Cesarean Section For Placenta Previa Research Articles

Major placenta previa among patients with and without previous cesarean section: Maternal characteristics, outcomes and risk factors

ObjectivesTo compare maternal characteristics and outcomes among patients having major placenta previa (PP) with and without previous cesarean section (CS). And to determine if previous CS alone is a risk factor for associated adverse maternal outcomes in these patients. Materials and methodsThis is a retrospective analysis including two groups of major PP patients, with previous CS (n = 184) and without CS (n = 115); who were admitted to Abha Maternity and Children's Hospital over the last ten-years (January 2012–December 2021), Aseer region, Saudi Arabia. ResultsCompared to those without previous CS, major PP patients with previous CS had significantly advanced ages with higher mean numbers of gravidity and parity, but significantly less rates of previous uterine surgery and IVF pregnancies. Moreover, they were more likely to acquire higher rates of adverse maternal outcomes. In the same way, these patients had an increased Odds Ratios of cesarean hysterectomy (OR of 20.462), urinary tract injuries (OR of 12.361), associated PAS (OR of 4.375), moderate/ heavy intra-operative bleeding (OR of 2.153) and the need for transfusion of 3+ units of packed RBCs (OR of 1.849). Conclusion(1) Patients with combined existence of major PP and previous CS had significantly higher rates of adverse maternal outcomes (2) Alone, prior CS in major PP patients increased the Odds Ratios of cesarean hysterectomy, urinary tract injuries, diagnosis of PAS, excessive intra-operative bleeding and repeated packed RBCs transfusions. (3) Among our PP patients with previous CS, the increased rate and OR of PAS diagnosis could in-part explain the adverse maternal outcomes.

Successfully conservative management of the uterus in acute pulmonary embolism during cesarean section for placenta previa: a case report from Tu Du Hospital, Vietnam and literature review

BackgroundCardiopulmonary collapse is a catastrophic event in cesarean section, which leads to adverse outcomes for both the mother and the fetus. Pulmonary embolism is one of the rare etiologies of this entity. We herein reported the successful management of acute embolism pulmonary associated with cesarean delivery on a healthy pregnant woman at our tertiary referral hospital.Case presentationA full-term pregnant woman hospitalized for planned cesarean delivery due to placenta previa without cardiorespiratory diseases. She was scheduled uneventfully for a planned cesarean section. After placental delivery, the patient spontaneously fell into cardiopulmonary collapse and her vital signs deteriorated rapidly. The obstetricians promptly completed the cesarean section and performed all procedures to prevent the PPH and preserve the uterus. At the same time, the anesthesiologists continued to carry out advanced heart-lung resuscitation in order to control her vital signs. After surgery, the multidisciplinary team assessed the patient and found a thrombus in her pulmonary circulation. Therefore, the patient was managed with therapeutic anticoagulation. The patient recovered in good clinical condition and was discharged after 2 weeks without any complications.ConclusionsThe diagnosis of acute pulmonary embolism is extremely difficult due to uncommon occurrence, sudden onset, and non-specific presentation. Awareness of this life-threatening pathology during cesarean delivery should be raised. Interdisciplinary assessment must be essentially established in this life-threatening condition. After the whole conventional management, uterine conservation may be acceptable where applicable. Further data is required to encourage this finding.

Placenta accreta on non-scarred uterus: About a case

Placenta accreta is an abnormally adherent placenta (abnormal adhesion of the placenta to the myometrium), due to the localized or diffuse absence of the decidua basalis. Its incidence increases with increasing cesarean section rates. Placenta accreta in a non-scarred uterus is very rare but remains possible due to other risk factors which are age, smoking, placenta preavia and finally invasive endouterine procedures. Among its consequences, we first note the hemorrhage of delivery which can be associated with significant maternal morbidity and mortality, uterine rupture and also the invasion of adjacent organs by the placental trophoblast. We report an interesting case of placenta accreta on a non-scarred uterus discovered during a planned cesarean section for placenta previa. This is a 41-year-old patient with no history of scarred uterus, 5th procedure, 3rd parity, with history of spontaneous miscarriage cured at 2 months, pregnant at 39 weeks, unmonitored pregnancy, admitted to the maternity emergency room for two days before for delivery method where the parturient benefited from a clinical examination and an obstetric ultrasound showing a completely covering anterior placenta, amniotic fluid of normal quantity and an estimate of the fetal weight at 2800g, then scheduled for a cesarean section. The diagnosis of placenta accreta is made during cesarean section. We opted for radical treatment. Placenta accreta is a pathology at risk of serious hemorrhagic complications during pregnancy and the postpartum period. This should encourage us to systematically search for ultrasound criteria for placenta accreta. The ultrasound report, in these patients, must explicitly mention this. Adequate care in the presence of a multidisciplinary team makes it possible to limit the mortality and morbidity associated with this pathology.

