘In recent years, the incidence of placenta previa has been increasing. According to the literature, it is mainly related to induced labor, artificial abortion, cesarean section, high aging pregnancy, multipara or smoking. The placenta previa is the chief cause of bleeding in late pregnancy and threatens the lives of mother and infant, resulting in a high risk problem in obstetrics. This article studies 322 cases of placenta previa from my hospital and Dalian Obstetrics and Gynecological Hospital from January, 2002 to July, 2009, on the basis of clinicretrospective analysis, in order to deepen our understanding and art of treating placenta previa. The study revealed that: 1. With 322 cases of placenta previa, the incidence was 0.73%. It was higher than the incidence 0.3% reported abroad and lower than the incidence 0.94% reported in our country. The data were from sampling survey and did not prove relations between placenta previa and ages, different from the result obtained abroad in which placenta previa had relation with pregnancy ages. The outcome needs further study. But artificial abortion, induced labor, cesarean section and multipara clearly influence the incidence. The study did not analyze the relation between smoking and placenta previa, but there was external data proving that smoking was related to placenta previa; 2. Ultrasound-B is a better method for examination at present; 3. In cases of vaginal childbirth there was a higher incidence of lateral placenta previa and partial placenta previa. The conservative temporization and timely cesarean section can greatly decrease the mortality of mother and infant.
文摘Introduction:?Worldwide increasing cesarean section rates are expected to have a parallel increase in the number of cases of Placenta Previa with all the expected complications, including pathologically adherent placenta. This morbidly adherent placenta constitutes a serious and possibly a life threatening complication. An efficient team capable for managing possible complicated situations will be able to reduce mortality and morbidity. Objectives: The aim of our study was to evaluate maternal outcome in cases of Placenta Previa with and without morbidly adherent placenta. Methods: Analysis of all pregnancies complicated by antepartum hemorrhage during the period from January 2013 to September 2017 at King Abdul-Aziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA) was done. Cases of Placenta Previa with gestational age > 28 weeks were included. They were classified into 2 groups;Group (A) included Placenta Previa cases without morbidly adherent placenta and Group (B) included cases with morbidly adherent placenta. Maternal outcomes were recorded. Results: Placenta Previa was the leading cause of antepartum hemorrhage constituting 76.8%, out of them 52% were unbooked. Morbidly adherent placenta constituted 13.5% of total Placenta Previa cases and was diagnosed prenatally in only 1 case. Morbidity rate in placenta previa patients with adherent placenta (Group B) was higher than in placenta previa without adherent placenta (Group A). We considered the occurrence of intrapartum hypovolemic shock, Intensive care unit admission, surgical complications and peripartum hysterectomy as parameters for morbidity. P value for hypovolemic shock was insignificant (P = 0.580), significant for Intensive care unit admission (P = 0.008), significant for surgical complications (P = 0.009) and significant for peripartum
文摘A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.
基金Special Funds of Natural Science Foundation of China No:2016YFC1000406.
文摘Objective:To discuss the effect of Hemabate combined with packing therapy on the systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section. Methods:70 patients with postpartum hemorrhage after placenta previa cesarean section who were treated in Chengdu Women & Children's Central Hospital between January 2014 and February 2017 were collected and then divided into the control group (n=35) who received uterine packing therapy and the observation group (n=35) who received Hemabate combined with packing therapy according to random number table. Serum levels of oxidative stress indexes and stress hormones immediately after operation and 24 h after operation were compared between two groups of patients.Results: Immediately after operation and 24 h after operation, serum oxidative stress indexes ROS and MDA levels of observation group were significantly lower than those of control group while SOD, GSH-px and CAT levels were significantly higher than those of control group, and serum stress hormones NE, E and Cor levels were significantly lower than those of control group.Conclusion: Hemabate combined with packing therapy can effectively reduce systemic stress response in patients with postpartum hemorrhage after placenta previa cesarean section, is a more ideal way of the bleeding.
文摘Background: Placenta previa (P.P) is a rare pregnancy complication where a placenta particularly or completely covers the internal cervical os thereby preventing normal vaginal delivery. This study was conducted to evaluate the relationship between repeated cesarean deliveries and subsequent development of placenta previa. Methods & Materials: This cross-sectional study was held in Imam Reza Hospital Kermanshah-Iran during 2008-2011. This study included all pregnant women with repeated cesarean sections while nullipara and patients with placenta previa without previous surgery were excluded. Diagnosis was made on ultrasound and at surgery. Results: among 2696 Women, 98 cases had P.P (3.63%). The mean age was 30 years, 76.5% (75 cases) had gravidity 2 and 3 and 87.8% (86 cases) had parity 1 - 3. Anterior location of placenta was 44.9% while posterior was 55.1%. 48% were complete P.P, 32.7% low lying P.P, 13.3% marginal P.P, and 6% Partial P.P. 26.5% of patients had history of abortion. 55.1% of patients had male fetus. There was an increase in frequency of placenta previa with just one previous C-section (74.5%). Frequency of accreta P.P 32% (n = 7), increta (14.3%, n = 3) and percreta 28% (n = 6). Among those who underwent emergency hysterectomy (21 cases) 23.8% cases had no abnormal placentation. 30.6% of newborns had birth weight < 2500 g. Conclusion: we concluded that patients with history of one pervious cesarean delivery had more Placenta previa and need to hysterectomy were more than those with history of 2 and 3 previous cesarean delivery. The most common type of abnormal placentation was accreta, percreta and increta respectively.
