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Ⅰ.EFFECT OF PLACENTA PREVIA AND LOW-LYING PLACENTA ON MATERNAlAND FETAL/NEONATAlOUTCOMES：COMPARATIVE VIEW IN RISK FACTORS, CLINICAlCOURSES, MANAGEMENT APPROCHES AND OUTCOMES IN WUHAN UNION HOSPITAL, CHINA.
[Objective] Data were retrieved prospectively from cases of placenta previa and low-lying placenta and comparative studies between the effects of placenta previa and low-lying placenta on both maternAland fetal-neonatAloutcomes were reported.
[Methods] between January 2008 and November 2009, 104 women with prenatAldiagnosis of placenta previa and low-lying placenta were collected in our department. Our institutionAlreview board approved the study, and verbAlinformed consent was obtained from each patient. Data were statistically analyzed by using SPSS for Windows software (version 18.0) and logistic Excel Windows 2007.
[Results] our cases concern 78.8％ of placenta previa and 21.2％ of low-lying placenta with a frequency of complete placenta previa (66％) and posterior location (45cases in PP group versus 11cases in LP). Concerning the risk factors, we found only that previous cesarean section as risk associated to both groups (P<0.05); while, no statisticAldifference were found with other factors in both groups (P>0.05). However, abnormAlinvasions were found in both groups (31accretas for PPvs. 11for LP, 15 incretas for PPvs. 6 for LP and 2 percretas for PPvs. 1for LP). ClinicAlmanifestation was present in 68 cases in PP groupvs. 17cases in LP, although, eleven (11) patients with abnormAlinvasion remained qasymptomatic throughout their pregnancies (8vs. 3 in pp and LP, respectively).VaginAldelivery was only attempted in 4.81％ in PP groupvs. 0.96％ in LP group. VerticAlextension in low-transverse uterine incision was performed in 14cases for PP group and only in one case for LP. In general, bleeding was moderated with a totAlmean of 359.23mL±384.25; although, it was slightly abundant in the LP than PP group (402.27±610.518ml in LPvs. 347.68±300.799ml in PP) and eventually 6patients in PP groupvs.4in LP required blood transfusion; while, PPH was recorded in 14 cases in PP group versus 5 cases in LP group. Hysterectomy has been performed for 2patients (one of each group, respectively). Tocolytic agents, corticosteroid, antibiotics were generally used in the antepartum time, while, uterotonics agents; endouterine hemostastic suture and mifepristone were an additionAltreatment to the conservative management. FetAlmalpresentation, low birth weight, low Apgar scores, fetAlgrowth retardation, fetal/neonatAldeath and RDS were most common with PP than LP. Furthermore, patient with PP have more likely to have long duration of hospitalization than those of LP.
[Conclusion] Placenta previa and low-lying placenta are both condition that may be life-threatening at various degrees for both mother and fetus. However, similar condition for maternAlrisk factors has been reported in both PP and LP group; although, concerning outcomes condition, women with PP have likely to have a better prognosis for maternAloutcomes than those with LP contrary to fetAland neonatAloutcomes condition in which, prognosis is better in LP group than PP group. Careful timing of delivery from35 weeks of pregnancy in PP group and 36weeks in LP may be usually the only active therapy required in pregnancies to achieve normAloutcome. VerticAlextension in low-transverse uterine incision, uterotonic use and endouterine hemostastic suture are the encouraging conservative management options.
Ⅱ.RETAINED PLACENTA PERCRETA IN THE EARLY SECOND TRIMESTER OF PREGNANCY AFTER TWO PRIOR CESAREAN SECTIONS：DIAGNOSIS AND SUCCESSFUL CONSERVATIVE MANAGEMENT APPROACHES IN WUHAN UNION HOSPITAL：A CASE REPORT
The term of placenta percreta is used to describe any abnormAlplacentAlimplantation in which the chorionic villi can reach not only the uterine serosa but also the adjacent organs. We reported an experience of successful conservative management of placenta percreta in the early second trimester of pregnancy. A 31year-old patient presenting retained placenta following spontaneous abortion at 17weeks of gestation was referred to our department from outlying hospitAlfor continuous vaginAlbleeding after failed long period of orAlmifepristone administration. Ultrasound and magnetic resonance imaging proved their roles in the diagnosis and in the follow up. Our patient desired the conservative management; however, Methotrexate embolization of uterine artery arteries, uterine curettage within 2weeks after Methotrexate embolization, surgicAlplacenta removAlwith localized excision and uterine repair were chosen as skills. In our case, uterotonic agents showed a capitAlimportance to prevent profuse hemorrhage. The follow up with seriAlserum b-Human chorionic gonadotropin testing was performed.