Risk Factors associated with Intrauterine Fetal Death at Birat Medical College Teaching Hospital

Background & Objective: Intrauterine fetal death is a tragic event, and despite efforts to reduce its incidence, it remains challenging to do so. Intrauterine fetal death is an important indicator of the maternal and perinatal health of a given population. This study aims to identify the maternal and fetal factors associated with intrauterine fetal death. Material and Methods: This is a descriptive cross-sectional study conducted in Obstetrics ward of Birat Medical College Teaching Hospital from 1st July 2021 to 31st August 2022. All pregnant women with ultrasound confirmed intrauterine fetal death after 28 or more weeks gestation who were admitted to the Obstetrics ward of Birat Medical College Teaching Hospital in the study period were enrolled in the study. Results: There were 4562 antenatal admissions and 3852 deliveries in the study period. Of these, 35 pregnant women were admitted with intrauterine fetal death. The intrauterine fetal death rate was 11 per 1000 deliveries in our institution. The mean age of women at presentation was 25.94±4.82 years, and 85.7% of pregnant women between the ages of 20-35 years. Of the study participants, 34.3% were Janajati and 82.9 % were Hindu. Out of 35 pregnant women, 37.1% had not received formal education, and all of them were housewives by occupation. Only one patient was smoker, and none of them were alcoholic. Among the 35 pregnant women, 40 % were preterm, 57.1% were term, and 2.9% were post-term. The majority (60%) of them were multigravida. Hypertensive disorder in pregnancy was the most common identified risk factor in 25.7% of pregnant women, and in 37.1 % of cases, causes were not identified. Out of the 35 pregnant women, 34 underwent vaginal delivery, while one underwent a caesarean section for placenta previa. Conclusion: Most of the pregnant women with intrauterine fetal death were illiterate housewives. The most commonly identified risk factor in this study was hypertensive disorder in pregnancy, which is preventable by regular antenatal care and timely intervention. Therefore, we should emphasize the importance of regular antenatal care for early detection and treatment of hypertension and other risk factors.

P185 Accidental administration of 30,000 IU of unfractionated heparin during an elective caesarean section for placenta praevia

P185 Accidental administration of 30,000 IU of unfractionated heparin during an elective caesarean section for placenta praevia

Efficacy of Preoperative Intravenous Tranexamic Acid Before Cesarean Section in Placenta Previa: A Randomized Double Blind Control Trial

