Risk Warning Of Dangerous Placenta Previa In Predelivery And Analysis Of The Outcome Of Delivery
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Chunli Ren, Xingguo Tang, Yufang Zhang, Xiaoming Yuan, Jinhuan Zhang and Yanwei Guo
Objective: To conduct analysis on the clinical outcome of establishment of surgical procedure after discussion by MDT by implementing prenatal ultrasound high risk warning for patients with dangerous placenta previa .Methods: 106 patients diagnosed as PPP after 28 weeks of gestation and delivered by cesarean section from January 2016 to December 2018 were selected in our hospital. According to the depth of intraoperative placenta implantation, they were divided into PA group (38 cases), PI group (35 cases) and PP group (33 cases).Results: 1. Comparison of general conditions between the three groups: There were no statistical significance in age, gestational weeks of delivery, time of initial prenatal bleeding, and proportion of occurrence of prenatal bleeding among the three groups (P > 0.05).2. Comparison of the amount of blood loss during the operation, time of operation and blood transfusion between groups.3. Comparison recombination rate of preoperative color Doppler ultrasound, ICU occupancy rate, rate of hysterectomy and urinary system injury rate between groups.4. Comparison of intraoperative methods for hemostasis between PI and PP: 2 cases with hysterectomy in the PI group, 13 cases with hysterectomy in the PP group, and the success rate of uterus retention was 85.85%.During the operation, bilateral uterine artery ligation and compression sutura for corpus uteri and lower uterine segment were performed, and wedge resection for uterine was performed when necessary. The integrated application of various hemostasis techniques played a good hemostatic effect. Conclusion: In this study, detailed preoperative preparation and evaluation were conducted through identification of preoperative high-risk factors, high risk early warning by color Doppler ultrasound diagnosis. Besides, MDT discussion was made accordingly to formulate the therapeutic schedule for the operation and flexible and various methods for hemostasis would be adopted in accordance with the conditions in implantation and hemorrhage, which proved to have received good clinical effect.
Dangerous placenta previa refers to the existence of cesarean section or hysteromyomectomy in the past, and this pregnancy is occurred with placenta previa. The patients whose placenta previa is attached to the scar site caused by the original surgery will higher risk of placental adhesion, implantation caused hemorrhage and fatal hemorrhage. The cesarean section rate in China has been in upward trend with the highest standing at 52.6%. With the efforts made in advocation of the two-child policy, more and more women of childbearing age with cesarean section were eager to give birth to another child, leading to a gradual increase of PPP incidence. In this study, the risk warning analysis was carried out before the operation for dangerous placenta previa, and the clinical procedures were carried out for individuals for analysis on impact on the clinical outcome.
Dangerous Placenta Previa; Placental Implantation; High Risk Factors; Ultrasound; Prenatal Diagnosis; Treatment For Hemostasis