[Objective] Data were retrieved prospectively from cases of placenta previa and low-lying placenta and comparative studies between the effects of placenta previa and low-lying placenta on both maternAland fetal-neonatAloutcomes were reported.
[Methods] between January 2008 and November 2009, 104 women with prenatAldiagnosis of placenta previa and low-lying placenta were collected in our department. Our institutionAlreview board approved the study, and verbAlinformed consent was obtained from each patient. Data were statistically analyzed by using SPSS for Windows software (version 18.0) and logistic Excel Windows 2007.
[Results] our cases concern 78.8％ of placenta previa and 21.2％ of low-lying placenta with a frequency of complete placenta previa (66％) and posterior location (45cases in PP group versus 11cases in LP). Concerning the risk factors, we found only that previous cesarean section as risk associated to both groups (P<0.05); while, no statisticAldifference were found with other factors in both groups (P>0.05). However, abnormAlinvasions were found in both groups (31accretas for PPvs. 11for LP, 15 incretas for PPvs. 6 for LP and 2 percretas for PPvs. 1for LP). ClinicAlmanifestation was present in 68 cases in PP groupvs. 17cases in LP, although, eleven (11) patients with abnormAlinvasion remained qasymptomatic throughout their pregnancies (8vs. 3 in pp and LP, respectively).VaginAldelivery was only attempted in 4.81％ in PP groupvs. 0.96％ in LP group. VerticAlextension in low-transverse uterine incision was performed in 14cases for PP group and only in one case for LP. In general, bleeding was moderated with a totAlmean of 359.23mL±384.25; although, it was slightly abundant in the LP than PP group (402.27±610.518ml in LPvs. 347.68±300.799ml in PP) and eventually 6patients in PP groupvs.4in LP required blood transfusion; while, PPH was recorded in 14 cases in PP group versus 5 cases in LP group. Hysterectomy has been performed for 2patients (one of each group, respectively). Tocolytic agents, corticosteroid, antibiotics were generally used in the antepartum time, while, uterotonics agents; endouterine hemostastic suture and mifepristone were an additionAltreatment to the conservative management. FetAlmalpresentation, low birth weight, low Apgar scores, fetAlgrowth retardation, fetal/neonatAldeath and RDS were most common with PP than LP. Furthermore, patient with PP have more likely to have long duration of hospitalization than those of LP.
[Conclusion] Placenta previa and low-lying placenta are both condition that may be life-threatening at various degrees for both mother and fetus. However, similar condition for maternAlrisk factors has been reported in both PP and LP group; although, concerning outcomes condition, women with PP have likely to have a better prognosis for maternAloutcomes than those with LP contrary to fetAland neonatAloutcomes condition in which, prognosis is better in LP group than PP group. Careful timing of delivery from35 weeks of pregnancy in PP group and 36weeks in LP may be usually the only active therapy required in pregnancies to achieve normAloutcome. VerticAlextension in low-transverse uterine incision, uterotonic use and endouterine hemostastic suture are the encouraging conservative management options.
Ⅱ.RETAINED PLACENTA PERCRETA IN THE EARLY SECOND TRIMESTER OF PREGNANCY AFTER TWO PRIOR CESAREAN SECTIONS：DIAGNOSIS AND SUCCESSFUL CONSERVATIVE MANAGEMENT APPROACHES IN WUHAN UNION HOSPITAL：A CASE REPORT
The term of placenta percreta is used to describe any abnormAlplacentAlimplantation in which the chorionic villi can reach not only the uterine serosa but also the adjacent organs. We reported an experience of successful conservative management of placenta percreta in the early second trimester of pregnancy. A 31year-old patient presenting retained placenta following spontaneous abortion at 17weeks of gestation was referred to our department from outlying hospitAlfor continuous vaginAlbleeding after failed long period of orAlmifepristone administration. Ultrasound and magnetic resonance imaging proved their roles in the diagnosis and in the follow up. Our patient desired the conservative management; however, Methotrexate embolization of uterine artery arteries, uterine curettage within 2weeks after Methotrexate embolization, surgicAlplacenta removAlwith localized excision and uterine repair were chosen as skills. In our case, uterotonic agents showed a capitAlimportance to prevent profuse hemorrhage. The follow up with seriAlserum b-Human chorionic gonadotropin testing was performed.