Background: Placenta previa is a common cause of postpartum hemorrhage (PPH) that contributes substantively to maternal morbidity and mortality rates. Tranexamic acid is an antifibrinolytic drug that is useful for the treatment of PPH. The recommendation from many guidelines is to start giving tranexamic acid as soon as PPH is diagnosed to reduce postpartum blood loss. Furthermore, some studies report the beneficial use of tranexamic acid given as a prophylactic before Cesarean section to decrease intraoperative blood loss and prevent PPH. To the authors’ knowledge, in high-risk obstetrics case such as placenta previa, there was insufficient data to support recommendations of the use of tranexamic acid for prevent PPH. Objective: To evaluate the efficacy of supplementary intravenous tranexamic acid before cesarean section versus prophylactic intravenous oxytocin after placenta delivery alone to decrease intraoperative blood loss and prevent PPH in placenta previa. Material and Methods: The present study conducted a double blinded placebo control trial comparing adjunct 1 g tranexamic acid given intravenously before skin incision with prophylactic intravenous oxytocin after placenta delivery alone before cesarean section for placenta previa. The study recruited 60 women who were diagnosed with placenta previa at gestational age (GA) of more than 28 completed weeks undergoing emergency cesarean section due to active bleeding or scheduled for elective cesarean section at 37 completed weeks at Chonburi Hospital between July 2021 and July 2022. The primary outcome was intraoperative blood loss. Results: Sixty diagnosed placenta previa women were recruited, with 30 patients per group. Group I patients were given 1 g tranexamic acid and Group II were given a placebo of 100 ml NSS before skin incision. Both groups received intravenous oxytocin 20 units after placenta delivery. The main outcome showed that preoperative tranexamic acid intravenous reduced intraoperative blood loss significantly compared with the placebo at 349.5 ml (range of 168 to 2,200) versus 619 ml (range of 288 to 3,243), p<0.001. The secondary outcome showed a significant decrease in the incidence of PPH at 4 (13.33%) versus 10 (33.33%), p=0.030 and decreased in the incidence of blood transfusion of more than one unit from 5 (16.67%) versus 13 (43.33%), p=0.047. Conclusion: Prophylactic supplementary 1 g tranexamic acid intravenously before cesarean section to prophylactic intravenous oxytocin after placental delivery was found to effectively reduce intraoperative blood loss and PPH. Keywords: Tranexamic acid; Preoperative; Placenta previa; Intraoperative blood loss; Cesarean section

Caesarean Section for Placenta Previa: A Retrospective Cohort Study of Anaesthesia Techniques.

Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, 36.24% were performed under regional anaesthesia and 63.76% under general anaesthesia. When compared to general anaesthesia, significantly less regional anaesthesia was used for emergency caesarean section (26% vs. 38.6%, P = .033) and for grade IV placenta previa (50% vs. 68.8%, P = .013). Blood loss was found to be significantly low with regional anaesthesia (P = .005) and posterior placenta (P = .042), while it was found to be high in grade IV placenta previa (P = .024). The odds of requiring blood transfusion were low in regional anaesthesia (odds ratio = 0.122; 95% CI = 0.041-0.36, P = .0005) and posterior placenta (odds ratio = 0.402; 95% CI = 0.201-0.804, P = .010), while they were high in grade IV placenta previa (odds ratio: 4.13; 95% CI = 0.90-19.80, P = .0681). The rate of neonatal deaths and intensive care admission was significantly lower in regional anaesthesia than in general anaesthesia (7% vs. 3% and 9% vs. 3%). The maternal mortality was zero; however, intensive care admission was less in regional anaesthesia compared to general anaesthesia (<1% vs. 4%).Our data demonstrated less blood loss, need for blood transfusion, and better maternal and neonatal outcomes with regional anaesthesia for caesarean section in women with placenta previa.

Placenta Accreta Spectrum Disorders: A. Chohan Continuous Squeezing Suture (ACCSS) for Controlling Haemorrhage from the Lower Uterine Segment at Caesarean Section.

To describe the simplicity, efficacy and safety of A. Chohan Continuous Squeezing Suture (ACCSS) for controlling haemorrhage from the lower uterine segment at caesarean section for placenta praevia and accreta spectrum disorders. This prospective study was conducted on 47 patients with placenta praevia and accreta spectrum disorders from February 2019 to May 2022 in two teaching hospitals of Lahore and ACCSS was applied. The outcome measures were peripartum hysterectomy procedure time, estimated blood loss, number of blood transfusions, duration of stay in the hospital, bladder trauma, uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage and maternal mortality. Descriptive statistics were calculated by using SPSS version 21. Out of 47 patients, 7 (15%) had placenta creta, 29 (61.7%) increta, 11 (23.3%) percreta (grade 3a), and 36 (76.6%) central anterior dominant placenta. Peripartum hysterectomy was prevented in 97.8% of patients. ACCSS procedure time was 5-10 minutes (87.2%), with mean blood loss 2500±485 ml, mean blood transfusion 1.85±1.02 units and mean hospital stay of 3.3±0.84 days. One patient had bladder trauma. There was no case of uterine necrosis, pelvic abscess formation, secondary postpartum haemorrhage or maternal mortality. ACCSS appears to be a simple, effective and safe treatment option for placenta praevia and accreta spectrum disorders, as an alternative to hysterectomy.

