Cases Of Pernicious Placenta Previa Research Articles

Study on the application of King\u2019s combined uterine suture for hemostasis during cesarean section

IntroductionPostpartum hemorrhage is a serious complication of childbirth and is still the leading cause of maternal death worldwide. Lower uterine segment hemorrhage during cesarean section is an important cause of postpartum hemorrhage. Our objective is to expore the efficacy and safety of King’s combined uterine suture for hemostasis during cesarean section.MethodsWe examined 48 cases: 16 cases of pernicious placenta previa (including one case of twins), 11 cases of central placenta previa (including one case of twins), 18 cases of uterine scarring (including two cases of twins), as well as one case of twin pregnancy, two cases of breech presentation, and one case of pulmonary hypertension. The “King’s combined uterine suture” method for hemostasis was used in patients with lower uterine segment hemorrhage during cesarean section.ResultsThe results showed that all patients had successful hemostasis during surgery, and there were no cases of hysterectomy.ConclusionWe have concluded that King’s combined uterine suture is a fast and safe hemostasis method for cesarean section that can effectively reduce blood loss and restore the normal shape of the lower uterine segment. Furthermore, this suture method can reduce postpartum hemorrhage and hysterectomy rate, as well as improve maternal prognosis.

Integrative analysis provides multi-omics evidence for the pathogenesis of placenta percreta.

Pernicious placenta previa with placenta percreta (PP) is a catastrophic condition during pregnancy. However, the underlying pathogenesis remains unclear. In the present study, the placental tissues of normal cases and PP tissues of pernicious placenta previa cases were collected to determine the expression profile of protein‐coding genes, miRNAs, and lncRNAs through sequencing. Weighted gene co‐expression network analysis (WGCNA), accompanied by miRNA target prediction and correlation analysis, were employed to select potential hub protein‐coding genes and lncRNAs. The expression levels of selected protein‐coding genes, Wnt5A and MAPK13, were determined by quantitative PCR and immunohistochemical staining, and lncRNA PTCHD1‐AS and PAPPA‐AS1 expression levels were determined by quantitative PCR and fluorescence in situ hybridization. The results indicated that 790 protein‐coding genes, 382 miRNAs, and 541 lncRNAs were dysregulated in PP tissues, compared with normal tissues. WGCNA identified coding genes in the module (ME) black and ME turquoise modules that may be involved in the pathogenesis of PP. The selected potential hub protein‐coding genes, Wnt5A and MAPK13, were down‐regulated in PP tissues, and their expression levels were positively correlated with the expression levels of PTCHD1‐AS and PAPPA‐AS1. Further analysis demonstrated that PTCHD1‐AS and PAPPA‐AS1 regulated Wnt5A and MAPK13 expression by interacting with specific miRNAs. Collectively, our results provided multi‐omics data to better understand the pathogenesis of PP and help identify predictive biomarkers and therapeutic targets for PP.

Mode of anesthesia for cesarean delivery with pernicious placenta previa - a retrospective study.

Anesthesia for cesarean delivery in parturients diagnosed with pernicious placenta previa remains controversial. This study aimed to review pernicious placenta previa cases to evaluate anesthetic management strategies. This retrospective analysis included patients who underwent cesarean delivery (CD) for pernicious placenta previa at the Affiliated Hospital of Zunyi Medical University between December 1, 2012 and November 31, 2017. Patient demographic data, obstetric characteristics, anesthetic management, and maternal outcomes were extracted from the hospital's computerized database. In all, 61 consecutive cases of pernicious placenta previa were identified among 9512 cesarean deliveries. General anesthesia was performed on 27 of the 61 patients (44.3%). Among GA group, 16 (59.3%) had placenta accreta, 8 of whom required cesarean hysterectomy. Also, 13 of the 27 (48.1%) GA patients required transfer to the intensive care unit. The other 34 patients (55.7%) were given regional anesthesia, 9 of whom were converted to general anesthesia due to excessive bleeding and prolonged operation times. Statistical results indicated that regional anesthesia was associated with a significantly shorter operation time, less perioperative blood loss, fewer intraoperative red blood cell transfusions, and a lower incidence of complications. Anesthetic management is important for parturients with pernicious placenta previa. Although regional anesthesia was our preferred method for these patients, general anesthesia is safe for patients with pernicious placenta previa who experience massive blood loss and prolonged operation times.