文摘Objective: To study the effect of gauze combined with water bag packing on the coagulation function, RAS system and stress response of patients with placenta previa complicated with postpartum hemorrhage. Methods: A total of 69 patients with placenta previa complicated with postpartum hemorrhage who were treated in the hospital between March 2013 and September 2016 were selected and randomly divided into the research group who accepted gauze combined with water bag packing, the control group A who accepted gauze packing and the control group B who accepted water bag packing. The coagulation function indexes, RAS system indexes and stress response indexes were measured 12 h after delivery. Results:D-D, FDP, REN, AT-II, ALD, NE, E, MDA and ET-1 contents as well as APTT, TT and PT levels of research group 12 hours after delivery were lower than those of control group A and control group B, and D-D, FDP, REN, AT-II, ALD, NE, E, MDA and ET-1 contents as well as APTT, TT and PT levels of control group A were not significantly different from those of control group B. Conclusion: Gauze combined with water bag packing for placenta previa complicated with postpartum hemorrhage can improve the coagulation function and inhibit the excessive activation of RAS system and stress response.
文摘Objective:To describe and determine the association between Covid-19 vaccination in pregnancy and placental pathology.Methods:Conducted in a tertiary hospital in Medan,Indonesia,from April 30th 2022 to June 30th 2022,this single-center cross-sectional study involved Covid-19 vaccinated and unvaccinated women with singleton full-term pregnancies delivering live fetuses via cesarean section.Maternal characteristics,placental pathologies,and the placental index were documented at enrollment.The association between Covid-19 vaccination status and placental pathology was assessed.Results:The study enrolled 200 pregnant women,including 110 vaccinated women and 90 unvaccinated women.No significant differences were observed in birthweight(P=0.48),placental index(P=0.48),and placental pathology findings[intervillous bleeding(P=0.20),increased syncytial knots(P=0.83),chorangiosis(P=0.13),villous stromal edema(P=0.13),vascular dilation and congestion(P=0.13),and vascular wall thrombus(P=0.71)]between the vaccinated and unvaccinated groups.Conclusions:This study revealed no statistically significant association between Covid-19 vaccination and placental pathology.The findings support the safety of Covid-19 vaccination during pregnancy,in regards to changes of the placental pathology.
文摘Introduction: Pre-eclampsia is a complication of pregnancy that generally occurs in the third trimester. It is associated with a maternal and foetal mortality rate of around 27%. In view of the grim picture painted by this condition for both mother and newborn, studies have been carried out into the early detection of patients at risk of developing pre-eclampsia. These make it possible to introduce pregnancy-specific monitoring and preventive strategies to reduce the incidence of the condition. Objective: To establish the link between placental ultrasound characteristics and the onset of pre-eclampsia. Methodology: A multicentre prospective cohort study was conducted in two hospitals in Yaoundé, namely the Yaoundé Gynaecological Obstetrics and Paediatrics Hospital and the Nkolndongo Health and Social Animation Centre, in the gynaecology and radiology departments over a period of 11 months, from October 2022 to August 2023. It included pregnant women who had undergone obstetric ultrasound between 12 and 18 weeks’ gestation. In addition to routine obstetric ultrasound, we performed obstetric Doppler measurements in these patients. The resistance index of the left and right uterine arteries, the umbilical artery and the placental volume were the characteristics sought. At the end of this examination, two groups were formed: cases (pathological Doppler group) and controls (normal Doppler group). Blood pressure and urine dipstick were taken at each antenatal visit until delivery, then during the immediate postpartum period and finally at 7 days, 21 days and 42 days after delivery. Results: Sixty-seven (67) patients were included. Of these, 35 (47.8%) had pathological Dopplers. Sixteen patients had arterial hypertension associated with proteinuria and were therefore labelled as pre-eclampsia (PE). This gives a prevalence of 23.9%. Fifteen (42.8%) of these patients belonged to the exposed group and one to the unexposed group. The mean IR of the pre-eclampsia patients was significantly higher than that of the patients without pre-eclampsia;respectively 0.74 ± 0.096 and 0.49 ± 0.097 for the right uterine arteries and 0.71 ± 0.13 and 0.52 ± 0.089 for the left uterine arteries. We found that an increase in the uterine artery resistance index was significantly associated with the onset of pre-eclampsia, with a relative risk of 13.7 and a p value Conclusion: Abnormal Doppler ultrasound between 12 and 18 weeks of amenorrhoea had good overall sensitivity for predicting pre-eclampsia. Among the Doppler indices, the uterine artery resistance index was the only one significantly associated with pre-eclampsia.