Efficacy and safety of autologous blood transfusion during cesarean section for placenta previa: a single-center retrospective study

Background: Postpartum hemorrhage is a life-threatening pregnancy complication and we want to evaluate the safety and efficacy of autologous blood transfusion during cesarean section in women with placenta previa to deal with postpartum hemorrhage. Methods: We conducted a retrospective study concentrating on all cases of placenta previa using autologous blood recovery during cesarean section in a single-center from August 2016 to July 2018, and then grouped and compared the clinical and patient characteristics. Linear regression analysis was conducted to analyze the linear relationships between estimated blood loss and recovered autologous blood volume, recovered autologous blood volume and transfused autologous blood volume, and transfused autologous blood volume and estimated blood loss. Results: In our study, autologous blood recovery technology was used during cesarean section for 294 patients with placenta previa, and a total of 266,660 mL of blood was collected and 134,342 mL of autologous blood was transfused, saving 746 U of red blood cell suspension. Recovered and transfused blood volumes were higher in patients with suspected placenta accreta and resection of the uterus. There were no serious adverse reactions related to autologous blood recovery and transfusion. Conclusions: The use of autologous blood transfusion during cesarean section in patients with placenta previa is safe and can save blood resources.

Effectiveness of Pre-operative Rectal Misoprostol in Reducing Blood Loss during Cesarean Section for Placenta Previa and Manual Removal of Retained Placenta: A Parallel Placebo-Controlled Study

BACKGROUND: Primary postpartum hemorrhage (PPH) contributes significantly to the high maternal mortality ratio, especially in the low resource nations. Placenta previa and retained placenta are major causes of postpartum hemorrhage. Uterotonics like misoprostol are medication used to improve uterine contractility with the purpose of reducing uterine bleeding after delivery of baby. Most studies on misoprostol for the prevention of obstetric hemorrhage have been focusing on its postpartum use.&#x0D; AIM: The aim of this study was to assess the effectiveness of pre-operative misoprostol in reducing blood loss during cesarean section for placental previa and manual removal of retained placenta.&#x0D; METHODS: This was a placebo-controlled study involving 154 women who were randomly assigned to the treatment and control groups. The study group received 400 ug of misoprostol rectally just before the commencement of the procedure. Estimation of blood loss was done in a standardized way. Data were analyzed using SPSS version 23. The level of significance was set at p &lt; 0.05.&#x0D; RESULTS: The average age of the participants was 31.64 years. The overall incidence of PPH was comparable in both groups (0.070), however, misoprostol group experienced lower incidence of severe PPH compared to the placebo (p = 0.013). Other maternal and perinatal outcomes were comparable.&#x0D; CONCLUSION: Excessive intraoperative and immediate post-operative bleeding can be prevented with pre-operative misoprostol. It should be made available for high-risk obstetrics procedures.

Applying Color Doppler Image based Virtual Surgery in Placenta Previa Cesarean Section

Abstract Objective: To study the application of image processing technology in cesarean section of placenta previa, thereby reducing the occurrence of high-risk pregnancy. Methods: First, the method of gray image enhancement is analyzed. This method enhances the gray difference between the target and the background, highlights useful information, summarizes the source and type of noise, and proposes common filtering and noise reduction methods to suppress the noise. For edge detection, pixel-level edge detection operators and sub-pixel-level edge detection operators are summarized. The Canny edge detection operator and the Gaussian fitting sub-pixel edge detection operator are introduced in detail, and innovative improvements are carried out for resolving the deficiencies of the algorithm. Results: The improved adaptive iterative segmentation thresholding method results in a threshold of T = 98 and 11 iterations. The image segmentation quality of the improved Otsu method has been greatly enhanced. After the second segmentation, the improved Otsu method finds the optimal threshold T = 76. Conclusion: Color Doppler ultrasound image processing technology has excellent application in placenta previa cesarean section.