Influence factors and pregnancy outcomes for pernicious placenta previa with placenta accreta.

To explore the influence factors for pernicious placenta previa (PPP) with placenta accreta and pregnancy outcomes of different types of PPP. A case-control study was conducted to collect 410 PPP patients admitted to a general hospital in Changsha from December 2013 to February 2018. Two hundred and fifty cases of PPP with placenta accreta were treated as a case group, and 160 cases of PPP without placenta accreta were treated as a control group. The relationship between clinical data and placenta accreta was analyzed, and the pregnancy outcomes of PPP was observed according to different types of placenta previa. Logistic regression showed that delivery times were more than 2 (OR=3.221), cesarean section times were more than 2 (OR=3.048), central placenta previa (OR=3.607), placental attachment site (anterior wall) (OR=4.592) were independent risk factors for PPP with placenta accrete (P<0.05). Living in cities (OR=0.614), systematic prenatal examination (OR=0.590) were protective factors (P<0.05). Average intraoperative blood loss, postpartum bleeding rate, hysterectomy rate in the central group were all higher than those in the marginal and low-set group. The incidence rates of ICU transfer, complications, and hospital stay were higher or longer than those in the marginal group (P'<0.008). There was no significant difference in stillbirth rate among the 4 groups (P>0.05). Preterm delivery rate was higher than that of the marginal and low-set group, and the birth weight was lower than that of the low-set group. Apgar score at 1 min and asphyxia rate were lower and higher than those of the other 3 groups, respectively (P'<0.008). Delivery times (>2), cesarean section times (≥2), central placenta previa, placenta attachment site (anterior wall) are independent risk factors for PPP with placenta accreta. Living in cities, systematic prenatal examination were protective factors. The central PPP is more likely to lead to postpartum hemorrhage, hysterectomy, and increases in the risk of preterm birth, low birth weight as well as asphyxia of fetus, which seriously threatens maternal and fetal life.

Transverse parallel compression suture: a new suturing method for successful treating pernicious placenta previa during cesarean section.

To report a novel method to achieve hemostasis and to evaluate efficacy and safety of controlling hemorrhage from the lower uterine segment (LUS) during cesarean section for placenta previa and accrete compared with conventional surgery. From January 2017 to June 2019, there were 65 cases of pernicious placenta previa admitted in our obstetric department. They all had performed selective cesarean sections. Transverse parallel compression suture was applied in 32 cases during cesarean sections. The bladder was reflected downward till the lowest point of placenta implanted. Two plastic drains were inserted into internal and through the external os, as a support for compressing and draining the uterine cavity. First, at one side of LUS, a Vicryl number one stitch was inserted borderline of myometrium from the anterior to the posterior. The stitch was then inserted borderline of myometrium from the posterior to anterior at the other side in horizontal direction and tightened on the anterior wall of uterine surface. Another suture was inserted superiorly or inferiorly to the first one, at 1cm interval. Then, such sutures were stitched until the bleeding and dilated LUS became all compressed. The uterine incision was then stitched [group 1 (Gr1)]. Other 33 cases were managed with conventional surgery [group 2 (Gr2)]. The efficiency of this novel technique, in term of blood loss, operation time, the intensive-care unit (ICU) admission rate and hospitalization time after surgery, complications, and postoperative recovery, was compared over the same period. With our transverse parallel compression suture, we were able to preserve the uterus in all cases, while two patients underwent hysterectomy in Gr2. Our success rate in hemostasis was 93.8% (30/32). The operation time, the length of ICU stay, and the rate of ICU admission of Gr1 were lower than Gr2. All patients resumed a normal menstrual flow, and no long-term complications were observed during follow-up. Transverse parallel compression suture is an easy, effective, and safe method to stop bleeding from the lower uterine segment in women with placenta previa and accrete.