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.

Does previous cesarean section per se, especially its number, increase the risk of allogeneic blood transfusion at cesarean section for placenta previa?

Objective: At cesarean section (CS) for placenta previa (PP), previous CS, especially multiple CS, is reported to be associated with massive bleeding. The authors attempted to determine which causes massive bleeding, previous CS per se or previous-CS-associated factors. The need for allogeneic blood transfusion (BT) at CS was set as a marker representing massive bleeding. Materials and Methods: This retrospective cohort study involved all 326 patients with PP who delivered in one institute using the same management protocol. The authors evaluated the associations between the number of previous CS, maternal characteristics, and perinatal outcomes, and calculated the odds ratio (OR) for allogeneic BT according to the number of previous CS. Results: With an increasing number of previous CS, the following significantly increased: abnormally invasive placenta, anterior placentation, total previa, and ultrasound-detectable lacunae. The rates of allogeneic BT for patients with previous CS of 0×, 1×, and &gt;2× were 6% (16/273), 37% (14/38), and 60% (9/15), respectively (p &lt; 0.001). On adjustment for anterior placentation, total previa, and lacunae, ORs (95% confidence interval) of allogeneic BT for previous CS 1× and &gt;2× were 6.3 (2.5-16.4) and 11.4 (3.0-42.2), respectively, with CS 0× being referent. On analysis of 308 (326-18) patients excluding 18 with an abnormally invasive placenta, the adjusted ORs of allogeneic BT for CS 1× and &gt;2× were 3.5 (1.1-10.8) and 6.2 (1.1-37.3), respectively, remaining high. Conclusion: The number of prior CS, and, thus the previous CS per se, increases the requirement for allogeneic BT, irrespective of the presence/absence of an AIP, anterior placentation, total previa, or lacunae. Management protocol of PP women with multiple CS should be adapted accordingly.

Effect of a Combined Hemostatic Technique during Cesarean Section in Placenta Previa

Objective: Only a few methods, besides cesarean hysterectomy, are available for controlling intractable bleeding in placenta previa. We aimed to evaluate the effect of the combined hemostatic technique during cesarean section for placenta previa. Methods: We retrospectively reviewed all cesarean deliveries for placental previa performed from April 2013 to December 2018 at Jeonbuk National University Hospital. Medical records were reviewed to determine the amount of red blood cell transfusion, degree of blood loss, and incidence of postpartum hysterectomy and uterine artery embolization between the conventional method and combined technique. Conventional hemostatic technique group undergo usual cesarean section surgery, and combined hemostatic technique comprises temporary bilateral ovarian artery clamping, bilateral uterine artery ligation, and intrauterine Bakri balloon (Cook Medical, Bloomington, IN, USA) tamponade. Results: There were 135 cesarean deliveries for placenta previa during the study period (conventional hemostatic method, n=100; combined hemostatic technique, n=35). The index of blood loss (conventional vs. combined, 0.22±}0.13 vs. 0.22±}0.11, P=0.90) was not different between the two groups. However, the mean amount of intraoperative red blood cell transfusion (0.88±}2.12 vs. 0.55±}0.93 units, P=0.02) was significantly lower in the combined technique group. The incidence of postpartum hysterectomies (5 vs. 0, P=0.025) and postpartum treatments (13 vs. 0, P=0.006) for continuous bleeding after cesarean section was also significantly lower in the combined technique group. Conclusion: Our findings suggest that combined hemostatic technique is associated with less intraoperative red blood cell transfusion and a decreased rate of postpartum hysterectomy and additional hemostatic procedures after cesarean section for placenta previa.

Planned versus urgent deliveries in placenta previa: maternal, surgical and neonatal results.

Placenta previa is abnormal localization of the placenta, associated with high rates of maternal-fetal morbidity and mortality. This abnormal implantation may also be in the form of invasion to surroundings defined as placenta accreta spectrum (PAS). The increasing rates of cesarean section raise the frequency of placenta previa and PAS in recent years. Although there are some recommendations, the optimal timing of caesarean delivery concerning fetal and maternal benefits is still unclear. The aim of this study is to compare maternal, surgical and perinatal outcomes of placenta previa cases who underwent emergency or planned surgery. The women who underwent cesarean section for placenta previa between October 2013 and February 2019 at a tertiary care center were retrospectively analyzed. They were divided into two main groups as planned and urgent, and into two subgroups as complicated (PAS) and uncomplicated (non-PAS). Of the 313 women who met the inclusion criteria, 176 were planned and 137 were urgent cesarean sections. In the urgent group, gestational age, duration of surgery, maternal preoperative and pre-discharge hemoglobin levels, requirement of blood and blood product, additional surgical interventions, length of maternal postoperative intensive care unit and hospital stay, neonatal birthweight, Apgar scores, length of the follow-up in neonatal intensive care unit, invasive and non-invasive mechanical ventilation were significantly different. Maternal complication rates are increased in women who are operated on emergency conditions due to placenta previa. Perinatal outcomes are better in women who underwent planned surgery and in those with gestational age greater than 37weeks.

Risk factors for severe postpartum haemorrhage during caesarean section for placenta praevia

The objective of this study was to evaluate the value of clinical and ultrasound risk factors in predicting severe postpartum haemorrhage (PPH) (≥1.5 L) in pregnancies undergoing caesarean section for placenta praevia. This cohort consists of all cases of placenta praevia undergoing caesarean delivery over a period of 5 years in a service unit. Patients and their delivery data were retrieved from an obstetric database. Ultrasound features were prospectively recorded before caesarean section. The incidence of caesarean section for placenta praevia was 0.98% (n = 215). Of these, 12.1% (n = 26) had severe PPH. A logistic regression model showed that major praevia, antepartum haemorrhage before delivery and anterior placenta remained significant factors associated with severe PPH. The sensitivity/specificity and positive/negative predictive value of the model are 96.2%, 59.8%, 24.8% and 99.1%, respectively. Our model had high sensitivity and negative predictive value for severe PPH during caesarean section for placenta praevia.Impact statementWhat is already known on this subject? Placenta praevia is known to be one of the leading causes of severe PPH. Many risk factors have been associated with severe bleeding during caesarean section for placenta praevia. However, the importance of individual factors in predicting pregnancy outcome remains controversial.What the results of this study add? Our model includes only three simple parameters, namely the presence of significant antepartum haemorrhage (APH) from the history, and anterior or posterior placenta and major or minor praevia from ultrasound findings, but could predict up to 96.2% of all severe PPH. More importantly, the absence of APH, a posterior minor praevia, was associated with a negative predictive value of 99.1% of severe PPH, implying that such cases could be treated as ‘normal’ low risk caesarean sections.What the implications are of these findings for clinical practice and/or further research? This simple model would allow differential pre-operative counselling of patients on risks and complications, planning and preparation of operation, allocation of staff as well as in contingency measures to be taken during operation. The establishment of a differential protocol for placenta praevia based on these simple risks factors and a prospective trial of such a protocol is suggested.

Caesarean section for placenta praevia: A retrospective study of anaesthetic technique and foeto-maternal

Introduction: Placenta praevia complicates approximately 0.3-0.8% of pregnancies in multiparous parturient and there is an increased risk in those with previous Caesarean section. The choice of anaesthetic technique usually poses dilemma to the attending anaesthetist. The aim of this study was to review the choice of anaesthetic technique for caesarean section complicated by placenta praevia and determine foeto-maternal outcome.Patients and Methods: This was a retrospective survey covering a period of four years (January 2013 - December 2016). After Ethics Committee approval, information was obtained from the anaesthetic and theatre records and the patients’ case notes. The information obtained were: patients’ characteristics, obstetric history, grade of placenta praevia, indications for surgery, choice of anaesthetic technique, PCV/haemoglobin level, haemodynamic changes, blood transfusion, maternal and foetal outcome. The data were analysed using IBM SPSS version 20.Results: A total of 4,388 Caesarean sections were carried out during the 4- year period of review. One hundred and forty-five cases (3.3%) with different degrees of placenta praevia progressing to Caesarean section were identified. The mean age (years) was 32.6+5.3 with a mean gestational age(weeks) of 36.7±1.11. Thirty-nine (26.9%) patients were offered general anaesthesia while 106 (73.1%) were done under spinal anaesthesia. The mean blood loss in the GA and spinal group was 1,080 + 970.53 and 753.77 + 568.19 ml respectively (P = 0.0135). 87.6% neonates were delivered alive. Seventy-nine (54.5%) were elective procedure with adequate preparation. There were two (1.4%) cases of maternal mortality and perinatal mortality of 12.4%.Conclusion: The anaesthetic technique for patients with placenta praevia should be determined by the patient’s haemodynamic status and the grade of the placenta praevia.