A retrospective analysis on the pernicious placenta previa from 2008 to 2014

To investigate the incidence changes, clinical characteristics and pregnant outcomes of pernicious placenta previa. A retrospective cohort analysis on 316 cases with placenta previa in the Peking University First Hospital from January 2008 to December 2014. The research group were 60 cases with the patients of placenta previa with the history of cesarean section, and the control group were placenta previa without the history of cesarean section. Compared with the incidence, intraoperative blood loss, the pregnancy outcomes and so on. (1) The average incidence rate of placenta previa during the past 7 years was 10.96 ‰ (316/28 837). And the cases of pernicious placenta previa was 60 (2.08‰, 60/28 837), the incidence of pernicious placenta previa was rising from 2008 to 2014 (0.91‰-3.08‰). (2) There were 145 cases of placenta privia had been translation from other hospitals in the past 7 years. The referral rate of pregnant women with placenta previa was 45.9% (145/316), and the referral rate of pernicious placenta previa (63.3%, 38/60) was significantly higher than that of non-pernicious placenta previa group (41.8%, 107/256; χ(2)=9.080, P=0.003). Referral the outcomes of these patients were good, and no maternal death occurred. (3) The placenta in the research group were mainly adhered in the front wall of the uterine, and the incidence was 38.5% (15/39), higher than that in the group of non-pernicious placenta previa (12.1%, 21/174; χ(2)=57.636, P<0.01). The incidence rate of complicated placenta increased in research group was 53.3% (32/60), higher than that in the group of non-pernicious placenta previa, compared with the control group, there was significant difference (15.6%, 40/256; χ(2)= 39.041, P<0.01). (4) The incidence of blood loss was more than 1 000 ml, blood transfusion rate, the rate of hysterectomy and the rate of asphyxia of newborn in the research group were respectively 41.7% (25/60), 38.3% (23/60), 8.3% (5/60), 15.0% (9/60), and the incidence of the group of non-pernicious placenta previa were respectively 4.7% (12/256), 12.9% (33/256), 1.2% (3/256), 8.6% (22/256), compared those in other two groups, there were not significant difference (P<0.05). The incidence rate of placenta previa increased year by year, patients with placenta previa has a history of cesarean section often combined with placenta in anterior wall of the uterus, and often with poor pregnancy outcomes. Hierarchical referral system is an effective means to reduce the mortality of the pernicious placenta previa.

Prophylactic bilateral internal iliac arteries balloon occlusion in 13 patients of pernicious placenta previa with placenta accreta

Objective To explore the efficacy of prophylactic bilateral internal iliac arteries balloon occlusion in treatment of women with pernicious placenta previa complicated with placenta accreta. Methods A retrospective analysis was conducted on 41 cases of pernicious placenta previa with placenta accreta admitted to Guangzhou Women and Children＇s Medical Centre from January 2010 to December 2012. The study group （n=13） underwent prophylactic bilateral internal iliac arteries balloon placement before cesarean section and occlusion after delivery. The control group （n= 28） received conventional haemostasis during cesarean section. The amount of blood loss and blood transfusion during the operation, the perioperative hemoglobin level, operation time and duration of hospitalization of the two groups were compared with t-test or Chi-square test. Results The volume of intraoperative hemorrhage of the study group was lower than of the control group [（1429±875） ml vs （4600±2090） ml, t= 6. 840, P=0. 000], the amount of intraoperative blood transfusion in the study group was also lower [（920±438） ml vs （3600±1225） ml, t=10.251, P=0.000]. Operation time and postoperative duration of hospitalization of the study group were shorter than those of the control group [（197±45） min vs （284±44） min, t=5.850,P=0.000; （6.7±1.3） d vs （8.2±2.2） d, t=2.272,P=0.029]. There was no statistical difference on hysterectomy rate between the two groups [11/13 vs 89%（25/28）, ）C2-0.181,P=0. 670）]. In addition, two cases of reoperation, one case of pulmonary edema, two cases of coagulation disorder, one case of venous thrombosis in lower limbs, one case of renal dysfunction and pulmonary edema were reported in the control group, but none in the study group. Conclusions Prophylactic bilateral internal lilac arteries balloonocclusion is effective in reducing intraoperative blood loss, transfusion, and relative complications in patients with pernicious placenta previa complicated with placenta accreta. Key words: Placenta previa ; Placenta accreta ; Iliac artery ; Embolization, therapeutic