Statistical Data About Risk Factors and Pregnancy Outcome of Placenta Previa

Placenta previa is a placental location close to or over the internal cervical os. The aim of this study was to evaluate: risk factors, maternal and neonatal outcomes in patients with placenta previa. Material and methods: We conducted a retrospective cohort study of 38 women who have had a caesarean section for placenta previa at a tertiary referral University Hospital of Obstetrics and Gynecology “Koço Gliozheni” in Tirana, Albania. The period of this study was from January 2015 to March 2018. Maternal and neonatal data were obtained from medical records and the hospital database system. All cases of placenta previa were managed by medical team, obstetric consultants and all data were calculated with SPSS.20 program. Results: In total, 38 women with placenta previa were classified in three different types of placenta previa: Marginal placenta previa occurred in 16 women(42.1%), Complete placenta previa occurred in 19 women(50%) and with accreta placenta previa in 3 women(7.9%). The mean age of mothers was 30,61 years old, mode = 35, median = 30 and Std. deviation = 4.641 years. Conclusions: The prevalence rate of section caesarean and placenta previa is increased during the years. Several obstetrical factors have been found to be risk for placenta previa including: advancing maternal age, previous caesarean delivery, previous abortions, previous uterine surgery, multiparity, previous placenta previa, low socio-economic status, mother’s cigarette smoking /alcohol use. Placenta previa is associated with an increase in preterm birth and neonatal and maternal outcome. Other complications of pregnancy can be associated with placenta previa, but the majority of women deliver healthy babies.

Hematometra following caesarean section for placenta previa

Hematometra following caesarean section is rare. We present here a case of 23-year-old woman who had undergone caesarean section for placenta previa. She presented with cryptomenorrhoea and hematometra after 5 months of caesarean delivery owing to adhesions in the vagina. The hematometra was drained vaginally.

Comparison of hemostatic effect of bilateral uterine artery upstream ligation and gauze intrauterine caused by preoperative placenta cesarean section hemorrhage

Objective To compare hemostatic effect of bilateral uterine artery superior branch ligation and gauze intrauterine filling two methods for the placenta previa cesarean section bleeding. Methods 100 patients with bleeding in cesarean section were randomly divided into observation group (50 cases) and control group (50 cases). The patients in the observation group were treated with bilateral uterine artery ascending branch, and the control group was treated with gauze.The number of blood transfusion, the time of operation, the amount of bleeding, the time of hemostasis, the number of hysterectomy and the occurrence of complications were compared between the two groups. Results The success rate of hemostasis in the observation group (98.0%) was higher than that in the control group (86.0%), the difference was statistically significant (χ2=4.891, P<0.05). The bleeding volume and hemostasis time were (577.8±55.9) mL, (19.2±10.2)min, the differences between the two groups were statistically significant (t=2.50, 3.25, all P<0.05). The operation time between the two groups had no significant difference (P<0.05). The transfusion rate and incidence rate of complications in the observation group were 8.0% and 6.0%, which were significantly lower than those in the control group (22.0%, 20.0%), and the differences were statistically significant (χ2=3.843, 4.332, all P<0.05). Conclusion The use of bilateral uterine artery esophageal branching in the placenta previa is effective in controlling bleeding, it has rapid bleeding and low incidence of complications, and is worthy of clinical application. Key words: Cesarean section; Placenta previa; Hemorrhage; Controlled clinieal trial